Follow the steps to successfully complete the referral process form.

1. Press the ‘Get Form’ button to access the referral form and open it in your editing platform.
2. Complete the referred youth's information section. Make sure to enter the first and last name, date of birth, middle initial, gender, race, primary language, secondary language, and social security number. Additionally, provide the current address, city, county, and contact numbers.
3. Indicate whether the youth is enrolled in a health home by selecting 'Yes' or 'No', and provide the name and state of the health home if applicable.
4. Fill out the parent or guardian information by providing their first and last names, relationship to the youth, and contact information, including languages spoken.
5. In the referral source information section, fill in the referral source name, agency, title, contact information, and address.
6. Select the type of referral from the available options and provide necessary context regarding related systems such as Child Welfare and Juvenile Justice.
7. Detail the youth's supervision and living situation at the time of referral by selecting applicable options from the provided list.
8. Complete the sections on past and current system involvement of the youth by selecting relevant categories and providing associated agency contact details.
9. Assess targeted system trajectory risks by evaluating and marking the likelihood of potential issues such as aggression, runaway status, substance abuse, or mental health concerns.
10. Fill out the school information section, detailing the current placement type, any attendance issues, and any special education needs.
11. Complete the medical information section, including the diagnosis source, details of any medications, and any relevant psychosocial issues.
12. In the care coordination section, indicate agency preferences if any, and ensure the parent/guardian provides their signature and date.
13. Finally, review the consent form and confirmation statements coded throughout the form.
14. Once you have completed all sections, save your changes and choose to download, print, or share the completed form as necessary.

Start filling out the Family Voices Network referral process form online today to support youth in need.