This page contains the clinical criteria and transfer protocols for receiving DMH Facility continuing care services and Request for Transfer Forms. There are separate forms for the transfer of adults and transfer of children and adolescents. These forms are listed below and are available in two downloadable formats: Adobe Acrobat PDF and Microsoft Word.

Request for Transfer for Adults


Request for Transfer for Children and Adolescents

There are two major types of forms: a Short Form and a Long Form. These forms are for request to transfer to a DMH continuing care inpatient facility, intensive residential treatment program (IRTP), and/or a clinically intensive residential treatment (CIRT) program.

Please note: Long Forms must be used for patients who are already clients of the Department of Mental Health (DMH). Likewise, Short Forms must be used for requestors who are not current DMH clients.


 


This information is provided by the Department of Mental Health