Get Lahsa/dhs/dmh Referral Form For

The LAHSA/DHS/DMH Referral Form is a crucial document for connecting individuals with housing services. This guide provides step-by-step instructions to assist users in filling out the form effectively online.

Follow the steps to complete the referral form accurately.

1. Use the ‘Get Form’ button to access the LAHSA/DHS/DMH Referral Form online and open it in your document editor.
2. Begin by filling in the client's name and date of birth at the top of the form. Ensure that you include accurate information for proper identification.
3. In the 'Referring Program Unit/Type' section, provide the date of referral and select the appropriate name of the referring agency or program.
4. Enter the referring staff's contact information including name, title, phone number, and email address. If applicable, include alternate contact information.
5. For the 'Referring Facility' section, choose the option that best describes your agency or program. If unsure, consult with a supervisor.
6. Complete the 'Referring Client Information' section by providing the required details about the client, including their primary language and contact number.
7. Check any mobility limitations and additional assistance required by the client. Be sure to fill this out for all household members.
8. If the client has assistance animals, complete the respective section with the type and number of animals. This is crucial for housing placement considerations.
9. For households with children, fill out the information regarding the number of minors, adults, and any additional dependents.
10. Indicate the client's current living situation based on HUD categories, ensuring to provide the most accurate description.
11. Fill out the medical information accurately and note any urgent issues that may affect the client's housing placement.
12. Complete the tuberculosis screening questions carefully. If any concerns arise from the responses, indicate the need for further health evaluation.
13. Finally, review the submission instructions specific to the client’s presenting issue and note the correct contact information for submitting the form.
14. After completing the form, save your changes. You can download, print, or share the form as needed.

Complete the LAHSA/DHS/DMH Referral Form online today to assist individuals in need of housing services.