Process - Physician - Fraser Health Authority

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CommunityMHSU ReferralFormBounceBackProgram ReferralCRESST/Afterhours/Car 67Referral FormEating DisordersProgramReferralsSubstance UseServicesNeuropsychAssessmentServicesEarly PsychosisInterventionReferralsBC PharmacarePlan G FormBC PharmacareSpecial <strong>Authority</strong>Form
REFERRAL FORM: Community Mental<strong>Health</strong> and Substance Use Services*MHXX*MHXX104521BA. REFERRAL SOURCERev: Mar 28/11Page: 1 of 2REFERRAL DATE(DD/MM/YY)DATE RECEIVEDAT MHC (DD/MM/YY)REFERRAL TIME(24 hr clock)TIME REFERRALRECEIVED (24 hr)REFERRAL SOURCE(i.e. self, program/site)REFERRAL MADE NAME ROLEPHONE #BY(incl. ext.)REFERRALRECEIVED BYB. CLIENT INFORMATIONNAMEADDRESSGENDERABORIGINAL IDENTITYALIAS(if any)NO FIXED PHNADDRESS DOBHOMELESS (DD/MM/YY)CITY PROVINCE POSTAL CODEPHONE NUMBER HOMENO PHONENUMBERNEXT OF KINMALE FEMALE UNKNOWN / UNDIFFERENTIATEDABORIGINALNON-ABORIGINALUNKNOWN / NOT ASKEDCAN WE LEAVE A MESSAGE AT THIS NUMBER?OTHER CAN WE LEAVE A MESSAGE AT THIS NUMBER? YES NONAMERELATIONSHIPPHONE CAN WE LEAVE A MESSAGE AT THIS NUMBER? YES NOALTERNATECONTACTNAME RELATIONSHIPSAME AS NEXT OFKINPHONE CAN WE LEAVE A MESSAGE AT THIS NUMBER? YES NOGENERALPRACTITIONERPHONEFAXYESNONO GENERAL PRACTITIONERDURING HOSPITALIZATION ONLYPrint Shop # 261974PSYCHIATRISTPHONEC. REASON FOR REFERRALREASON FOR REFERRAL:FAXNO PSYCHIATRISTDURING HOSPITALIZATION ONLYSERVICES REQUESTED / DESIRED OUTCOME:CURRENT DIAGNOSES (IF KNOWN, PSYCHIATRIC AND MEDICAL):
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SteppedCareLevel 1PSP Mental Health
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Fold back this page before administ
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CBISCOGNITIVE BEHAVIOURAL INTERPERS
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Table of ContentsINTRODUCTION. . .
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IntroductionThe following modules h
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TipsTeachingSelling Strategies• E
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Flow ChartsThis module contains flo
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Patient NeedsTryThe Circle of Depre
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AnxiousSymptomsTryOverwhelmedChaoti
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Assessment ModuleThe Assessment Mod
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5 Energy levela. How would you rate
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15 Phobiasa. Any unrealistic or exc
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21 CAGEHow many drinks might you ha
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DIAGNOSTIC SCREENING WORKSHEET (CON
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Problem List Action PlanACTIVATIONR
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Self-Assessment QuestionnaireName:
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Self-Assessment ProfilePleaser: Hig
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Self-Assessment ProfileOver-Thinker
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Understanding Depression- Frequentl
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Depression: System-Wide CrashDepres
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Activation ModuleThe Activation Mod
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Depression’s Energy BudgetEvery d
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Small GoalsThe concentration, fatig
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Problem SolvingDepression can make
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Chunk the DayStrategies that give p
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Appreciation Exercise“Good for Me
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The Circle of DepressionCognitive-b
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Common Thinking ErrorsThe situation
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THOUGHT CHANGE PROCESS (CONTINUED)T
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Thought StoppingDepression often ma
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Good Guilt / Bad GuiltA world witho
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Setting LimitsMost of us like to be
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Is Anger a Problem for You?Tom arri
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Stress ResponseIntroduction to Rela
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Variation - Box BreathingABDOMINAL
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Body ScanPurpose• Body scan is a
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Stress BustersPurpose• Shorter te
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MindfulnessPurpose• Mindfulness i
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BreathMINDFULNESS MEDITATION (CONTI
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Healthy Habits for SleepingDepressi
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IT’S TRUE: YOU ARE WHAT YOU EAT!
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The Wellness WheelPHYSICALGROWTHSEL
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CBISCognitive Behavioural Interpers
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FLOW CHARTS……………………
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PANIC DISORDER• Anxiety “System
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The Many Faces of AnxietyPanic Diso
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Medical ConsiderationsMost Common M
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Anxiety“System-Wide Explosion”A
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Resources for Self-HelpOnline Resou
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GAD: Self-Assessment QuestionnaireN
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GAD: Self-Assessment ProfileHard Dr
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How Anxiety WorksTHOUGHTSBODYFEELIN
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Panic CircleEvent (public speaking)
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Your Emotional Thermometer• Imagi
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Anxiety EquationAnxiety arises out
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2. When something bad happens, I wo
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Coping CardsAnxious people often ma
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Problem SolvingAnxiety is strengthe
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Example: Kelly begins by making a l
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D.E.S.C. ScriptAssertiveness doesn
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Application forPsychiatric Medicati
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APPENDIX 2: WOMEN’S MENTAL HEALTH
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Pharmacotherapy in the Perinatal Pe
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FAMILY PHYSICIAN GUIDE | ADDRESSING
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Olanzapine (Zyprexa)Tablets, wafers
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Consortium forOrganizationalMentalH
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3. Gather details on current andpre
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Task Two: ADVISE1. Provide meaning
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SUPPORTED SELF‐MANAGEMENT FOR DEP
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TABLE OF CONTENTSIntroduction 1What
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INTRODUCTIONTake a moment now to as
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WHAT IS DEPRESSION?The two most com
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WHAT CAUSES DEPRESSION?People becom
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WHAT CAUSES DEPRESSION?ThoughtsEach
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WHAT CAUSES DEPRESSION?EmotionDepre
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WHAT CAUSES DEPRESSION?ActionDepres
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WHAT CAN YOU DO ABOUT DEPRESSION?MI
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MORE ABOUT MEDICATIONMedication is
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ANTIDEPRESSANT SKILLSIn this sectio
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REACTIVATING YOUR LIFEStep 1: Ident
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REACTIVATING YOUR LIFESmall DutiesE
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REACTIVATING YOUR LIFEStep 2: Choos
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REACTIVATING YOUR LIFEStep 3: Set r
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REACTIVATING YOUR LIFEStep 4: Carry
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THINKING REALISTICALLYNegatively di
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THINKING REALISTICALLYStep 1: Learn
Page 178 and 179: THINKING REALISTICALLYStep 3: Learn
Page 180 and 181: THINKING REALISTICALLYStep 3: Learn
Page 182 and 183: THINKING REALISTICALLYStep 4: Pract
Page 184 and 185: SOLVING PROBLEMS EFFECTIVELYStep 1:
Page 194 and 195: REDUCING THE RISK OF RELAPSEPlan ah
Page 196 and 197: Congratulations! You have now made
Page 198 and 199: SUGGESTED READINGON DEPRESSION AND
Page 200 and 201: DIETThe Canada Food GuideGuidelines
Page 202 and 203: SLEEPStress, anxiety, and depressio
Page 204 and 205: CAFFEINECaffeine stimulates the sym
Page 206 and 207: CHALLENGING DEPRESSIVE THOUGHTSSitu
Page 208 and 209: PROBLEM SOLVINGACTION ADVANTAGES DI
Page 210 and 211: AnxietyDementiaDementiaBipolar155
Page 212 and 213: Practice Support ProgramGeneralized
Page 214 and 215: Montreal Cognitive Assessment(MoCA)
Page 216 and 217: Serial 7s: Administration: The exam
Page 218 and 219: Appendix CNAME OF PATIENTStandardiz
Page 220 and 221: Item 11Scoring WORLD backwards (ins
Page 222 and 223: Appendix CStandardized Mini Mental
Page 224 and 225: SCORING THE MOOD DISORDERQUESTIONNA
Page 226 and 227: FORM 4MENTAL HEALTH ACT[ Sections 2
Page 230 and 231: REFERRAL FORMMental Health and Subs
Page 232 and 233: MENTAL HEALTH AFTER HOURSPLEASE LEA
Page 234 and 235: DOCUMENTATION REQUIRED UPON REFERRA
Page 236 and 237: Adult Eating Disorders ProgramRefer
Page 238 and 239: Medical History:Medical causes of l
Page 240 and 241: Who Are We?This is a specialized pr
Page 242 and 243: Fraser South Eating Disorders Progr
Page 246 and 247: Fraser South Eating Disorders Progr
Page 250 and 251: Fraser East:This program is part of
Page 252 and 253: Fact SheetPanic Disorder GroupDoes
Page 254 and 255: Fact SheetGeneralized Anxiety Group
Page 256 and 257: 4 th Floor Sherbrooke Centre Tel (6
Page 258 and 259: Early Psychosis Intervention Progra
Page 260 and 261: *Additional Resources*For Informati
Page 262 and 263: Mental Healthand Addiction… suppo
Page 264 and 265: Fraser Health Mental Healthand Addi
Page 266 and 267: ADDICTION SERVICESAddiction Service
Page 268 and 269: ADDICTION SERVICESYouth Addictions
Page 270 and 271: ADDICTION SERVICES6. Long-term Resi
Page 272 and 273: MENTAL HEALTH SERVICESMental Health
Page 274 and 275: MENTAL HEALTH SERVICESDelta Mental
Page 276 and 277: MENTAL HEALTH SERVICES4. Community
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MENTAL HEALTH SERVICESMinistry of E
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MENTAL HEALTH SERVICES7. Residentia
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Mental Health & AddictionsHEALTHY L
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Client name: ______________________
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Client name: ______________________
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Taking Wellness to Heart! Metabolic
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Mental Health and Substance Use Rev
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Collaborative Care Process Map-Epis
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Fax the Special Authority Request t
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o o o o o o o • • • o o o o o
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Process - Physician - Fraser Health Authority

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