Get Resolve Outpatient Referral Form - Colonial Intermediate Unit 20 - Ciu20

This guide provides clear and supportive instructions for users on how to effectively complete the Resolve Outpatient Referral Form for Colonial Intermediate Unit 20 online. By following the outlined steps, you can ensure that all necessary information is accurately submitted.

Follow the steps to fill out the Resolve Outpatient Referral Form online.

1. Press the ‘Get Form’ button to access the Resolve Outpatient Referral Form. This will enable you to open the document in an online format for editing.
2. Begin by entering the client demographic information. Fill in the client's full name, including their last, first, and middle names.
3. Select the client's gender by marking the appropriate box: Female, Male, or Other. Ensure you provide the date of birth in the specified format (mm/dd/yyyy).
4. Indicate the child’s primary language and fill in the school name along with the grade the child is currently in. If applicable, check the box next to the relevant educational plan or service agreement.
5. Complete the guardian's name and address information, including the street address, city, state, and zip code. Include the best contact number for reaching the guardian and the ideal time for contact.
6. In the 'Reason for Referral' section, choose the type of service being requested, such as Individual therapy or Psychiatrist, by marking the respective box.
7. List any specific areas of concern by checking the boxes that apply. You can select multiple concerns as relevant.
8. Provide the name of the person referring the client, along with the district or agency name and their contact telephone number.
9. Review all the information entered for accuracy and completeness. Make any necessary edits before proceeding.
10. Once you have completed the form, you can save your changes, download the document, print it for records, or share it as required.

Complete your documents online today to ensure timely access to necessary services.