This manual contains every policy and procedure you would need to have in order to obtain accreditation for ambulatory outpatient behavioral health businesses to include dual diagnosis, pysch disorders, drug detox, etoh detox. This manual has everything you need and is fully customizable to meet your individual facility needs.
INITIAL INTAKE FORM Referral Source: Date: Patient Name: Phone: Address: Zip: DOB: Sex: M F Marital Status: Ethnicity: Religion: Medicare #: Medicaid #: SS#: Veteran Benefits: Secondary Insurance: Conservator/Guardian: Phone: Address:
Pages to are hidden for
"2004 - Initial Intake Form"Please download to view full document