If you are a facility who is transferring a patient to Kootenai Health’s Behavioral Health program or a family member of a patient being transferred, please use the relevant forms listed below.
For Youth Transfers:
Transfer Request Form (for facilities that are transferring a youth)
Admission Packet (for families to complete)
- Patient Intake Form
- Acknowledgement of Custody and Consent for Discharge
- Medical History Questionnaire
- School Release of Information
- My consent to Medical Care
- Youth Communication List
- Family Expectations Evaluation
- Unemancipated Consent
Information for families (about the unit your child is going to)