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***If referral is for an AOT violation, do not fill out this form. Instead, contact the AOT Program. If your consumer is at imminent risk, call 911 then contact AOT Program***DateReferral OrganizationReferral
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How to fill out aot program referral form
How to fill out aot program referral form
01
Obtain a copy of the AOT Program Referral Form from the designated agency or organization.
02
Fill out the personal information section, including name, address, contact information, and date of birth.
03
Provide information on the reasons for seeking AOT services and any relevant medical history.
04
Include details about the individual's current mental health diagnosis and treatment history.
05
Obtain signatures from the individual requesting AOT services, as well as any required healthcare providers or legal guardians.
06
Submit the completed form to the designated agency or organization for review and processing.
Who needs aot program referral form?
01
Individuals who are experiencing severe mental illness and are not able to adhere to a treatment plan on their own may need an AOT Program Referral Form.
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What is aot program referral form?
AOT program referral form is a document used to refer an individual to the Assisted Outpatient Treatment program.
Who is required to file aot program referral form?
Mental health professionals, family members, or concerned individuals can file an AOT program referral form.
How to fill out aot program referral form?
The form must be completed with the individual's information, reason for referral, and supporting documentation.
What is the purpose of aot program referral form?
The purpose of the AOT program referral form is to request court-ordered treatment for individuals who are unable to seek help voluntarily.
What information must be reported on aot program referral form?
The form must include the individual's name, address, mental health history, current situation, and reasons for seeking treatment.
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