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Referral for Behavioral Health ServicesThis form is current as of 9/3/2019. Please discard any referral forms prior to this date. Thank you for helping someone reach our agency! BHC has an array of
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How to fill out referral and release behavioral

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How to fill out referral and release form

01
Obtain the referral and release form from the relevant organization or healthcare provider.
02
Fill in your personal details accurately, including your full name, contact information, and date of birth.
03
Provide details of the referral source, such as the name of the referring doctor or organization.
04
Sign and date the form to indicate your consent for the release of information as specified.
05
Review the completed form for accuracy and completeness before submitting it to the appropriate party.

Who needs referral and release form?

01
Individuals who are being referred to another healthcare provider or organization for further treatment or services.
02
Anyone who is required to authorize the release of their medical information to a third party.

What is REFERRAL AND RELEASE BEHAVIORAL HEALTH SERVICES - Fill Form?

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Referral and release form is a document used to refer a client to another service provider or to release information related to the client's case.
The individual or organization responsible for the client's case is required to file the referral and release form.
To fill out a referral and release form, provide all necessary information about the client and the reason for the referral or release.
The purpose of a referral and release form is to facilitate communication and coordination between service providers involved in the client's case.
Information such as client's name, contact information, reason for referral or release, and any relevant details about the case must be reported on the form.
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