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Click HERE or on the box below to access all of the required items and documents that need to be submitted at least 10 BUSINESS DAYS prior to youth's admittance to treatment.
Please submit all items/documents via fax:
Fax # (808) 293-7196
Attention: Andrea Tuialuuluu
Contact (808) 376-3011 if you need assistance or have questions
Failure to submit any of the following will result in a delay in the youth's admission and may even result in the youth being placed on a waiting list.
Required Items
Copy of youth's Birth Certificate
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CAFAS-5 Scale (CAMHD youth only)
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Coordinated Service Plan (CSP) (CAMHD youth only)
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Copy of youth's medical/dental card(s)
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Copy of youth's ID card (If available)
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School IEP (if applicable)
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Any pertinent legal documents
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Any other updates pertaining to the youth that may affect their treatment (i.e. changes to their physical/mental health or legal situation)
Required Documents
Access the Medical and Intake Forms HERE
PHYSICAL EXAM: Documentation completed by a Physician of the youth's Physical Exam. The exam must have a full review of systems and be signed and dated by the Physician. Date of the exam must be within one year of the date of youth's admission to Bobby Benson Center. If physical has expired prior to youth's date of admission to Bobby Benson Center they will need to see a physician to obtain a current physical exam.
TB: TB clearance dated within one (1) year of admissions date at Bobby Benson Center. TB clearance must include induration results and be signed and dated by the medical professional administering and reading the test results. TB tests that come back as positive must have clearance by the State of Hawaii's TB branch prior to being admitted to the center.