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What is an inter-agency referral? A referral is the process of directing a client to another service provider because s/he requires help that is beyond the expertise or scope of work of the current service provider.
The referral form and guide can be used by any service provider for example, by a Doctor working in a primary healthcare centre referring a child to a child friendly space or a nutrition feeding programme, or a Case Manager referring a client for physical rehabilitation.
I, (client name), understand that the purpose of the referral and of disclosing this information to (receiving agency) is to ensure the safety and continuity of care among service providers seeking to serve the client.
Yes No (If yes, explain below) Referral delivered via: Phone (emergency only) E-mail Electronically (e.g., App or database) In Person Follow-up expected via: Phone E-mail In Person. By date (DD/MM/YY): Information agencies agree to exchange in follow up: Name and signature of recipient: Date received (DD/MM/YY):
When a program participant is in need of support that your organization may not be able to provide, please follow the inter-agency referral protocol below:
This process requires a commitment by organizations to co-create a community of regard. By engaging inthis process we are creating bridges between organizations, people and places. We do not stop serving our community simply because they are not perceived as a good fit for our organizations.