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This version of the form is not currently in use and is provided for reference only. Download this version of
Form FA-11B
for the current year.
Form FA-11B Mental Health Request for Php / Iop Services (Partial Hospitalization Program and Intensive Outpatient Program) - Nevada
What Is Form FA-11B?
This is a legal form that was released by the Nevada Department of Health and Human Services - a government authority operating within Nevada. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is the purpose of Form FA-11B?
A: The purpose of Form FA-11B is to request mental health services in Nevada's Partial Hospitalization Program (PHP) and Intensive Outpatient Program (IOP).
Q: What are the services offered in Nevada's Partial Hospitalization Program?
A: Nevada's Partial Hospitalization Program (PHP) offers intensive mental health services during the day while allowing individuals to return home at night.
Q: What are the services offered in Nevada's Intensive Outpatient Program?
A: Nevada's Intensive Outpatient Program (IOP) provides mental health services on a less intensive basis, usually for a few hours a day.
Q: Who can request services using Form FA-11B?
A: Any individual in Nevada who requires mental health services in the Partial Hospitalization Program (PHP) or Intensive Outpatient Program (IOP) can request services using Form FA-11B.
Q: What information is required on Form FA-11B?
A: Form FA-11B requires information such as personal details, insurance information, diagnosis, and a statement of need for mental health services.
Q: What should I do after completing Form FA-11B?
A: After completing Form FA-11B, submit it to the mental health department or facility providing the Partial Hospitalization Program (PHP) or Intensive Outpatient Program (IOP) in Nevada.
Q: Are there any fees for the mental health services provided in Nevada?
A: Fees for mental health services in Nevada's Partial Hospitalization Program (PHP) and Intensive Outpatient Program (IOP) may vary depending on insurance coverage and individual circumstances.
Q: Can I request mental health services for someone else using Form FA-11B?
A: Yes, you can request mental health services for someone else using Form FA-11B, provided you have the necessary authorization or legal authority.
Form Details:
- Released on January 22, 2021;
- The latest edition provided by the Nevada Department of Health and Human Services;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of Form FA-11B by clicking the link below or browse more documents and templates provided by the Nevada Department of Health and Human Services.
Download Form FA-11B Mental Health Request for Php / Iop Services (Partial Hospitalization Program and Intensive Outpatient Program) - Nevada
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