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Davis Behavioral Health 934 South Main Layton UT 84041 pH: (801) 5461168 Fax: (801) 5440770 AUTHORIZATION TO USE AND DISCLOSE HEALTH INFORMATION Name: Date of Birth: Address: SSN: City: State: Zip
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To fill out Davis Behavioral Health form:
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Start by entering your personal information such as your name, address, and phone number.
03
Provide your insurance information, including your policy number and contact information for your insurance provider.
04
Answer the questionnaire about your medical history, current symptoms, and any medications you are currently taking.
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If applicable, provide additional information about your primary care physician and any previous mental health treatments you have received.
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Sign and date the form to confirm that the information you have provided is accurate.
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Submit the completed form to Davis Behavioral Health either in person or through their online portal.

Who needs davis behavioral health?

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Davis Behavioral Health is for individuals who are facing mental health issues or emotional challenges.
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It is for those who require counseling, therapy, psychiatric evaluation, or other mental health services.
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Davis Behavioral Health provides support for individuals of all ages, including children, adolescents, and adults.
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Anyone seeking professional help and support for their mental well-being can benefit from Davis Behavioral Health resources and services.
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Davis Behavioral Health is a mental health organization that provides services and support for individuals experiencing behavioral health issues.
Licensed mental health professionals, clinics, and organizations providing behavioral health services are required to file Davis Behavioral Health reports.
Davis Behavioral Health reports can be filled out online through the designated portal or submitted via mail using the provided forms.
The purpose of Davis Behavioral Health reporting is to collect data on behavioral health services provided within a certain time period.
Information such as type of services provided, number of clients served, and outcomes of treatment must be reported on Davis Behavioral Health forms.
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