In the landscape of mental health, developmental disabilities, and substance abuse services in North Carolina, the Regional Referral Form serves as a crucial bridge connecting individuals in need with appropriate state psychiatric hospitals or Alcohol and Drug Abuse Treatment Centers (ADATC). This document, a product of the NC Division of Mental Health, Developmental Disabilities, and Substance Abuse Services, is comprehensive, crafted to ensure that referring entities — ranging from regional psychiatric hospitals to self-referrals or Local Management Entities (LME) — can provide detailed and necessary information to facilitate tailored and timely care. At its core, the form captures essential patient information including demographics, medical history, substance use specifics, and the ASAM PPC-2R criteria for those specifically referred to ADATC, streamlining the admission process to either voluntary or involuntary treatment. The scope of information extends further to encompass pending legal charges, signifies whether the patient is pregnant, involving perinatal referrals, and underscores the importance of a proposed discharge plan and treatment objectives, weaving a comprehensive picture of the patient's current condition and needs. The form's design underscores an integral approach toward treatment, emphasizing on aligning the patient with the most suitable level of care while also considering the legal and socio-economic facets of their lives, which may influence their journey towards rehabilitation and recovery.
| Question | Answer |
|---|---|
| Form Name | Nc Regional Referral Form |
| Form Length | 5 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 1 min 15 sec |
| Other names | regional referral nc, adatc referral fillable, nc cdsa referral form, amazon |