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DHSLTSS702 11/19DEPARTMENT OF HUMAN SERVICES Division of Long Term Services & Supports (LTSS) Hillsview Plaza, 3800 East Highway 34 c/o 500 East Capitol Avenue Pierre, SD 57501 PHONE: 6057733656 or
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To fill out a mental health certificate, follow these steps:
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Begin by gathering all necessary information and documents.
03
Provide your personal details such as full name, date of birth, contact information, and address.
04
Clearly state the purpose of the certificate and the duration for which it is required.
05
Describe your mental health condition or reason for needing the certificate in detail.
06
If applicable, attach any supporting medical reports, diagnosis documents, or treatment records.
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Make sure to include the date of issuance and the signature of the mental health professional issuing the certificate.
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Double-check all the provided information for accuracy and completeness before submitting the form.
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Submit the completed mental health certificate to the designated authority or organization as per their requirements.

Who needs mental health certificate of?

01
A mental health certificate may be required by various individuals and organizations including:
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- Students applying for academic accommodations or special assistance programs due to mental health conditions.
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- Employees requesting medical leave or workplace accommodations related to mental health.
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- Individuals seeking disability benefits or financial support due to mental health-related issues.
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- Individuals applying for legal or court cases where mental health condition plays a significant role.
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- Individuals participating in certain sports or activities that require mental health clearance for safety reasons.
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- Individuals seeking admission to mental health treatment facilities or rehabilitation centers.
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The mental health certificate is a formal document that verifies an individual's mental health status, usually required for legal, employment, or educational purposes.
Individuals applying for certain jobs, educational programs, or legal matters may be required to file a mental health certificate, particularly if mental health is a relevant factor.
To fill out a mental health certificate, consult with a licensed mental health professional who will evaluate you and complete the necessary sections of the certificate.
The purpose of the mental health certificate is to provide evidence of an individual's mental fitness, necessary for certain jobs, schools, or legal situations.
The certificate typically includes personal identification details, evaluation results, diagnoses, treatment history, and recommendations if applicable.
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