№ lp_1_2_45003
File format: docx
Character count: 5084
File size: 34 KB
This form is used by case managers to refer clients for eligibility review for services under the Residential Support Waiver (RSW) and Expanded Behavior Supports (EBS) programs, aimed at individuals requiring specific behavioral health and residential care services.
Year:
2026
Region / City:
Not specified
Topic:
Healthcare Services, Behavioral Health, Medicaid
Document Type:
Referral Form
Organization / Institution:
Aging and Long-Term Support Administration (ALTSA)
Author:
Not specified
Target Audience:
Case Managers, Healthcare Providers, Medicaid Professionals
Period of Validity:
Not specified
Approval Date:
Not specified
Date of Amendments:
Not specified
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Year:
Not specified
Region / City:
Not specified
Topic:
Eligibility determination for Residential Support Waiver and Expanded Behavior Supports
Document Type:
Form
Organization:
Aging and Long-Term Support Administration
Author:
Not specified
Target Audience:
Case managers, regional Residential Support Waiver Committees
Period of Validity:
Not specified
Approval Date:
Not specified
Amendment Date:
Not specified
Year:
2020
Region / City:
Noida, Uttar Pradesh
Subject:
Payroll Processing
Document Type:
Business Process Manual
Organization / Institution:
Indian Ports Association (IPA)
Author:
Senthil
Target Audience:
Payroll Executives, Payroll Managers, Payroll Administrators, Staff maintaining payroll master data
Period of Effectiveness:
Not specified
Approval Date:
Not specified
Date of Changes:
Not specified
Year:
2016
Region / City:
Washington
Topic:
Residential Support Services
Document Type:
Policy & Procedure Bulletin
Organization:
Department of Social and Health Services
Author:
Bea Rector
Target Audience:
Home and Community Services Division Regional Administrators, Residential Care Services Division Regional Administrators, Area Agency on Aging Directors
Period of Validity:
N/A
Approval Date:
November 7, 2016
Date of Changes:
N/A
Year:
Not specified
Region / City:
Not specified
Topic:
Eligibility determination for Residential Support Waiver and Expanded Behavior Supports
Document Type:
Form
Organization:
Aging and Long-Term Support Administration
Author:
Not specified
Target Audience:
Case managers, regional Residential Support Waiver Committees
Period of Validity:
Not specified
Approval Date:
Not specified
Amendment Date:
Not specified
Year:
Not specified
Region / City:
Thompson, Manitoba
Topic:
Employment, Social Services, Mental Health
Document Type:
Job Posting
Organization:
Keewatin Tribal Council (KTC)
Author:
Not specified
Target Audience:
Individuals with relevant qualifications in social services, First Nations community members
Period of Action:
Not specified
Approval Date:
Not specified
Amendment Date:
Not specified
Year:
2023
Region / City:
Penn Yan, NY
Topic:
Mental Health Services, Housing Assistance
Document Type:
Referral Form
Organization:
Yates County Adult SPOA
Author:
Yates County Mental Health Services
Target Audience:
Health and social service providers, individuals with mental health concerns
Effective Period:
Ongoing
Approval Date:
Not specified
Date of Changes:
Not specified
Contextual Description:
A referral form for supportive housing, ACT services, and non-Medicaid care management for individuals with mental health diagnoses in Yates County.
Year:
2023
Region / City:
North Central London
Topic:
Healthcare Referral Form
Document Type:
Referral Form
Organization / Institution:
North Central London
Author:
N/A
Target Audience:
Healthcare professionals
Period of Validity:
N/A
Approval Date:
N/A
Amendment Date:
N/A
Year:
2020
Region / City:
United States
Theme:
Emergency Housing Assistance, COVID-19 Response
Document Type:
Referral Form
Author:
SSVF
Target Audience:
Veterans, SSVF Grantees, Community Stakeholders
Action Period:
During COVID-19 Pandemic
Approval Date:
N/A
Date of Changes:
N/A
Context:
A referral form used for Emergency Housing Assistance under the SSVF program during the COVID-19 crisis, outlining eligibility and procedures for providing temporary housing to at-risk Veterans.
Year:
20XX
Region / City:
Illinois
Topic:
Affordable Housing
Document Type:
Agreement
Organization / Institution:
Illinois Housing Development Authority
Author:
Not specified
Target Audience:
Property Managers, Housing Authorities, Service Providers
Effective Period:
Not specified
Approval Date:
Not specified
Amendment Date:
Not specified
Year:
2024
Region / City:
Gwent, Wales
Theme:
Child Safeguarding
Document Type:
Referral Form
Institution / Organization:
Various Local Authorities in Wales
Author:
Not specified
Target Audience:
Professionals involved in child safeguarding
Period of validity:
Not specified
Approval Date:
Not specified
Date of Amendments:
Not specified
Year:
2023
Region / City:
Perth, Australia
Topic:
Psychosocial support, Mental health recovery, Social services
Document type:
Referral form
Organization:
Richmind WA
Target Audience:
Individuals experiencing mental health challenges
Period of validity:
6 to 12 months
Date of approval:
Not specified
Date of amendments:
Not specified
Year:
2023
Region / City:
Inner Eastern Melbourne, Outer Eastern Melbourne, Southern Melbourne, Inner Gippsland, Outer Gippsland
Subject:
Early childhood support, National Disability Insurance Scheme
Document type:
Referral form
Organization / Institution:
National Disability Insurance Scheme (NDIS)
Author:
National Disability Insurance Scheme (NDIS)
Target audience:
Families and carers of children with developmental concerns or disabilities under 9 years old
Period of validity:
Not specified
Approval date:
Not specified
Date of changes:
Not specified
Year:
2025
Region / City:
Wisconsin
Subject:
Referral Process for Nursing Home Residents Regarding Return to the Community
Document Type:
Instructional Form
Agency:
Department of Health Services (DHS)
Author:
Division of Quality of Assurance
Target Audience:
Skilled Nursing Facility (SNF) Staff
Period of Validity:
Not Specified
Approval Date:
Not Specified
Modification Date:
Not Specified
Year:
Not specified
Region / City:
Devon, England
Theme:
Adult ADHD Assessment and Treatment
Document Type:
Referral Form
Organization / Institution:
Harrow Health CIC
Author:
Not specified
Target Audience:
Healthcare professionals, GPs
Period of Validity:
Not specified
Approval Date:
Not specified
Amendment Date:
Not specified
Year:
2026
Region / City:
United Kingdom
Topic:
Paediatric fatigue assessment and referral
Document Type:
Referral Form
Organization / Institution:
NHS
Author:
Not specified
Target Audience:
Healthcare professionals
Period of Validity:
Indefinite
Approval Date:
Not specified
Date of Changes:
Not specified
Year:
2025
Date:
7 April 2025
Region / City:
Swindon and Wiltshire, Gloucestershire
Country:
United Kingdom
Healthcare System:
NHS
Clinical Area:
Diabetes foot care
Topic:
Diabetic foot ulcer referral pathways
Document Type:
Clinical referral guidance and referral form
Issuing Organizations:
Gloucestershire Hospitals NHS Foundation Trust; Wiltshire Community Podiatry; Swindon Community Podiatry
Target Audience:
General practitioners, community podiatrists, healthcare professionals
Referral Pathways:
Same Day Emergency Care (SDEC); Foot Attack Clinic; Community Podiatry; Vascular Surgery
Urgency Categories:
Urgent referrals; Routine referrals
Associated Services:
Diabetes Foot MDT; Community Diabetes Teams
Clinical Conditions Covered:
Diabetic foot ulceration; infection; ischaemia; Charcot foot; neuropathy
Required Clinical Information:
Patient demographics; diabetes history; comorbidities; ulcer characteristics; investigations; treatments
Investigations Referenced:
Blood tests; wound swab; tissue sample; X-ray; ultrasound
Contact Methods:
Email referrals; ERS submissions; telephone
Period of Applicability:
Ongoing as of April 2025
Year:
2026
Region / City:
Oxford, UK
Document Type:
Referral Form
Institution:
Oxford University Hospitals NHS Foundation Trust
Intended Audience:
General Practitioners, Hospital Consultants
Clinical Focus:
Bone and Joint Infections
Required Attachments:
Imaging, Microbiology Results
Referral Method:
Direct email for hospital referrals, e-referral service for GPs
Patient Eligibility:
UK residents
Year:
2024
Region / City:
Minnesota
Subject:
Child Care, Training Delivery
Document Type:
RFP (Request for Proposals)
Organ / Institution:
DCYF (Department of Children, Youth, and Families)
Author:
Not specified
Target Audience:
Organizations or agencies applying to provide child care training services
Period of Action:
FY26/FY27
Approval Date:
Not specified
Modification Date:
Not specified
Year:
2024
Region / City:
Denbighshire
Theme:
Housing Support
Document Type:
Referral Form
Organization / Institution:
Denbighshire County Council
Author:
Denbighshire County Council
Target Audience:
Social Services, Health, Local Authority Homeless Team, Police, Probation, YOT, Housing Associations, Hostels, and other related services
Effective Period:
From April 1st, 2024
Approval Date:
January 2024
Date of Changes:
N/A