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Community Housing Network, Inc.570 Kits Blvd., Suite 231 Troy, MI 48084 Phone (248) 9280111 Fax (248) 9280122 www.communityhousingnetwork.orgMSHDA Region 8 Homeless Initiative Grant PREVENTATIVE FUNDS
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How to fill out preventative funds referral and

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How to fill out preventative funds referral and

01
Obtain a referral form for preventative funds from your healthcare provider or insurance company.
02
Fill out the form with your personal information, including name, address, date of birth, and insurance information.
03
Provide any necessary documentation or medical records to support your request for preventative funds.
04
Submit the completed form and supporting documents to the appropriate agency or organization for review and approval.

Who needs preventative funds referral and?

01
Individuals who are at risk for developing certain health conditions or diseases.
02
Individuals who have a family history of specific medical issues.
03
Individuals who have been recommended by their healthcare provider to undergo preventative screenings or interventions.

What is Preventative Funds Referral and Application Acknowledgement Form?

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Preventative Funds Referral and Application Acknowledgement template instructions

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Preventative funds referral is a process of reporting information regarding funds allocated for prevention purposes.
Organizations or individuals responsible for overseeing or disbursing the preventative funds are required to file the referral.
To fill out the preventative funds referral, one needs to provide detailed information about the funds allocated, purpose of allocation, and any outcomes achieved.
The purpose of preventative funds referral is to track and monitor the usage of funds allocated for prevention activities.
Information such as the amount of funds allocated, purpose of allocation, activities funded, and any results or outcomes achieved must be reported on preventative funds referral.
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