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RBHA and RSA/VR Referral Coordination Form Gila & Pinal Member Name: ___ Member Phone: ___ DOB: ___ TXIX: NTXIX: AHCCCS ID: ___HH Location: ___ HH Staff Name: ___ Phone: ___ HH Staff Email: ___Per

How to fill out rbha and rsavr referral

How to fill out rbha and rsavr referral

1. Obtain the necessary RBHA and RSAVR referral forms from your healthcare provider's office or website.
2. Fill out the patient's personal information including name, date of birth, and contact information.
3. Provide details about the referring provider, including their name, contact information, and specialty.
4. Include relevant medical history and reasons for the referral in the designated section.
5. Indicate the preferred specialist or service (RBHA or RSAVR) and any specific notes or requests.
6. Review the completed forms for accuracy and completeness.
7. Submit the referral forms via the specified method (fax, email, or in-person).
8. Keep a copy of the submitted referral for your records.

Who needs rbha and rsavr referral?

1. Individuals experiencing mental health issues requiring specialized care.
2. Patients needing access to behavioral health services through RBHA.
3. Those with specific needs for assessments or services available under the RSAVR program.
4. Referrals may also be necessary for patients transitioning to different levels of care.

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What is rbha and rsavr referral?

RBHA (Referral for Behavioral Health Assessment) and RSAVR (Referral for Substance Abuse and Vocational Rehabilitation) are referrals used to guide individuals seeking mental health and substance abuse services.

Who is required to file rbha and rsavr referral?

Individuals seeking behavioral health services, healthcare providers, and organizations that refer patients for these types of assessments are required to file the RBHA and RSAVR referrals.

How to fill out rbha and rsavr referral?

To fill out the RBHA and RSAVR referral, complete the form with accurate patient information, specify the type of assessment requested, provide relevant medical history, and sign the document.

What is the purpose of rbha and rsavr referral?

The purpose of RBHA and RSAVR referrals is to facilitate access to necessary behavioral health and vocational services, ensuring individuals receive appropriate assessments and interventions.

What information must be reported on rbha and rsavr referral?

The information that must be reported includes the patient's personal details, reason for referral, specific services requested, prior treatments, and any pertinent health history.