NC Sandhills Center Care Coordination Referral Form 2013-2025 free printable template
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MANAGING MENTAL HEALTH, INTELLECTUAL/DEVELOPMENTAL DISABILITIES AND SUBSTANCE ABUSE SERVICES 910.673.9111 ? (FAX) 910.673.6202 ? WWW.SANDHILLSCENTER.ORG ? VICTORIA WHITE, CEO Care Coordination Referral
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How to fill out NC Sandhills Center Care Coordination Referral
How to fill out NC Sandhills Center Care Coordination Referral Form
01
Start by downloading the NC Sandhills Center Care Coordination Referral Form from the official website.
02
Fill in the client's personal information at the top of the form, including name, date of birth, and contact details.
03
Provide details about the referral source, including your name, position, and contact information.
04
Describe the reason for the referral in the appropriate section, clearly outlining the client's needs.
05
Include any relevant medical or behavioral health history that may assist in the care coordination process.
06
Ensure that you check off any specific services or support that the client may require.
07
Review all information for accuracy and completeness before submission.
08
Submit the form via the specified method outlined in the instructions (e.g., email, fax, or mail).
Who needs NC Sandhills Center Care Coordination Referral Form?
01
Individuals seeking mental health or substance use services who require coordinated care.
02
Families or caregivers looking to access support services for a loved one.
03
Healthcare providers needing to refer clients for specialized care coordination.
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What is NC Sandhills Center Care Coordination Referral Form?
The NC Sandhills Center Care Coordination Referral Form is a document used to facilitate the referral of individuals for care coordination services within the Sandhills Center mental health regional service area.
Who is required to file NC Sandhills Center Care Coordination Referral Form?
The form must be filed by individuals, caregivers, or professionals who are seeking care coordination services for individuals with mental health, intellectual/developmental disabilities, or substance use issues.
How to fill out NC Sandhills Center Care Coordination Referral Form?
To fill out the form, individuals must provide personal information of the client, the reason for referral, and any relevant medical or background information that may assist in the care coordination process.
What is the purpose of NC Sandhills Center Care Coordination Referral Form?
The purpose of the form is to ensure that individuals receive timely and appropriate care coordination services tailored to their specific needs.
What information must be reported on NC Sandhills Center Care Coordination Referral Form?
Required information includes the client's demographic details, contact information, the nature of their needs, any previous services received, and the referral source's contact details.
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