Get the free Comprehensive Community Services Referral Form - newhorizonsnorth

Comprehensive Community Services Referral Form Referral Date: Name: Date of Birth: Gender: Male Female SSN: Address: City: State: Phone: Cell: Zip: Work: If this is a child under 18, please obtain

How to fill out comprehensive community services referral

How to fill out a comprehensive community services referral:

Start by gathering the necessary information:

1. Collect the individual's personal details, such as their full name, date of birth, address, and contact information.
2. Take note of any relevant identification numbers, such as social security or Medicaid numbers.
3. Obtain a brief background about the individual's current situation and any specific needs they may have.

Identify the referring agency or individual:

1. Provide the name and contact information of the agency or individual making the referral.
2. Include any pertinent identification numbers or codes associated with the referring entity.

Specify the reason for the referral:

1. Clearly outline the purpose for seeking comprehensive community services.
2. Include details about the individual's challenges or requirements that necessitate such services.
3. Describe any specific goals or outcomes the individual hopes to achieve through the referral.

Describe the recommended services:

1. List the specific comprehensive community services that are being recommended.
2. Provide details about each service, including the name, description, and any additional relevant information.
3. Note any preferences or specific requirements the individual may have regarding the services.

Attach supporting documentation:

1. Include any supporting documents that can further clarify the individual's situation or needs.
2. This could include medical records, evaluations, assessments, or previous treatment plans.
3. Ensure that all attachments are properly labeled and organized for easy reference.

Who needs a comprehensive community services referral:

Individuals with complex care needs:

1. Those who require a combination of medical, mental health, and social services to address their diverse needs.
2. This can include people with chronic illnesses, disabilities, or individuals recovering from a traumatic event.

Vulnerable populations:

1. Individuals who may be at risk due to factors such as poverty, homelessness, or substance abuse.
2. This referral can provide them with access to a wide range of support services tailored to their unique circumstances.

Individuals seeking specialized care:

1. People who require specific services such as rehabilitation, psychological counseling, or vocational training.
2. This referral can help connect them with the appropriate resources and professionals within the community.

Overall, anyone who would benefit from an integrated and comprehensive approach to their care can benefit from a comprehensive community services referral. It ensures that their multifaceted needs are addressed efficiently and effectively.

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