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Alpaca County Department of Health and Human Services
Maternal and Child Health Programs
EXTERNAL REFERRAL FORM
For Office Use Validate Received:Submit form to: Corey Anderson, Healthy Beginnings
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What is external referral form?
The external referral form is a document used to refer a client or customer to an external service provider.
Who is required to file external referral form?
Any employee or representative who believes a client would benefit from services provided by an external organization is required to file the external referral form.
How to fill out external referral form?
To fill out the external referral form, one must provide the client's information, details of the referral service, and reason for the referral.
What is the purpose of external referral form?
The purpose of the external referral form is to connect clients with external services that can further support their needs.
What information must be reported on external referral form?
The external referral form must include the client's name, contact information, reason for referral, and any relevant background information.
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