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Belmont Behavioral Health

Direct Admission Checklist

· Patient demographics

· Patient insurance information (including secondary and tertiary)

· Axis I – V

· Current clinical presentation (including any current substance abuse)

· Current medical status (if available):

Current vitals
BAL results
UDS results

· Mental health and substance abuse history

· Emergency contact and family support information

· Authorization from all insurance carriers



To Request an Appointment

Call 1-800-EINSTEIN