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ADOLESCENT PARTIAL FAX REFERRAL FORM ***PLEASE CALL 7818297121 TO SCHEDULE AN APPOINTMENT PRIOR TO SUBMITTING THIS FORM.*** The Adolescent Partial Hospitalization Program at Pembroke Hospital is a

How to fill out adolescent partial fax referral

How to fill out adolescent partial fax referral

1. To fill out an adolescent partial fax referral, follow these steps:
2. Start by gathering the necessary information of the adolescent, including their name, date of birth, address, and contact information.
3. Identify the reason for the referral and describe the specific concerns or issues that need attention.
4. Determine the referring healthcare provider's details, such as their name, contact information, and their relationship to the adolescent.
5. Specify the preferred mode of communication and the availability of the referring provider for further coordination.
6. Include any relevant medical history or previous treatments that can assist in the assessment and care of the adolescent.
7. Provide additional relevant information, such as insurance details, preferred healthcare facility, or any other pertinent information.
8. Review the completed referral form for accuracy and completeness before faxing it to the appropriate recipient.
9. Keep a copy of the fax referral for future reference and follow-up if necessary.

Who needs adolescent partial fax referral?

1. Adolescent partial fax referral is needed for healthcare providers who require specialized care or consultation for adolescents.
2. This referral is typically used when a healthcare professional believes that the adolescent would benefit from the expertise of another provider or a specific healthcare facility.
3. It may be necessary in cases where the adolescent's condition or situation requires a multidisciplinary approach or when additional assessments, treatments, or interventions are needed beyond the referring provider's scope of practice.
4. The referral ensures a seamless transfer of information and coordination of care between the referring provider and the recipient provider or facility.

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What is adolescent partial fax referral?

Adolescent partial fax referral is a form used to request partial hospitalization services for adolescents who require intensive mental health treatment.

Who is required to file adolescent partial fax referral?

Adolescent partial fax referral can be filed by a licensed mental health professional, such as a psychiatrist, psychologist, or therapist.

How to fill out adolescent partial fax referral?

To fill out adolescent partial fax referral, include the adolescent's information, reason for referral, mental health diagnosis, treatment goals, and any other relevant information.

What is the purpose of adolescent partial fax referral?

The purpose of adolescent partial fax referral is to ensure that adolescents receive the appropriate level of mental health treatment and support.

What information must be reported on adolescent partial fax referral?

Information reported on adolescent partial fax referral includes adolescent's personal information, mental health diagnosis, treatment history, and reasons for referral.