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NORTH METROPOLITAN HEALTH SERVICE MENTAL HEALTHSurnameSex U.R. NoForenamesYCATT REFERRAL FORM. O.B. Address WardRegistrarConsultantUse Patient I.D. Label when available REFERRER DETAILS Name:Organization

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How to fill out medical behavioral comanagement referral

01

Obtain the necessary referral form from the appropriate medical facility.

02

Fill out the patient's personal information including name, date of birth, address, and contact information.

03

Provide detailed information about the patient's medical history and current health condition.

04

Specify the need for behavioral health services and why a co-management approach is necessary.

05

Include any relevant diagnoses, prescriptions, and treatment plans.

06

Obtain signatures from the patient or legal guardian, as well as the referring healthcare provider.

Who needs medical behavioral comanagement referral?

01

Patients who require coordinated care between their medical and behavioral health providers.

02

Patients with complex physical and mental health needs that would benefit from a collaborative approach to treatment.

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What is medical behavioral comanagement referral?

Medical behavioral comanagement referral is a process where a patient is referred to both a medical provider and a behavioral health provider for coordinated care.

Who is required to file medical behavioral comanagement referral?

The primary care physician or healthcare provider is required to file the medical behavioral comanagement referral.

How to fill out medical behavioral comanagement referral?

To fill out a medical behavioral comanagement referral, the provider must provide patient information, medical history, reason for referral, and contact information for both medical and behavioral health providers.

What is the purpose of medical behavioral comanagement referral?

The purpose of medical behavioral comanagement referral is to ensure that patients with both medical and behavioral health conditions receive holistic and coordinated care.

What information must be reported on medical behavioral comanagement referral?

The medical behavioral comanagement referral must include patient demographics, medical history, reason for referral, treatment plan, and contact information for both providers.

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