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CONFIDENTIAL REFERRAL/FOLLOW-UP REPORT PM 161 LAC LOS ANGELES COUNTY-CHILD HEALTH AND DISABILITY PREVENTION PROGRAM (CHIP) http://publichealth.lacounty.gov/cms/CHDP.htm CHIP Referring Provider: ? Obtain

How to fill out confidential referral pm 161

Instructions on how to fill out confidential referral pm 161:

1. Start by gathering all the necessary information. Ensure you have the complete details of the individual or organization to whom the referral is being made.
2. Open the confidential referral pm 161 form. It is typically available online or can be obtained from the appropriate department or agency.
3. Begin by entering your personal information in the designated fields. This may include your name, address, contact number, and any other relevant details as required.
4. Proceed to fill in the information of the individual or organization being referred. This includes their name, address, contact information, and any other pertinent data that may be requested.
5. If applicable, provide the reason for the referral. Be as specific as possible, outlining the concerns or issues that warrant the referral. Use clear and concise language to accurately convey the situation.
6. Review and verify all the information you have entered to ensure its accuracy. It is crucial to double-check everything before submitting the form.
7. If the referral form contains any confidentiality agreements or disclosures, make sure to read and understand them thoroughly. If you have any questions or concerns, seek clarification from the appropriate authority.
8. Once you are satisfied with the accuracy of the information provided, sign and date the form. This validates your submission and acknowledges your responsibility for the referral.
9. Determine the preferred method of submission. Some referral forms can be submitted electronically, while others may require mailing or hand-delivering the document. Follow the specified instructions to ensure proper submission.

Who needs confidential referral pm 161?

Confidential referral pm 161 is typically required by individuals or organizations who have information or concerns regarding a person or entity that may require further investigation, assistance, or intervention by the relevant authorities. Examples of those who may need to fill out this referral form include:

1. Social workers or caseworkers who come across potential cases of abuse, neglect, or mistreatment of individuals, especially children or vulnerable adults.
2. Healthcare professionals who identify patients or clients showing signs of endangerment, mental health issues, or substance abuse that require attention from appropriate services.
3. Teachers or school administrators who suspect any form of misconduct, violence, bullying, or other inappropriate behavior within educational institutions.
4. Law enforcement officers who become aware of criminal activities or individuals involved in illegal actions that necessitate further investigation or intervention.

It is essential to understand the specific guidelines of each institution or agency where the referral pm 161 is to be submitted, as requirements may vary.

For pdfFiller’s FAQs

What is confidential referral pm 161?

Confidential referral pm 161 is a form used to report confidential information to the appropriate authorities.

Who is required to file confidential referral pm 161?

Individuals who have access to confidential information are required to file confidential referral pm 161.

How to fill out confidential referral pm 161?

Confidential referral pm 161 can be filled out by providing the required confidential information in the designated fields.

What is the purpose of confidential referral pm 161?

The purpose of confidential referral pm 161 is to ensure that confidential information is reported and handled appropriately.

What information must be reported on confidential referral pm 161?

Confidential referral pm 161 must include details of the confidential information being reported and the circumstances surrounding it.

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