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REFERRAL FORM Connect is a program of Florida Healthy Start www.HealthyStartFlorida.comFAX (239)4256921Call Connect:(239)4256930 CLIENT INFORMATION InsuranceClient (select one) Pregnant Woman Due

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How to fill out coordinated intake and referral

01

Contact the local coordinated intake and referral system in your area.

02

Provide information about the individual or family in need of services.

03

Follow the instructions given by the intake coordinator on filling out the necessary forms or providing documentation.

04

Be prepared to answer questions about the individual or family's situation and needs.

05

Keep in touch with the intake coordinator for updates on the referral process.

Who needs coordinated intake and referral?

01

Individuals or families who are seeking access to social services such as housing assistance, counseling, food assistance, childcare, or other support services.

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What is coordinated intake and referral?

Coordinated intake and referral is a process where individuals are connected to appropriate services and resources based on their needs and preferences.

Who is required to file coordinated intake and referral?

Service providers and agencies working with individuals seeking assistance or support are required to file coordinated intake and referral.

How to fill out coordinated intake and referral?

Coordinated intake and referral forms can be filled out electronically or in person, providing information about the individual's needs, demographics, and preferences.

What is the purpose of coordinated intake and referral?

The purpose of coordinated intake and referral is to streamline the process of connecting individuals with appropriate services, ensure they receive timely support, and avoid duplication of services.

What information must be reported on coordinated intake and referral?

Information such as the individual's name, contact information, needs, preferences, and any relevant documentation must be reported on coordinated intake and referral.

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