Get Inter-agency Referral Form Protection Cluster August 2017.doc

The Inter-Agency Referral Form is a crucial document for facilitating assistance to individuals affected by conflict. This guide provides step-by-step instructions to help you fill out this form online efficiently and accurately.

Follow the steps to complete the form online:

1. Click the 'Get Form' button to access the document and open it in your preferred online editor.
2. Begin with the priority section, selecting the appropriate urgency level: Emergency (within 24 hours), Urgent (within 72 hours), or Normal (within 2 weeks).
3. Complete the Bio-Data/General Information section. Fill in the name or case code (if applicable), date of birth, gender, disability status (if applicable), national ID, UNHCR ID (if refugee), address details, phone number, and household size.
4. If the client is a minor, provide details of the primary caregiver, their relationship to the child, and their contact information. Ensure to confirm whether the caregiver is informed of the referral and if the child is separated or unaccompanied.
5. In the Special Note/Specific Need section, include any additional information pertinent to the individual's circumstances.
6. Outline the Reasons for Referral, providing a detailed explanation and supporting notes if available. You may use additional pages if necessary.
7. Indicate the Services Requested by checking all applicable options, such as psychosocial support, medical assistance, shelter, legal aid, etc. Provide explanatory details for any requested services already provided.
8. In the Consent to Release Information section, have the concerned individual sign, acknowledging their understanding of the referral's purpose. Ensure they are aware of the information being disclosed.
9. Complete the Referred By and Referred To sections by filling in contacts, positions, agencies, and dates of referral. Specify any contact or referral restrictions if applicable.
10. Lastly, after reviewing all the information for accuracy, save changes, download, print, or share the form as necessary.

Complete your documents online today to streamline the referral process.