McLean at Naukeag Ambulatory Treatment Program Self-Refferral Packet 2013 free printable template
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McLean at Naukeag Ambulatory Treatment Program Self-Referral Packet NOTE To be considered for admission application must be complete in full If you need assistance with the application call 978-827-5115 ask for admissions How did you hear about Naukeag PATIENT INFORMATION DATE Have you been to Naukeag previously Yes No ----------------------------------- Are you being referred by any program or treatment provider N Y name Patient Name Age Gender DOB Address State/Country ZIP Email Daytime...
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How to fill out McLean at Naukeag Ambulatory Treatment Program Self-Refferral Packet
01
Obtain the McLean at Naukeag Ambulatory Treatment Program Self-Referral Packet from the program's website or contact their office.
02
Carefully read the instructions included with the packet to ensure you understand the requirements.
03
Fill out the personal information section, providing accurate details such as your name, contact information, and date of birth.
04
Complete the mental health history questionnaire, detailing any previous treatments, diagnoses, and current symptoms.
05
Include information about your support system, such as family, friends, and any other relevant support services you may have.
06
Review all information for completeness and accuracy before submission.
07
Submit the completed packet as instructed, either by mail or electronically, according to the submission guidelines provided.
Who needs McLean at Naukeag Ambulatory Treatment Program Self-Refferral Packet?
01
Individuals seeking outpatient mental health treatment or support.
02
People experiencing emotional difficulties or mental health challenges that require professional intervention.
03
Individuals looking for structured treatment options in an ambulatory setting.
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What is McLean at Naukeag Ambulatory Treatment Program Self-Referral Packet?
The McLean at Naukeag Ambulatory Treatment Program Self-Referral Packet is a document designed for individuals seeking admission into the McLean at Naukeag outpatient treatment program, providing necessary information and documentation for the referral process.
Who is required to file McLean at Naukeag Ambulatory Treatment Program Self-Referral Packet?
Individuals who wish to receive treatment at the McLean at Naukeag Ambulatory Treatment Program must complete and file the Self-Referral Packet.
How to fill out McLean at Naukeag Ambulatory Treatment Program Self-Referral Packet?
To fill out the Self-Referral Packet, individuals must carefully follow the instructions provided within the document, ensuring all required fields are completed accurately and honestly.
What is the purpose of McLean at Naukeag Ambulatory Treatment Program Self-Referral Packet?
The purpose of the Self-Referral Packet is to gather essential information about the applicant's mental health history, needs, and eligibility for the outpatient treatment program.
What information must be reported on McLean at Naukeag Ambulatory Treatment Program Self-Referral Packet?
The Self-Referral Packet typically requires information such as personal identification details, mental health history, current symptoms, previous treatments, and contact information for healthcare providers.
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