CA DHS/DMH/LAHSA Referral Form for Interim Housing - County of Los Angeles 2019 free printable template
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DHS/DM/LASSA REFERRAL FORM FOR INTERIM HOUSING PROGRAMS **REFERRAL SUBMISSION INSTRUCTIONS REFER TO ONE PROGRAM ONLY** DHS INTERIM HOUSING PROGRAM A. IF REFERRING ENTITY IS A PRIVATE OR COUNTY HOSPITAL
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How to fill out CA DHSDMHLAHSA Referral Form for Interim Housing
How to fill out CA DHS/DMH/LAHSA Referral Form for Interim Housing
01
Obtain the CA DHS/DMH/LAHSA Referral Form from the appropriate website or agency.
02
Fill in the client’s personal information, including full name, date of birth, and contact information.
03
Provide detailed information on the client's current living situation, including homelessness status and any relevant history.
04
Complete the section regarding the client's health and mental health status, including any diagnoses and treatments received.
05
Include information on any supporting documents that may be attached, such as proof of income or identification.
06
Sign and date the form to certify that the information provided is accurate.
07
Submit the completed form to the designated agency, either electronically or via mail, as instructed.
Who needs CA DHS/DMH/LAHSA Referral Form for Interim Housing?
01
Individuals experiencing homelessness who are seeking interim housing assistance.
02
Clients with mental health needs who require supportive services in conjunction with housing.
03
Service providers assisting clients who need to access temporary housing resources.
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What is CA DHS/DMH/LAHSA Referral Form for Interim Housing?
The CA DHS/DMH/LAHSA Referral Form for Interim Housing is a document used to request access to interim housing services for individuals experiencing homelessness or housing instability in California.
Who is required to file CA DHS/DMH/LAHSA Referral Form for Interim Housing?
Service providers, social workers, or case managers assisting individuals who need interim housing support are required to file the CA DHS/DMH/LAHSA Referral Form.
How to fill out CA DHS/DMH/LAHSA Referral Form for Interim Housing?
To fill out the CA DHS/DMH/LAHSA Referral Form, you need to provide accurate personal information of the individual seeking housing, details about their current living situation, and any relevant service history.
What is the purpose of CA DHS/DMH/LAHSA Referral Form for Interim Housing?
The purpose of the CA DHS/DMH/LAHSA Referral Form is to facilitate access to interim housing resources and support for individuals facing homelessness, ensuring they receive the necessary services and assistance.
What information must be reported on CA DHS/DMH/LAHSA Referral Form for Interim Housing?
The information that must be reported on the CA DHS/DMH/LAHSA Referral Form includes the applicant's full name, contact information, date of birth, current housing situation, assessed needs, and any relevant support services previously received.
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