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OPPORTUNITY CENTER EXTENDED STAY INTAKE APPLICATION 600 Poplar Ave PO Box 330 Memphis, TN 381010330 Phone: (901) 5268403 Fax: (901) 5265430 www.MemphisUnionMission.orgPersonal Data Name: ___ Today's

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How to fill out extended stay intake application

01

Obtain the extended stay intake application from the appropriate source, such as the facility or organization providing the services.

02

Fill out all required personal information, including name, contact details, date of birth, and address.

03

Provide information about your reason for needing extended stay services, including any medical conditions or support needs.

04

Include details about your insurance coverage or payment method for the extended stay services.

05

Submit the completed application to the facility or organization according to their specified instructions.

Who needs extended stay intake application?

01

Individuals who require extended stay services due to medical conditions, rehabilitation needs, or other reasons that necessitate a longer stay in a facility or organization.

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What is extended stay intake application?

Extended stay intake application is a form that individuals must submit to request permission to stay in a certain place for an extended period of time.

Who is required to file extended stay intake application?

Individuals who need to stay in a particular location for an extended period of time are required to file the extended stay intake application.

How to fill out extended stay intake application?

The extended stay intake application can usually be filled out online or in person, and requires information such as personal details, reason for stay, and length of stay.

What is the purpose of extended stay intake application?

The purpose of the extended stay intake application is to inform the relevant authorities of the individual's need to stay in a particular location for an extended period of time.

What information must be reported on extended stay intake application?

Information such as personal details, reason for stay, length of stay, and any supporting documentation may need to be reported on the extended stay intake application.

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