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Level of Care Form

Level of Care Form

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Instructions and help about Level Of Care Form

this higher level of care form is for hpsm mild to moderate mental health providers only if you need to refer a member to mental health treatment please stop watching and use the behavioral health referral form which you can find at hpsm.org this higher level of care form is to be used when members have severe mental health issues and service needs the health plan of san mateo only manages mild to moderate outpatient mental health services so when a member needs a higher level of care they must be referred to san mateo county's behavioral health and recovery services this referral is not for emergency services this form is not how to request a change of provider for a mild to moderate service please ask the member to contact hpsm's matching team at 650-616-2557 to be matched to a new provider this form is not how to refer a member for medication support or for substance use treatment please use the behavioral health referral form before using this form please ensure a c

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