Making A Referral
There are certain guidelines that must
be met and a procedure to make a referral to CBR YouthConnect
. You can access the TriWest website and download the required 3 page form at: www.triwest.com
(it may take a few minutes to download the form) or please request one from the CBR YouthConnect
admissions office. The client must be evaluated by a medical doctor or psychiatrist and this form completed by the doctor. In addition, the following must accompany this from (part of the form):
1. Current Psychiatic Evaluation by a Psychiatrist (within 30 days of this request).
2. Detailed Psychosocial Assessment.
3. Discharge Summaries (from any Behavioral Health Hsopitalizations within
the last 12 months).
4. Psychological Testing Results (IQ & Projective Tests), if applicable.
5. School Testing, School Social History, and an Individualized Education Plan (IEP),
6. If hospitalized, include the family therapy, individual therapy, and MD/DO
progress notes for the current stay and a letter indicating the outpatient
provider(s) support of RTC.
7. If outpatient, include a letter form each outpatient provider summarizing
the intensity of treatment over the past 6 months and why treatment is
failing or a copy of the treatment records for the past 8 visits.
8. Any other applicable or specialized assessment (i.e., Pediatric, Neurologist, Other).
Completed Forms can be faxed to: 1-866-269-5892