Fit for confinement form 2026

1. Click ‘Get Form’ to open the fit for confinement form in the editor.
2. Begin by filling out the REQUESTOR INFORMATION section. Enter the Requesting Agency Name, Agency Representative's Name, and Phone Number. Select the type of confinement assessment requested: Medical or Psychiatric.
3. Next, move to the PATIENT INFORMATION section. Input the Patient's Name, Date of Birth, Current Medical Problems, and Current Medications. Ensure all fields are completed accurately.
4. In the PHYSICAL FINDINGS section, document vital signs such as Temperature, Pulse, Respiratory rate, Blood Pressure, and any Allergies.
5. Review the EXAMINATION SUMMARY to confirm if copies of labs and reports are attached. Answer whether the patient is medically and psychiatrically fit for confinement by checking YES or NO.
6. Complete the OUTPATIENT REFERRAL/TREATMENT RECOMMENDATION section if applicable. Provide details on medications or treatment recommendations.
7. Finally, fill in FACILITY/DOCTOR INFORMATION with Facility Name, Phone Number, Physician Name (Printed), Date/Time of Evaluation, and ensure to sign at the bottom.

Start using our platform today to easily complete your fit for confinement form online for free!