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NIAGARA COUNTY DEPARTMENT OF MENTAL HEALTH Hospital Diversion Referral Form CLIENT Informational (Last, First, M.I.):Sex:Address:MaleFemaleDOB: Phone (H):Marital status:City:SinglePartneredPhone (M):State:MarriedSeparatedPhone
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How to fill out tele-mental health services information

01
Gather all necessary information such as personal details, insurance information, and reason for seeking tele-mental health services.
02
Contact the tele-mental health provider or visit their website to access the necessary forms or online portal.
03
Fill out the forms accurately and completely, making sure to provide all requested information.
04
Review the completed forms to ensure accuracy and completeness before submitting them to the provider.
05
Follow any additional instructions provided by the provider for submitting the forms and obtaining tele-mental health services.

Who needs tele-mental health services information?

01
Individuals who are seeking mental health services but prefer the convenience and accessibility of receiving care remotely.
02
People who have limited access to traditional mental health services due to geographical barriers or mobility issues.
03
Those who prefer the privacy and comfort of receiving mental health services from their own home or preferred location.
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Tele-mental health services information pertains to data related to mental health services provided remotely through technology.
Healthcare providers offering tele-mental health services are required to file this information.
Providers can fill out tele-mental health services information by including details of the services offered, patients served, and technology used.
The purpose of tele-mental health services information is to track and monitor the delivery of mental health care through telecommunication.
Information such as types of services provided, number of patients served, technology used, and outcomes achieved must be reported on tele-mental health services information.
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