Referral Information

Determining Level of Care

Does the patient meet one of the following inpatient level of care determinations?

• Behavior which is life threatening, destructive or disabling to self or others
• Symptoms/behaviors indicative of need for 24 hour professional monitoring and assessment of the patient’s condition
• Active psychiatric disorder with potential to interfere with serious medical condition
• Acute onset confusion or memory loss due to a DSMV psychiatric disorder that endangers patient’s welfare
• Severe deterioration of level of functioning
• Failure of outpatient treatment evidenced by clinical instability which precludes safe treatment at a lesser level of care
• Patient with a dementing disorder who requires evaluation and treatment of an acute psychiatric comorbidity

If you answer YES to any of these questions, please call us at (920) 390-7303.

If you answer NO to all of these questions, the patient will be better served on an outpatient level. If you are having difficulty-finding resources for this individual, please give us a call, we are happy to suggest ideas.

Requirements

Our Medical Director requires reviewing the individual’s face sheet, history and physical, medication list, progress notes (describing behaviors). Once our Medical Director approves the admission, we require all patients are required to go through medical clearance. Our Medical Director requires the following:

• Complete Blood Count (CBC)
• Comprehensive Metabolic Panel (CMP)
• BAL if alcohol use present (needs to be 0 prior to transfer),
• Drug levels if indicated (Lithium, Depakote, Carbamazepine, Tylenol if OD, etc)
• UA, Urine drug screen if relevant or suspected’
• EKG should be done on all transfers
• CT scan if acute mental status change present
• If BP >180/110, need to be stabilized
• Other vitals should also be stable

Admission Type

Voluntary Admission

• Patient is oriented to person and place
• The patient is willing and able to participate in psychiatric treatment
• Patient will have to sign our Consent for Inpatient Psychiatric Treatment consent form prior to admission.
   - In the state of Wisconsin, an Activated Health Care Power of Attorney cannot sign the principal in for Mental Health Treatment.
   - This does not mean the principal cannot receive mental health treatment. Please call us and we can talk through it. (920) 390-7303.

Limitations on mental health treatment. My health care agent may not admit or commit me on an inpatient basis to an institution for mental diseases, an intermediate care facility for the persons with intellectual disability, a state treatment facility, or a treatment facility. My health care agent may not consent to experimental mental health research or psychosurgery, electroconvulsive treatment or drastic mental health treatment procedures for me.

Involuntary Admission

An individual is under a 72- Hour Emergency Detention (Ch. 51.15) through law enforcement or a county. Emergency Detention paperwork is must be present on admission.