Missouri Department of Mental Health

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					                                    Missouri Department of Mental Health
                                                Housing Team

                                      Shelter + Care Referral

TO:           Staff Person @ Processing Center (ph. 123-456-7890)
CC:           Jane Smith, Case Manager

FAX NO.:      123-456-7891

FROM:         Housing Team Member, DMH Housing

DATE:         October 3, 2012

RE:           Shelter + Care Referral for Joe Green

Please issue a Shelter + Care subsidy for client Joe Green. The provider
information is:

Provider:                   Name of Referring Agency
Case Manager:               Applicant’s Case Manager
Case Manager’s Phone:       456-789-1011

The DMH Program is: MO 01C104001 – SCK3

The Processing Center will contact the case manager within 72 hours to set up
an appointment for an initial briefing that the case manager and client must
attend. If anyone has any questions or needs any additional information, please
don’t hesitate to contact me.

Housing Team Member, Housing Development Officer
Missouri Dept. of Mental Health
573-751-9206 Office
573-526-7797 FAX
housing@dmh.mo.gov

[Copy of Shelter Plus Care Application attached]




MODMH Housing Manual Attachment 7                                     August 2006

				
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