Your Tasks
Contact Parent/Guardian(s) to Fill Out Consent Forms
1. Contact attempts made? *
2. Contact made with parent/guardian? *
3. School Support needed?
4. Consent forms received? *
Schedule Initial Appointment
Appointment Date and Time *
Provider *
Location *
Case Updates
| Tasks | Status | User | Date Started | Date Due |
|---|---|---|---|---|
| Mental Health Referral Form | Done | 07/06/2026 | 07/09/2026 | |
| Contact Parent/Guardian | Done | 07/07/2026 | 07/10/2026 | |
| Receive consent forms | Done | 07/09/2026 | 07/13/2026 | |
| Schedule with Clinician | Scheduled | 07/13/2026 | 07/16/2026 | |
| Initial Appointment Complete | Not Started | - | - | |
| Evaluation Documentation Uploaded | Not Started | - | - | |
| Referral Status | Not Started | - | - |
Clinical Documentation
Documents from the clinician appointment will automatically be uploaded here. If they do not appear here, you can manually upload the files.
No files uploaded.
For InSite Staff
Internal Notes
No notes entered.
Case Details
Case Files and Attachments
Any files and attachments uploaded in the comments will appear below.
No files uploaded.
Referral Details
Managing Organization
School District Name
School Team
| Name | |
|---|---|
| Bobby Smith | bobby.smith@centralavems.com |
| John Doe | john.doe@centralavems.com |
Student Information
Student Name
Sophia Martinez
Date of Birth
08/14/2011
Grade
8
Gender Identity
Female
School
Central Avenue Middle School
Student Email
sophia.martinez@centralavems.org
Guardian 1
Carmen Martinez
(973) 555-0148
carmen.martinez@email.com
3135 Lakewood Dr, Newark, NJ 07102
Guardian 2
Luis Martinez
(973) 555-0172
luis.martinez@email.com
3135 Lakewood Dr, Newark, NJ 07102
Referral Reason
IEP Initial Psychiatric Evaluation
Assign case
John Doe (Principal - Central Avenue MS)
Referral Details
Notes on referral reason
Details on referral reason
Add Optional Media Evidence (ex. electronic evidence)
No files uploaded.
Payment
School based provider
Next Alternative to InSite Care
ER/Hospital