Blank Referral Forms

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					Draft protocols for receiving referrals in the SLRC from hospital d/c planners

Anyone answering the phone will have blank referral forms handy to fill in if the
discharge planner is calling in the referral. The fax will be regularly checked as

Incoming referrals will be passed on immediately to the LTS counselor.
She will document the referral in the contact database and attempt to contact the
individual referred after three and within seven days of receipt of the referral.

She will call the person and, depending on what is worked out with the facility
social work staff, may also call the social work staff to say contact has been
initiated. (Protocols for how to work with the SW staff will be worked out when
SLRC directors and the planning team members meet with the SW staff at each
facility in each pilot county). On the phone with the patient, the LTS counselor
will determine whether a face-to-face visit is warranted/desired. If so, one will be
planned. The LTS counselor will be sure in the initial call to identify herself and
explain why she is calling and reference the discharge packet and hospital staff
who made the referral. Then the LTS counselor will present the ways in which
they may be able to assist the patient, including coming to meet with the patient to
provide information about community-based long-term supports and discuss


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