
Complete this behavioral health history as detailed as possible. This document is used to complete a prior authorization with your insurance company. Your insurance will want to ensure that your daughter meets medical necessity for inpatient treatment. An incomplete, inaccurate or minor mental health clinical history will delay the admission process with your insurance company.
Note: It is possible to save this form and return to finish it at a later date. Simply scroll to the bottom and hit "save and continue later." After clicking the button, you will receive a custom link to your form and the option of receiving that link via email. Links to saved forms are valid for 30 days.