Get the free CCBHC Referral Form

CC BHC Referral Form Please Email, Fax, Mail, Or Deliver Referral Form To Either of our Locations:Lamina CC BHC 1830 S Honoapiilani Hwy (Just below Civic Center) Lamina, HI 96761 Phone: (808) 4955113 Email:

How to fill out ccbhc referral form

How to fill out ccbhc referral form

1. Obtain a copy of the CCBHC referral form from the designated source.
2. Fill out the patient's personal information, including name, address, date of birth, and contact information.
3. Provide details about the reason for the referral, including the patient's mental health or substance use issues.
4. Include any relevant medical history or treatment information that may be helpful for the CCBHC provider.
5. Obtain necessary signatures from the referring provider and the patient, if required.
6. Submit the completed referral form to the CCBHC provider for review and processing.

Who needs ccbhc referral form?

1. Individuals who require mental health or substance use services from a Certified Community Behavioral Health Clinic (CCBHC) may need to fill out a CCBHC referral form.
2. Referring providers, such as primary care physicians, mental health professionals, or social workers, may also need to complete a CCBHC referral form for their patients.

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What is ccbhc referral form?

The CCBHC referral form is a document used to refer patients to Certified Community Behavioral Health Clinics (CCBHCs) for mental health and substance use disorder treatment.

Who is required to file ccbhc referral form?

Healthcare providers and organizations that identify individuals in need of behavioral health services are required to file the CCBHC referral form.

How to fill out ccbhc referral form?

To fill out the CCBHC referral form, you need to provide patient demographic information, details about the referring party, the reason for referral, and any relevant medical history.

What is the purpose of ccbhc referral form?

The purpose of the CCBHC referral form is to facilitate access to comprehensive behavioral health services, ensuring that individuals receive the appropriate level of care.

What information must be reported on ccbhc referral form?

The CCBHC referral form must report patient identification details, contact information, the referring provider's information, the reason for referral, and any medical history pertinent to the referral.