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LTSR CRITERIA CHECKLIST Consumers Name: ___ Date: ___ Person Completing Referral: ___ Agency: ___ Phone: ___ Ext. ___ Email: ___18 years or olderPsychiatric DiagnosisPsychiatric Evaluation Attached
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The DBHIDS SOAR Referral Form is a document used to initiate the process for individuals seeking services through the Department of Behavioral Health and Intellectual disAbility Services (DBHIDS).
Individuals in need of behavioral health or intellectual disability services, as well as their advocates or service providers, are required to file the DBHIDS SOAR Referral Form.
To fill out the DBHIDS SOAR Referral Form, provide accurate personal information, details regarding the individual's needs, and any relevant medical or service history as requested in the form.
The purpose of the DBHIDS SOAR Referral Form is to streamline the referral process for individuals seeking access to behavioral health and supportive services, ensuring they receive the necessary assistance promptly.
The information that must be reported includes the individual's personal details, contact information, service needs, and any relevant background information that supports their referral.
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