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Clear FormDHS4797BENGBehavioral Health Home (BAH) Services Rights, Responsibilities and Consent Purpose of this form The purpose of this form is to explain what behavioral health home (BAH) services
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01
To fill out the DHS-4797B-ENG Behavioral Health Home form, follow these steps:
02
Start by providing your personal information, including your name, address, and contact details.
03
Indicate your demographic information, such as your date of birth, gender, and preferred language.
04
Specify your Medicaid ID or Social Security Number, as well as your primary care provider's name and contact information.
05
Answer the questions related to your eligibility for the behavioral health home program.
06
Provide information about any current behavioral health providers you are seeing, including their names and contact details.
07
Answer the questions regarding your history of substance use, mental health conditions, and any past hospitalizations.
08
If applicable, provide details about your caregiver or guardian, including their name and contact information.
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Finally, review all the information you have provided and sign and date the form.
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Submit the filled-out DHS-4797B-ENG behavioral health home form according to the instructions provided.

Who needs dhs-4797b-eng behavioral health home?

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Individuals who may need the DHS-4797B-ENG behavioral health home include those:
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- Who have a Medicaid eligibility
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- Who have a diagnosis or history of mental health conditions
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- Who require coordinated and integrated behavioral health services
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- Who may benefit from additional support and care management
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- Who may have a complex health condition requiring a holistic approach to care
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However, it is best to consult with a healthcare professional or contact the relevant authorities to determine specific eligibility criteria for the behavioral health home program.
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The DHS-4797B-ENG Behavioral Health Home is a form used to collect specific information about individuals receiving behavioral health services, aimed at assessing their needs and coordinating their care effectively.
Providers of behavioral health services who are participating in the behavioral health home program are required to file the DHS-4797B-ENG form.
To fill out the DHS-4797B-ENG form, providers must include accurate client identification details, service information, and any relevant behavioral health assessments, ensuring all sections are completed thoroughly.
The purpose of the DHS-4797B-ENG Behavioral Health Home is to facilitate the integration of care for individuals with behavioral health needs and to ensure they receive comprehensive and coordinated services.
The information that must be reported on the DHS-4797B-ENG form includes client demographics, service types provided, dates of service, and any relevant clinical information pertaining to the client's behavioral health.
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