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DA ODAS CONFIDENTIAL SHIRT REFERRAL FORM Date: Medicaid Number: Referral Source Contact Information: Provider Name: Company/Organization: Phone Number: Fax Number: Client Name: Client Address: Client
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How to fill out daodas confidential sbirt referral
How to fill out daodas confidential sbirt referral:
01
Start by gathering all necessary information, including the individual's name, contact information, and any relevant medical history.
02
Ensure that you have the required consent from the individual to complete the referral process.
03
Complete the referral form accurately, providing all relevant details about the individual's substance use and any associated risk factors.
04
Make sure to include any additional information that may be helpful for the referral recipient, such as the individual's willingness to participate in treatment or any specific concerns they may have.
05
Double-check the completed form for any errors or missing information before submitting it.
Who needs daodas confidential sbirt referral:
01
Individuals who are at risk of substance use disorders and require screening, brief intervention, and referral to treatment (SBIRT) services.
02
Healthcare providers who suspect that their patients may benefit from additional substance use assessment and support.
03
Any organization or individual involved in providing substance use services, such as addiction treatment facilities or counselors, who may need to refer individuals to appropriate resources.
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