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SACRAMENTO COUNTY ASSISTED OUTPATIENT TREATMENT (AOT) REFERRAL FORM Email to AOT Referral Box: dhsmhaot@saccounty.govAttachIF THIS IS A PSYCHIATRIC EMERGENCY, PLEASE CALL 988*INSUFFICIENT DETAILS MAY DELAY THE REFERRALrecentREFERRING PARTY INFORMATION Per WIC 5346 (b)(2) AGENCY NAME:DATE COMPLETED: PHONE:NAME:EMAIL:Relation to Candidate:FAX:Adult Residing with CandidateTreating Mental Health Professionalphoto hereDirector of Treating AgencyAdult Family Member of CandidateCandidates
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How to fill out mental health service request
How to fill out mental health service request
01
Begin by gathering your personal information, such as your name, address, and contact details.
02
Identify and document the specific mental health issues you are experiencing.
03
Research the mental health services available in your area or through your insurance provider.
04
Fill out the service request form with the required details, including your medical history and any relevant previous treatments.
05
Include information about your current situation and any urgent needs for mental health support.
06
Review the completed form for accuracy and completeness.
07
Submit the form to the appropriate mental health service provider, either online or in person.
Who needs mental health service request?
01
Individuals experiencing mental health challenges or disorders.
02
People seeking support for emotional or psychological difficulties.
03
Those requiring professional diagnosis and treatment for mental health issues.
04
Family members or caregivers looking to assist loved ones with mental health concerns.
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What is mental health service request?
A mental health service request is a formal notification or application made by an individual or a provider to access mental health services for assessment, treatment, or support.
Who is required to file mental health service request?
Typically, mental health service requests can be filed by individuals seeking help, their legal guardians, or healthcare providers on behalf of their patients.
How to fill out mental health service request?
To fill out a mental health service request, you should gather relevant personal information, specify the type of mental health services needed, include any supporting documents, and submit the form to the appropriate mental health service provider.
What is the purpose of mental health service request?
The purpose of a mental health service request is to initiate the process of obtaining mental health care and support, ensuring that the individual receives the necessary evaluations and services.
What information must be reported on mental health service request?
Information that must be reported includes the individual’s personal details, contact information, the nature of the mental health issue, previous treatments received, and any other relevant medical history.
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