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October 2021Sober Life Peer Recovery Coaching & Care Coordination Referral Form All Information Entered in this Form is Kept Secure and Strictly Confidential Note: If you prefer to fill out this form

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How to fill out emergency department peer recovery

01

Obtain a copy of the emergency department peer recovery form.

02

Fill out the personal information section, including your name, date of birth, address, and contact information.

03

Provide details about your emergency situation and reasons for seeking peer recovery support.

04

Specify any preferences or requirements for the type of peer support you are looking for.

05

Sign and date the form, indicating that all information provided is true and accurate.

Who needs emergency department peer recovery?

01

Individuals who have recently experienced a mental health crisis or substance abuse emergency may benefit from emergency department peer recovery.

02

Those who are in need of immediate support and guidance from someone who has gone through similar challenges can also benefit from this service.

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What is emergency department peer recovery?

Emergency department peer recovery is a program where individuals who have experienced recovery from substance abuse provide support and guidance to patients in the emergency department.

Who is required to file emergency department peer recovery?

Healthcare facilities with emergency departments are required to file emergency department peer recovery.

How to fill out emergency department peer recovery?

Emergency department peer recovery forms can be filled out online or submitted in person at the healthcare facility.

What is the purpose of emergency department peer recovery?

The purpose of emergency department peer recovery is to provide additional support and resources to patients struggling with substance abuse in the emergency department.

What information must be reported on emergency department peer recovery?

Information such as patient demographics, substance abuse history, peer recovery interactions, and outcomes must be reported on emergency department peer recovery.

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