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Broome County Central Intake/Thrive Referral Referrals are accepted by phone (6077782700) MondayFriday between 8am4pm. Referrals can also be completed and emailed to DSSCentralIntakeUnit@broomecountyny.gov.
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How to fill out central intake referral formdocx

01
Open the central intake referral formdocx document on your computer.
02
Fill in the patient's personal information, including name, date of birth, address, and contact information.
03
Provide details of the referral, including the reason for the referral and any relevant medical history.
04
Include information about the referring healthcare provider, such as their name, specialty, and contact information.
05
Save the completed form and submit it according to the instructions provided.

Who needs central intake referral formdocx?

01
Healthcare providers who are referring patients to a central intake system.

What is Central Intake Referral .docx Form?

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The central intake referral formdocx is a standardized document used to gather and submit information for referrals to central intake programs or services.
Typically, healthcare providers, social workers, or organizations that wish to refer individuals to specific services are required to file the central intake referral formdocx.
To fill out the central intake referral formdocx, one must enter the relevant information requested in the sections provided, including patient details, service requested, and any additional notes.
The purpose of the central intake referral formdocx is to streamline the process of referring individuals for services, ensuring that all necessary information is collected for proper evaluation and processing.
The information that must be reported includes personal details of the individual being referred, the nature of the services needed, and contact information for the referring party.
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