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JURUPA UNIFIED SCHOOL DISTRICT BEHAVIORAL HEALTH SERVICES REFERRAL FORM REFERRALS TO BE MADE TO THE DEPARTMENT OF PARENT INVOLVEMENT & COMMUNITY OUTREACH (JUST) EMAIL: Behavioral Health JUST. K12.CA.US

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How to fill out referrals to be made

01

Step 1: Obtain a referral form from the appropriate source.

02

Step 2: Fill out the patient's personal information, such as name, date of birth, and contact details.

03

Step 3: Provide the reason for the referral and include any relevant medical history or test results.

04

Step 4: Indicate the preferred specialist or healthcare provider to whom the referral is being made.

05

Step 5: Sign and date the referral form.

06

Step 6: Submit the completed referral form to the designated recipient, such as a primary care physician or insurance company.

07

Step 7: Keep a copy of the referral form for your records.

Who needs referrals to be made?

01

Patients who require specialized medical care or services beyond the scope of their primary care doctor.

02

Individuals seeking second opinions or alternative treatment options.

03

Individuals participating in insurance plans that require referrals for specialist visits.

04

Patients undergoing medical procedures or treatments that need coordination between different healthcare providers.

05

Employees who need referrals for occupational health services.

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What is referrals to be made?

Referrals to be made refers to the process of recommending or directing someone to a particular person, organization, or service for further assistance or action.

Who is required to file referrals to be made?

Various professionals such as doctors, social workers, counselors, and teachers may be required to file referrals to be made.

How to fill out referrals to be made?

Referrals to be made can typically be filled out by providing the relevant information about the individual in need of assistance, along with details of the recommended service or organization.

What is the purpose of referrals to be made?

The purpose of referrals to be made is to ensure that individuals receive the necessary support, services, or treatments that they may require.

What information must be reported on referrals to be made?

Information such as the individual's name, contact details, reason for referral, and any relevant background information may need to be reported on referrals to be made.

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