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2150 Corbin Avenue New Britain. CT 06053 TELE: 8608274751 FAX: 8608326278Department of Psychology Referral Intake & MD Order form Please complete the entire form for referral processingREFERRING PRACTICE/PHYSICIAN
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Obtain the necessary forms from the hospital for special care.
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Fill out the forms completely and accurately, including your personal information, medical history, and reason for seeking care.
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Provide any additional documentation required, such as insurance information or referral letters.
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Who needs hospital for special care?

01
Individuals with complex medical conditions that require specialized care.
02
Patients needing long-term or intensive treatment for their conditions.
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People who have disabilities or chronic illnesses that need ongoing medical supervision.
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Hospital for special care is a facility that provides specialized medical treatment for patients with complex medical conditions or disabilities.
The hospital administration or management is required to file for hospital for special care.
Hospital for special care forms can be filled out electronically or manually, following the specific instructions provided.
The purpose of hospital for special care is to ensure that patients with complex medical needs receive the specialized care and treatment they require.
Information such as patient demographics, medical history, treatment plans, and progress notes must be reported on hospital for special care forms.
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