Get the free SUD Universal Referral Form to Youth System of Care (SOC)

This document may contain PHI. Please ensure HIPAA compliance by sending via secure email or fax. Department of Health Services Division of Behavioral Health Services Substance Use Prevention and

How to fill out sud universal referral form

How to fill out sud universal referral form

1. Step 1: Obtain a copy of the SUD Universal Referral Form from the designated authority or agency.
2. Step 2: Start by filling out the general information section of the form. This may include details like the client's name, contact information, date of referral, and any identification numbers.
3. Step 3: Move on to the referral source information section. Here, you will need to provide details about the person or organization making the referral, such as their name, contact information, and professional credentials.
4. Step 4: Proceed to the client information section. This is where you will need to enter comprehensive information about the client, including their demographic details, medical history, mental health history, substance use history, and any previous treatment episodes.
5. Step 5: Complete the reason for referral section, outlining the specific concerns or issues that necessitate the referral.
6. Step 6: Provide any relevant supplementary documentation, such as medical reports or assessment results, to support the referral.
7. Step 7: Review the completed form for accuracy and completeness, ensuring all required fields are duly filled.
8. Step 8: Submit the filled-out SUD Universal Referral Form to the appropriate recipient, as specified by the referring agency or authority.
9. Step 9: Keep a copy of the form for your records.
10. Step 10: Follow up with the recipient or referring agency to ensure the referral has been received and processed.

Who needs sud universal referral form?

1. Individuals seeking substance use disorder (SUD) treatment or intervention may need to fill out the SUD Universal Referral Form.
2. Healthcare professionals, counselors, social workers, or any relevant agency involved in referring clients to SUD treatment services may also require the form.
3. Referral agencies, mental health clinics, treatment centers, or any organization responsible for coordinating SUD care and services may utilize the SUD Universal Referral Form.

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What is sud universal referral form?

The SUD Universal Referral Form is a standardized document used for referring individuals for substance use disorder treatment and support services.

Who is required to file sud universal referral form?

Individuals seeking substance use disorder treatment, healthcare providers, and organizations involved in treatment referrals are typically required to file the SUD Universal Referral Form.

How to fill out sud universal referral form?

To fill out the SUD Universal Referral Form, provide accurate information regarding the individual's personal details, medical history, substance use history, and any previous treatment experiences.

What is the purpose of sud universal referral form?

The purpose of the SUD Universal Referral Form is to streamline the process of referring individuals to appropriate treatment services and ensure that they receive timely and adequate care.

What information must be reported on sud universal referral form?

The SUD Universal Referral Form must report personal information of the individual, including name, date of birth, contact information, substance use history, and relevant medical and treatment history.