
Get the free South Dakota Division of Behavioral Health High Intensity Referral Form
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Sd. us. PRINT FOR MAILING CLEAR FORM DSS High Intensity Services Authorization Notification Form Version 1/31/2017 HELP. SD EForm - 2473 V1 Complete and use the button at the end to print for mailing. Department of Social Services Division of Behavioral Health 605-773-3123 HIGH INTENSITY REFERRAL FORM TO BE COMPLETED BY REFERRAL AGENCY All fields are REQUIRED. Incomplete forms will be returned Client s First and Last Name STARS ID DOB Last 4 of Social Security Mother s First Name Street...
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