Get the free MH Initial Review Fax Form Revised 10-03-13doc

AMERICAN BEHAVIORAL INITIAL REVIEW FAX FOR MENTAL HEALTH TREATMENT Telephone: (205) 8717814 Fax Completed Information To: (205) 8689625 Patient Name: Contract Name Patient Phone # (Required): Does

How to fill out mh initial review fax

1. Start by gathering all the necessary information and documents required for the MH initial review fax. This may include personal details of the patient, their medical history, relevant diagnosis codes, and any supporting documentation.
2. Begin filling out the fax form by entering the patient's full name, date of birth, and contact information. Make sure to provide accurate and up-to-date details to ensure proper communication.
3. Next, include the patient's medical history, including any previous diagnoses, treatments, surgeries, or medications. This information will help the reviewer understand the patient's overall health status and any previous interventions.
4. Provide specific details about the current medical condition or issue being addressed in the initial review. Include any symptoms, recent changes in health, or particular concerns that need attention.
5. Include any relevant diagnostic codes if available. These codes are used to classify the patient's condition and assist in the review process. Check with the healthcare provider for the correct codes to be used.
6. Attach any supporting documentation that helps justify the need for the MH initial review. This can include lab reports, imaging studies, referral letters, or progress notes from previous healthcare encounters.
7. Double-check all the information provided to ensure accuracy and completeness. Any missing or incorrect information may delay the review process or lead to misunderstandings.
8. Finally, send the completed MH initial review fax to the appropriate recipient. This can vary depending on the healthcare facility or insurance company involved. Confirm the fax number and contact details before transmission.

Who needs the MH initial review fax?

1. Healthcare providers: Doctors, specialists, or any medical professionals involved in the patient's care might require the MH initial review fax to initiate the review process or seek additional guidance from mental health specialists.
2. Insurance companies: If the MH initial review is necessary for insurance purposes, the insurance company may request this document to ensure the medical necessity of specific treatments or interventions.
3. Care coordinators or case managers: Individuals responsible for coordinating the patient's care, such as care coordinators or case managers, may require the MH initial review fax to provide a comprehensive overview of the patient's condition and guide the care planning process.

By following these steps and understanding who needs the MH initial review fax, you can ensure a smooth review process and facilitate effective communication among healthcare stakeholders.

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