Humana Military, the TRICARE East Region contractor, uses this form to learn when a beneficiary leaves behavioral health care and what follow-up is in place. The discharging facility records discharge diagnoses, disposition, medications, a safety plan and community or school supports, plus medication management and therapy appointments at 7 and 30 days. The form states that post-discharge appointments should be within seven days of discharge.
The discharging behavioral health facility or provider completes the whole form, including the discharge planner's name and the dates the plan was discussed with the beneficiary and family.
Download the current version from the source each time; forms change without notice.
Behavioral health discharge form
If your copy of the form is a fillable PDF, upload it once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.
Vero is not affiliated with, or endorsed by, the agencies and insurers listed here. Read our editorial policy.
Humana Military's form says post-discharge appointments should be within seven days of discharge. It has separate rows for medication management, therapy and other appointments at the 7-day and 30-day marks, each with a provider, date and time, so the aftercare plan is documented before the beneficiary leaves.
Submit it online through Humana Military provider self-service with the referral or authorization request. Humana Military says referrals and authorizations must go through self-service, and fax is a fallback only when online submission is not possible. The form is listed with the other behavioral health forms on Humana Military's provider resources page.