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Carelon Behavioral Health/Gold Coast Health Plan Behavioral Health Care Management Referral Form Referral Date:___ Member Name:___MediCal CIN ID#:___DOB: ___ Parent/Guardian Name:___ Preferred Language:
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How to fill out dhmh 4465 aftercare referral
How to fill out dhmh 4465 aftercare referral
01
Begin by filling out the top section of the form with the individual's personal information.
02
Proceed to the next section to indicate the reason for the referral and any relevant details.
03
Fill out the aftercare treatment plan section with the appropriate information.
04
Complete the bottom section with your contact information and any additional notes.
05
Ensure all sections are filled out accurately and legibly before submitting the form.
Who needs dhmh 4465 aftercare referral?
01
Individuals who have completed a substance abuse treatment program and are in need of aftercare services.
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What is dhmh 4465 aftercare referral?
DHMH 4465 aftercare referral is a form used to refer individuals to aftercare services following a hospitalization for mental health treatment.
Who is required to file dhmh 4465 aftercare referral?
Healthcare providers and facilities are required to file DHMH 4465 aftercare referrals for patients who have been discharged from inpatient mental health treatment.
How to fill out dhmh 4465 aftercare referral?
DHMH 4465 aftercare referral should be filled out by providing the patient's information, reason for referral, and details of the aftercare services recommended.
What is the purpose of dhmh 4465 aftercare referral?
The purpose of DHMH 4465 aftercare referral is to ensure patients receive appropriate follow-up care and support after being discharged from mental health treatment.
What information must be reported on dhmh 4465 aftercare referral?
The DHMH 4465 aftercare referral must include the patient's name, contact information, diagnosis, treatment received, reason for referral, and recommended aftercare services.
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