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INTENSIVE INCOME SERVICES REFERRAL FORM Send completed form, along with a CFA and ISP to intake away.org or fax to 2053139015DHR INFORMATION DHR COUNTY DHR CASE # DATE OF REFERRAL DHR WORKER OFFICE
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How to fill out intensive in-home services referral

01
Gather all necessary information: client's name, contact information, date of birth, and insurance information.
02
Fill out the client's demographic information section, providing accurate details about the client's age, gender, and address.
03
Provide a detailed description of the client's mental health or behavioral needs. Include any relevant medical history or diagnoses.
04
Indicate the reasons for seeking intensive in-home services and explain why this referral is necessary for the client's well-being.
05
Ensure all required signatures are obtained, including the client or guardian's consent for the referral.
06
Double-check the referral form for accuracy and completeness before submitting it to the appropriate agency or service provider.

Who needs intensive in-home services referral?

01
Intensive in-home services referral is needed for individuals who require comprehensive support and intervention in their own homes.
02
These services are often recommended for individuals with significant mental health or behavioral challenges that require intensive therapeutic interventions.
03
Clients who may benefit from intensive in-home services referral include those struggling with severe depression, anxiety disorders, self-harm tendencies, disruptive behavior disorders, or trauma-related issues.
04
It is essential to consult with a mental health professional or a healthcare provider to determine if intensive in-home services would be suitable for an individual's specific needs.
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Intensive in-home services referral is a process where individuals in need of intensive support and services are referred to a program that provides in-home care and treatment.
Mental health professionals, social workers, or other qualified professionals are required to file intensive in-home services referral for individuals who require intensive support.
Intensive in-home services referral can be filled out by providing detailed information about the individual in need, their situation, and the services they require.
The purpose of intensive in-home services referral is to ensure that individuals in need of intensive support receive the appropriate care and services in their home environment.
Information such as the individual's name, contact information, current situation, mental health history, and specific needs must be reported on intensive in-home services referral.
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