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Recommendation Information

Send or obtain the following information with all referrals:

  • History
  • Physical examination
  • Medications, if any
  • Laboratory and imaging results, if any
  • Summary of case (ie, impression of substance use concern)
  • Assessment of psychosocial concerns
  • Contact information for the referring physician
  • Contact information for the patient/family

An example primary care referral and feedback form follows:

DCT-Form

Courtesy of the AAP Mental Health Initiatives. Available at: http://pediatrics.aappublications.org/content/125/Supplement_3/S172.