Transfer Protocols and Forms

DMH Transfer Protocols and Forms

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. 

For contact information, please see the DMH Liaison List For Hospitals. 

Request for Transfer for Adults

 

• Continuing Care at DMH Facilities/Units: Processes for Referrals 
• DMH Continuing Care Referral Transfer Form for Adults (Word)
  • DMH Continuing Care Referral Checklist  
  • DMH Continuing Care Contact Information 

Request for Transfer for Children and Adolescents

When to submit a Transfer Screening Request to DMH CYF statewide programming - Decision Tree  When to submit a Transfer Screening Request to DMH CYF statewide programming - Interactive Graphic 

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.

If you are a child/adolescent licensed inpatient psychiatric unit and you are interested in a training facilitated by DMH about the Transfer Screening process please contact Kara McTague at [e-mail].

• 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)