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MOUNTAIN COMPREHENSIVE CARE CENTER WESTERN KENTUCKYSCHOOL BASED REFERRAL FORM (CONFIDENTIAL) Student Name___ Grade___ Teacher___ Parent/Guardian Name___ Phone #___ Referred by:___Teacher ___Parent
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Visit the Mountain Comprehensive Care Center website or location to obtain the necessary forms.
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Fill out personal information such as name, address, phone number, and insurance information.
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Provide detailed information about your medical history, current health issues, and any medications you are currently taking.
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Make sure to sign and date the forms before submitting them to the facility.

Who needs mountain comprehensive care center?

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Individuals who require comprehensive medical care
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Individuals with chronic health conditions
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Individuals seeking mental health services
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Individuals in need of dental care
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Mountain comprehensive care center is a healthcare facility that provides a wide range of medical services to patients in the mountainous region.
Mountain comprehensive care center administration or management is responsible for filing the necessary documentation.
The mountain comprehensive care center form must be completed with accurate and up-to-date information regarding the facility's operations and services.
The purpose of mountain comprehensive care center is to ensure that patients in mountainous areas have access to quality healthcare services.
Information such as number of patients served, types of services offered, staff credentials, and financial data may need to be reported on mountain comprehensive care center.
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