Get Referral Form Atr Sober Home Pilot - Ma Atr

Filling out the REFERRAL FORM ATR Sober Home Pilot - MA ATR is an important step for authorized ATR referring providers to assist individuals facing housing instability. This guide provides a detailed, step-by-step approach to completing this form accurately and efficiently.

Follow the steps to complete the referral form online.

1. Press the ‘Get Form’ button to acquire the form and launch it in your preferred editor.
2. Enter the name of the ATR participant in the designated field. Ensure the name is spelled correctly, as it is essential for identification.
3. Fill in the participant's date of birth (DOB) using the format MM/DD/YYYY.
4. Provide the participant's Social Security Number. This is critical for processing their referral.
5. Input the participant's phone number to facilitate communication regarding their referral status.
6. List the name of the participant’s ATR Coordinator, as this person will need to be contacted during the referral process.
7. Select the ATR region where the participant resides by checking the appropriate box: Boston, New Bedford/Fall River, Springfield/Holyoke, or Worcester.
8. Verify and check off that the participant meets the eligibility criteria. Ensure that all descriptions correspond accurately to the individual’s situation.
9. In the area provided, specify how the individual qualifies as having housing instability and readiness for independent living associated with a Sober Home.
10. Complete the Referring Provider Information section by entering your name, email, program name, and phone number.
11. Indicate the duration of time you have been working with the individual, providing clear context for the referral.
12. Once all sections are filled, double-check for accuracy and completeness. Save your changes, then print or download the form.
13. Fax the completed form, along with any required documentation, to the ATR Sober Housing Coordinator at 833.257.6056. You can also reach them via email at datsyaponte@healthrecovery.org.

Complete the REFERRAL FORM ATR Sober Home Pilot - MA ATR online today to assist those in need of housing stability.