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CLIENT REFERRAL FORMMental Health, Substance Use & Violence Prevention Services Effective September 28, 2020DIVERSEcity Office Use Only Referral Received Date: Screening Completion Date:Assigned By:

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How to fill out substance screening and referral

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Obtain the necessary forms for substance screening and referral.

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Provide accurate personal information on the forms.

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Complete the questionnaire honestly and thoroughly.

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Follow any specific instructions provided by the screening facility.

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Submit the forms to the appropriate personnel for review.

Who needs substance screening and referral?

01

Individuals who have a history of substance abuse

02

Individuals who display symptoms of substance addiction

03

Individuals who have been referred by medical professionals

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What is substance screening and referral?

Substance screening and referral is a process used to assess an individual's substance use and determine the need for treatment or support services.

Who is required to file substance screening and referral?

Individuals or entities that are mandated by law, such as healthcare providers or organizations involved in substance use treatment, are required to file substance screening and referral.

How to fill out substance screening and referral?

To fill out substance screening and referral, individuals need to provide specific details about the individual's substance use history, complete the required forms accurately, and submit them to the designated authority.

What is the purpose of substance screening and referral?

The purpose of substance screening and referral is to identify individuals who may be struggling with substance use issues and connect them with appropriate treatment or support services.

What information must be reported on substance screening and referral?

The information that must be reported includes demographic data, substance use history, assessment results, and recommendations for further evaluation or treatment.

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