Tay fsp form 2026

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The document is a referral and notification form for the Transition Age Youth (TAY) Full Service Partnership program by the County of Los Angeles Department of Mental Health. It collects essential information about individuals aged 16-25 who may require mental health services, including personal details, current living situation, insurance status, and mental health history. The form outlines criteria for eligibility, diagnostic considerations, and the process for referral and enrollment in mental health services, ensuring compliance with confidentiality laws.

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Click ‘Get Form’ to open the tay fsp form in the editor.
Begin by filling out the Referral Information section. Enter the DMH IS/IBHIS# and SSN, followed by the date, last name, first name, and date of birth. Ensure you select the preferred language and race/ethnicity.
Next, provide contact details including address, city, zip code, gender, and phone number. Indicate if the client has insurance and specify any benefits they receive.
In the Level of Service section, check one option that best describes the individual's current mental health service status. If applicable, provide details for any checked items.
Complete the Diagnostic Considerations section by entering primary diagnoses and checking all relevant symptoms that apply to the individual.
Finally, review all entered information for accuracy before submitting your completed form through our platform.

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Versions	Form popularity	Fillable & printable
2017	4.8 Satisfied (41 Votes)
2008	4.3 Satisfied (302 Votes)

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What is an FSP?

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