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									               INTERAGENCY/INTEROFFICE REFERRAL AND FOLLOW-UP
                      FORM 713 INSTRUCTIONS (Rev. 10/2003)



PURPOSE

The Interagency/Interoffice Referral and Follow-Up, Form 713, is used to make client
referrals to other programs that may be able to assist the family.



PREPARATION

The Form 713 is to be completed by the assigned case manager.


                                INSTRUCTIONS FOR USE

The case manager should check the agency or program to whom the referral is being made
and check that the referral if from the Division of Family and Children Services. Include the
name and contact information for the person/agency to whom the referral is being made.

The client’s name, address, city, telephone number, sex, birth date, race and social security
number (if known) or the case number (“other ID #”) are completed on the form. The name
of the case manager making the referral and the person/agency to whom the referral is
being sent must be included. The reason for the referral and any specific information should
be recorded on the form.

The case manager should complete identifying information so that the agency can return the
form to update the case manager on the results of the referral.

Before sending the form to the agency to whom the referral is made, a copy of the referral
form is made for the case record.


FILING

File the copy of the completed 713 in the case record. Route the original form to the agency
to whom the referral is made.

When the 713 is returned from the other agency/program with the action taken described on
the form, this “returned” Form 713 should be filed in the case record. The earlier 713 can be
destroyed.




(Rev. 10/03)                                1                         Instructions F. 713

								
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