Get the free DCC referral form

Submit form at FAX to 773.444.0934 or EMAIL illinoishelpline@alz.org or go online to fill out form: alzheimersillinois.org/directconnectDirect Connect Referral Form Name of person being referred (patient):Zip

How to fill out dcc referral form

How to fill out dcc referral form

1. Obtain a copy of the DCC referral form
2. Fill in the required patient information such as name, date of birth, and contact details
3. Provide details about the reason for the referral and any relevant medical history
4. Make sure to include the referring physician's information and signature
5. Review the completed form for accuracy and completeness before submitting it

Who needs dcc referral form?

1. Patients who require specialized medical care or treatment that cannot be provided by their primary care physician
2. Healthcare providers who wish to refer a patient to a specialist for further evaluation or management of a specific condition

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What is dcc referral form?

The dcc referral form is a document used to refer a case to the Division of Child Care (DCC) for further investigation and action.

Who is required to file dcc referral form?

Any individual or organization that suspects child abuse or neglect is required to file a dcc referral form.

How to fill out dcc referral form?

To fill out a dcc referral form, one must provide detailed information about the suspected abuse or neglect, as well as information about the child and the alleged perpetrator.

What is the purpose of dcc referral form?

The purpose of the dcc referral form is to report suspected cases of child abuse or neglect to the appropriate authorities for investigation and intervention.

What information must be reported on dcc referral form?

The dcc referral form must include information about the child, the alleged perpetrator, the nature of the suspected abuse or neglect, and any other relevant details.