Behavioral Health Practitioner Communication Form

QualityTool

Behavioral Health Practitioner Communication Form

Description

This form aids physicians in communicating vital information about patients to behavioral health practitioners when referring them. The form details relevant health information such as medication use (to avoid contraindications), past and present medical conditions, allergies, relevant lab results, and contact information for the referring physician. It can also aid in discussions about treatments and provide a full picture of past treatments and methodologies with patients.

Although the form was created for Independence Blue Cross physicians, it can be easily adapted for use in other practices.

Developer:

Independence Blue Cross

Funding Sources:

Independence Blue Cross

History

Original Summary: January 2011
Last Updated: 02/02/11

Disclaimer: The inclusion of a tool in the Innovations Exchange does not constitute or imply an endorsement by the U.S. Department of Health and Human Services, the Agency for Healthcare Research and Quality or Westat of the tool or of the submitter or developer of the tool. Read more.

This website is certified by Health On the Net Foundation. Click to verify. This site complies with the HONcode standard for trustworthy health information: verify here.