The type of information that will be requested for the completion of referral paperwork includes:
- Name, address, phone number and relationship of person or agency making the referral
- Client demographic information, including client name, address, phone number, marital status, date of birth, social security number, sex and race
- Nature of the problem for which the individual is being referred
- Source of income and availability of insurance
- Names (and phone numbers if available) of current service providers
- Name, address and phone number of a family member or friened who is a contact person for the client
- Level of education and current or previous vocational history
- Current living arrangements
- TBI information, including date and type of injury, length of loss of consciousness (if known), and the problems the individual is experiencing as the result of the brain injury
- Current medications
- Substance abuse information, including drugs of choice and any previous substance abuse treatment
- Current legal status
- Information from referrals is reviewed by the agency admission committee. Both the client and the referral source are advised in writing of the client's eligibility determination. If additional information is required prior to admission decision, the potential client or referral source will be contacted by phone (or in writing if a phone number is not available) as to the additional information necessary prior to determination of eligibility for services.
- Upon determination of eligibility, the client will be assigned to a case manager or, if all caseloads are full, to the agency waiting list. Upon assignment for services, the client will be scheduled to come into the agency for an intake appointment with his/her case manager.