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Reset FormREFERRALState Form 55940 (R7 / 418) FAMILY AND SOCIAL SERVICES ADMINISTRATION DIVISION OF MENTAL HEALTH AND ADDICTION Please verify the following eligibility requirements. Check all boxes
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How to fill out recovery works referral form
How to fill out recovery works referral form
01
Start by obtaining the recovery works referral form from the appropriate healthcare provider or organization.
02
Complete the personal information section with your full name, contact details, date of birth, and any other required information.
03
Provide details of your current medical condition or reason for seeking recovery works services in the designated section.
04
If applicable, include any relevant medical history or medications you are currently taking.
05
Have the form reviewed and signed by your healthcare provider to confirm the need for recovery works services.
06
Submit the completed form to the designated department or individual as instructed.
Who needs recovery works referral form?
01
Individuals who are seeking recovery works services for addiction treatment or mental health support.
02
Patients who have been recommended for recovery works programs by their healthcare providers.
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What is recovery works referral form?
The recovery works referral form is a document used to refer individuals to recovery services and programs that assist them in their rehabilitation process.
Who is required to file recovery works referral form?
Individuals seeking recovery services, as well as organizations or professionals facilitating access to these services, are required to file the recovery works referral form.
How to fill out recovery works referral form?
To fill out the recovery works referral form, provide the necessary identification information, details about the individual being referred, and information about the specific services required for recovery.
What is the purpose of recovery works referral form?
The purpose of the recovery works referral form is to streamline the process of connecting individuals with the appropriate recovery services and ensure they receive the necessary support.
What information must be reported on recovery works referral form?
The form must report information such as the individual's name, contact details, a summary of their recovery needs, and the services being requested.
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