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
- Clinical Criteria and Protocols for Requesting Transfer to DMH Continuing Care Inpatient Facilities & Intensive Residential Treatment Programs (IRTP and CIRT: Children, Adolescents and Adults)
- Continuing Care at DMH Facilities/Units: Processes for Referrals 9/21/12
- DMH Continuing Care Referral Transfer Form for Adults (PDF)
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.
- Clinical Criteria and Protocols for Requesting Transfer to DMH Continuing Care Inpatient Facilities & Intensive Residential Treatment Programs (IRTP and CIRT: Children, Adolescents and Adults)
- Request for Transfer to Child or Adolescent DMH Continuing Care Inpatient Facility, IRTP, or CIRT Program - Long Form (for patients who are already DMH clients) (PDF)
-
Request for Transfer to Child or Adolescent DMH Continuing Care Inpatient Facility, IRTP, or CIRT Program - Short Form (for requestors who are not already DMH clients)
(PDF)
- Request for DYS Transfer to a DMH Intensive Residential Treatment Program (PDF)
- Level of Care Indicator Grid (PDF)
This information is provided by the Department of Mental Health