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Is this patient 15 years and older? Attempted Suicide Aftercare Program (ASAP) Referral Form Anglican will be in touch with the client within 48 hours of receiving this referral Patient Name Patient
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Storesamhsagovsitesdefaultafter an attempt is needed by individuals who have previously made a suicide attempt and are seeking assistance or support from the Substance Abuse and Mental Health Services Administration (SAMHSA). This online platform may provide resources, information, or a means to connect with professionals in the mental health field. It is particularly relevant for those who are looking for guidance or access to services after an attempted suicide.

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It is the form used to report all information related to an attempted suicide.
Healthcare providers, medical facilities, and mental health professionals are required to file this form.
The form must be completed with details of the incident, including date, time, location, and any relevant information about the individual.
The purpose is to gather data and statistics on suicide attempts in order to provide better prevention strategies and support.
Information such as demographics of the individual, circumstances surrounding the attempt, any previous attempts, and follow-up care provided.
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