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

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.