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For Inpatient Hospital CSU Detox or Partial Hospitalization- IOP use only Regional Assessment and Referral Form RARF REFERRAL INFORMATION Staff Taking Referral Referral Agency Phone Number Outpatient Psychiatrist Follow up appointment scheduled Yes No If yes where and when and telephone number Date Time Referral Source s Name Fax Number Outpatient Provider Voluntary Was involuntary paperwork sent to this facility Yes Involuntary HISTORY AND DEMOG.

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