How to apply for a DHS referral form?

How to apply for a DHS referral form?

This is a PDF fillable form and must be electronically completed and submited. Forms that have been handwriten and/or faxed will not be accepted. To use this form: 1- Call the DHS Referral Line at 212-361-5590 to determine if the pa�ent is a new or current DHS client. a.

Is the paent new to the DHS system?

If the pa�ent is new to the DHS System or has not been in shelter in the past 12 months, go to Sec�on 2. 1.3 Is patient new to Single Adult Shelter System or have they not been in a single adult shelter within the past 12 months?

When to refer a patient to a DHS shelter?

If the patient has one or more of the health conditions, limitations of independent activities, or functional needs listed below, they are medical ly inappropriate for DHS single adult shelter or Safe Haven • Inability to care for self and independently manage ac�vi�es of daily living; use the ADL Assessment Form included on the Referral Form.

What do you need to know about the DHS discharge form?

Completion of this form for each patient will help Department of Homeless Services (DHS) to determine if: (1) The patient is medically appropriate to reside in a single adult DHS shelter or Safe Haven facility; and (2) All efforts have been made first to discharge the patient to a non -shelter setting.

How to submit a referral to triangle Veterinary Referral Hospital?

You can download a printable copy of our referral and transfer forms and fax the completed forms to us at 919-213-6664 or you can submit your referral or transfer using the online submission forms below.

Who are the writers of the TV show Eh?

Also on board as executive producer is original series producer and actor, Mitch Markowitz. Writers on the series include Diana Moore, Nisha Khan, Jan Caruana and Kara Harun. Original Art Design by Aaron Hong and Animation Services by Keyframe Digital Studios in St. Catharines, Ontario.