OLDER ADULT (AGES 60+) - file lacounty 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out the Referral Information section. Enter the DMH IS#, date, SSN, last name, first name, date of birth, race/ethnicity, age, contact address, phone number, preferred language, and gender.
3. Next, provide details about the current living situation and insurance status. Check all applicable benefits such as Medi-Cal or Medicare.
4. In the Referral Source section, input the agency name, contact person’s details, and whether the individual is currently receiving mental health services.
5. For the Focal Population section, check appropriate reasons for referral based on the individual's circumstances. Provide additional details if necessary.
6. Complete the Level of Service and Diagnostic Considerations sections by checking relevant boxes and providing any required explanations.
7. Finally, ensure all information is accurate before submitting your completed form via fax to the designated Impact Unit Coordinator.

Start using our platform today to easily fill out your OLDER ADULT (AGES 60+) - file lacounty form for free!