Get Referral For Services - Columbus County Government

This guide provides clear instructions on how to complete the REFERRAL FOR SERVICES form for Columbus County Government. Whether you are assisting someone in need or referring them for services, this comprehensive guide is designed to support you throughout the process.

Follow the steps to effectively complete the form.

1. Click ‘Get Form’ button to obtain the form and open it in your preferred document editor.
2. Begin filling out the form by entering the date and the name of the staff person who will be processing the referral.
3. In the 'Referred By' section, provide the name of the individual making the referral.
4. Fill in the personal details of the individual being referred, including their name, gender, race, telephone number, Social Security number, and Medicaid number.
5. Enter the verification details, including the name of the person verifying the information and the date of birth of the individual being referred.
6. Indicate the Medicaid eligibility dates relevant to the individual.
7. Provide the name and telephone number of the individual's physician, along with the address.
8. Specify the client’s living arrangements in the designated section.
9. Enter the caregiver's details, including their relation to the individual, address, and telephone number.
10. Document the primary diagnosis of the individual being referred.
11. Fill out the communication section, indicating any speech, vision, or hearing limitations as applicable.
12. Indicate the activities permitted for the client, selecting from options such as complete bed client, cane, wheelchair, partial bed rest, crutches, up as tolerated, or walker.
13. Provide any additional comments that may assist in the evaluation of the referral.
14. Fill in details regarding any agency service involvement, including home health agency, in-home services, hospice, or Meals on Wheels.
15. Once all fields are completed, save your changes and choose to download, print, or share the completed form.

Complete the REFERRAL FOR SERVICES form online today to ensure timely assistance.