Get the free PG Referral and Intake Worksheet 3.2 Conversion.doc

Multnomah County, Oregon Office of the Public Guardian and Conservator (MC PGC) 421 SW Oak Street, Suite 510 Portland, Oregon 97204 Phone (503) 9884567 Fax (503) 9884075 Web: www.multco.us/ads/publicguardianprogram

How to fill out pg referral and intake

How to fill out pg referral and intake

1. To fill out the PG referral and intake form, follow these steps:
2. Start by providing your personal information, such as your full name, date of birth, and contact details.
3. Enter your current address and any previous addresses you have resided in.
4. Indicate your gender and marital status.
5. Specify your employment details, including your occupation and employer's information.
6. Answer the questions related to your health history, including any medical conditions or medications you are currently taking.
7. Provide information about any previous psychiatric or counseling treatments, if applicable.
8. Mention any substance abuse history or addiction issues, if relevant.
9. Answer the questions regarding your current mental health symptoms and concerns.
10. Indicate your availability for appointments and preferred mode of communication.
11. Review all the information provided and sign the form to authorize the referral and intake process.

Who needs pg referral and intake?

1. PG referral and intake is needed by individuals who are seeking professional help or treatment for gambling addiction or problem gambling.
2. This form is typically filled out by individuals who are referred to a specialized program or counseling service for their gambling-related concerns.
3. It is also required by individuals who voluntarily seek assistance in managing their gambling habits or overcoming addiction.

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What is pg referral and intake?

PG referral and intake is a process of referring individuals to receive assistance from a particular program or service, and collecting information on their needs and background.

Who is required to file pg referral and intake?

Service providers and organizations are required to file pg referral and intake for individuals who are seeking assistance from their programs.

How to fill out pg referral and intake?

To fill out pg referral and intake, service providers need to gather information on the individual's needs, background, and the services they are seeking. This information is then recorded in the designated form or system.

What is the purpose of pg referral and intake?

The purpose of pg referral and intake is to ensure that individuals receive the appropriate services and assistance they need, based on their needs and background information.

What information must be reported on pg referral and intake?

Information such as the individual's name, contact details, needs, background, services sought, and any relevant supporting documents must be reported on pg referral and intake.