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Click ‘Get Form’ to open the PSYCHOLOGIST EMERGENCY EXAMINATION REQUEST in our editor.
Begin by entering the PERSON’S NAME at the top of the form. Ensure accuracy as this is crucial for identification.
Fill in the DIRECTIVE AND AUTHORIZATION section, specifying the town in Connecticut where the request is being made.
In the AUTHORIZED AND DIRECTED section, indicate the name of the General Hospital where you are directing the individual for examination.
Complete the SIGNATURE section with your name, CT LICENSE NUMBER, and BUSINESS ADDRESS. Don’t forget to include your DATE OF REQUEST and TELEPHONE NUMBER.
Provide details about the PERSON TO BE EXAMINED, including their PRESENT ADDRESS, SEX, BIRTH DATE, MARITAL STATUS, and SOC. SEC. NO.
Document any relevant HISTORY OF PRESENT CONDITION and OTHER PERTINENT HISTORY that may assist in their evaluation.
Finally, ensure that both copies of the form are signed and dated appropriately before submission.
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A psychological evaluation may consist of a series of formal or structured psychological or neuropsychological tests as well as clinical interviews designed to identify and describe emotional, behavioral, or learning problems.
What is an emergency psychiatric evaluation?
The psychiatric emergency evaluation is a concise, focused evaluation with a goal of diagnostic assessment, management of acute symptoms, and disposition to the appropriate level of care.
What is a pree in CT?
The PREE is solely meant as a tool to assist those suffering from mental or emotional impairment. There is no State form for officers to complete when a 17a-683 transport is authorized, but some departments have produced their own form to assist in these situations.
What qualifies as a psychiatric emergency?
Psychiatric emergencies are acute disturbances in thought, behavior, mood, or social relationship that require immediate intervention as defined by the patient, family, or social unit to save the patient and/or others from imminent danger.
What are the 5 psychiatric emergencies?
Definition. Symptoms and conditions behind psychiatric emergencies may include attempted suicide, substance dependence, alcohol intoxication, acute depression, presence of delusions, violence, panic attacks, and docHub, rapid changes in behavior.
SHaW-MH clinical psychologists and psychiatrists are authorized to complete a PEER. (Psychologist Emergency Evaluation Request) authorizing the transport.
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