Get the free EXTENDED DAY TREATMENT - The Village

DCF4100 Rev. 08/2014Send this completed form to: Catherine G. CortoMergins, LCSW ccorto@thevillage.org 8602970568EXTENDED DAY TREATMENT REFERRAL FORM (see instructions attached to this form)REFERRAL

How to fill out extended day treatment

How to fill out extended day treatment

1. To fill out extended day treatment, follow these steps:
2. Gather all the necessary information and documents.
3. Start by filling out the client's personal information, such as name, date of birth, and contact details.
4. Provide the client's medical history, including any existing conditions, medications, and allergies.
5. Specify the reason for seeking extended day treatment and provide any relevant details or referrals.
6. Include any insurance or payment information, if applicable.
7. Review the completed form for accuracy and completeness.
8. Sign and date the form.
9. Submit the filled-out extended day treatment form to the appropriate department or facility.

Who needs extended day treatment?

1. Extended day treatment is suitable for individuals who:
2. - Require intensive therapy or treatment for mental health issues.
3. - Need a structured program to manage their symptoms or improve their overall well-being.
4. - May benefit from a supportive group environment or peer interaction.
5. - Have difficulty functioning independently or attending regular outpatient sessions.
6. - Are transitioning from inpatient care or hospitalization.
7. - Have been recommended extended day treatment by their healthcare provider or therapist.
8. It is important to consult with a healthcare professional to determine if extended day treatment is appropriate for a specific individual.

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What is extended day treatment?

Extended day treatment is a structured mental health program that provides therapeutic services for individuals, often children or adolescents, for a longer period during the day, typically focusing on emotional, behavioral, and social development.

Who is required to file extended day treatment?

Facilities or providers that offer extended day treatment services are typically required to file for licensing, reimbursement, or compliance with regulations set by health care authorities or insurance companies.

How to fill out extended day treatment?

To fill out extended day treatment forms, providers must accurately document the patient's information, treatment details, service dates, and any other required data specified by the health authority or insurance provider.

What is the purpose of extended day treatment?

The purpose of extended day treatment is to provide intensive therapeutic support within a structured environment, helping individuals stabilize their mental health, develop coping skills, and enhance their quality of life.

What information must be reported on extended day treatment?

Information that must be reported includes patient demographics, clinical diagnosis, treatment plans, outcomes, service dates, attendance records, and any incidents that occur during treatment.