More Info

Intake and Referral Form: Ohio ADRC

02/04/2008 | Requests *

Summary

What questions should be asked when someone first contacts and ADRC? Ohio’s Aging and Disability Resource Network has provided this example of their Intake and Referral Form. Questions address contact information, income, employement, disability, insurance, benefits, and living arrangements. There is also space for referent information.

Author

Available Files

Form Word (30K, 3 pages)
Form PDF (64K, 3 pages)
Website Off-site link

Keywords

Information and Referral; Aging and Disability Resource Center

Topic

Aging Issues, Developmental/Psychiatric Disabilities, Resource Center, State/Agency Information

Type/Tool

Assessments, Links / Websites

Source

Grantee produced, Ohio

State

Ohio, All States/Territories

Date Created

02/13/2008

Contact

Aging and Disability Resource Network Ohio Department of Aging
50 W. Broad St., 9th Floor
Columbus, OH 43215
614-466-6191

Short URL

www.hcbs.org/moreInfo.php/doc/2164

Permission to use any element of this document should be obtained by the above named contact person. Always name the originator as the source of this material.

* Reflects requests since January 1, 2007

HCBS / Clearinghouse for the Community Living Exchange Collaborative / (http://www.hcbs.org)