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Odyssey House Referral Form 6.12ODYSSEY HOUSE REFERRAL FORM 4730 Washington Ave, New Orleans, Louisiana 70125 Date: Referral Source/Name/Phone Number 1. CLIENT DEMOGRAPHICS: Name: DOB: Race: Address:

How to fill out odyssey house referral form

How to fill out odyssey house referral form

1. To fill out the Odyssey House referral form, follow these steps:
2. Begin by accessing the Odyssey House website or obtaining a physical copy of the referral form.
3. Gather all necessary information, including the client's personal details, contact information, and relevant background information.
4. Start by filling out the client's basic information, such as their name, address, date of birth, and social security number.
5. Provide contact information for the client, including their phone number and email address.
6. Fill out the sections related to the client's history, such as their substance abuse or mental health issues, prior treatments, and any legal involvement.
7. Complete additional sections, if applicable, regarding the client's family history, housing situation, employment, and support system.
8. Include any additional comments or necessary information in the designated comment section.
9. Review the form to ensure all information is accurately filled out and all sections are completed.
10. Submit the completed Odyssey House referral form either online or by mailing it to the provided address.
11. Keep a copy for your records if needed.

Who needs odyssey house referral form?

1. The Odyssey House referral form is typically required for individuals who are seeking assistance or treatment for substance abuse or mental health issues.
2. This form may be needed by individuals who are seeking admission into Odyssey House treatment programs, as well as those who are referred by other healthcare professionals or organizations.
3. It is important to note that specific eligibility criteria may vary depending on the program or service being sought, so it is recommended to consult with Odyssey House or the respective referring authority to determine if a referral form is necessary.

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What is odyssey house referral form?

Odyssey House referral form is a document used to refer individuals to the residential treatment program provided by Odyssey House.

Who is required to file odyssey house referral form?

Anyone can fill out the Odyssey House referral form, but typically it is filled out by a healthcare provider, social worker, or case manager.

How to fill out odyssey house referral form?

To fill out the Odyssey House referral form, you need to provide information about the individual being referred, their medical history, and contact information for follow-up.

What is the purpose of odyssey house referral form?

The purpose of the Odyssey House referral form is to facilitate the referral process for individuals seeking residential treatment for substance abuse.

What information must be reported on odyssey house referral form?

The Odyssey House referral form typically requires information about the individual's demographics, medical history, substance abuse history, and contact information.