Form 1653 Behavioral Health and Narcotic Medication Consent Request - New Hampshire

What Is Form 1653?

This is a legal form that was released by the New Hampshire Department of Health and Human Services - a government authority operating within New Hampshire. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is Form 1653?
A: Form 1653 is the Behavioral Health and Narcotic Medication Consent Request form in New Hampshire.

Q: What is the purpose of Form 1653?
A: The purpose of Form 1653 is to obtain the patient's consent for the use of narcotic medications in behavioral health treatment.

Q: Who needs to fill out Form 1653?
A: Patients who are receiving behavioral health treatment and require narcotic medications in New Hampshire need to fill out Form 1653.

Q: Is Form 1653 specific to New Hampshire?
A: Yes, Form 1653 is specific to New Hampshire.

Q: What information is required on Form 1653?
A: Form 1653 requires the patient's personal information, details about their behavioral health treatment, and their consent for narcotic medication use.

Q: Can someone else fill out Form 1653 on behalf of the patient?
A: In most cases, Form 1653 needs to be filled out by the patient themselves. However, if the patient is unable to do so, a legal representative may fill it out on their behalf.

Q: Are there any fees associated with submitting Form 1653?
A: There are typically no fees associated with submitting Form 1653.

Q: How should Form 1653 be submitted?
A: Form 1653 should be submitted according to the instructions provided by the healthcare provider or facility where the patient is receiving behavioral health treatment.

Q: How long is Form 1653 valid for?
A: The validity of Form 1653 may vary depending on the healthcare provider or facility. It is best to confirm this with them.