Intake and Referral Form: Ohio ADRC

File Downloads / Links

Article Publication Date: 
2/4/2008
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.
Topics: 
Resource Center
Types/Tools: 
Sources: 
Grantee produced
Ohio
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Contact

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

Short URL: http://www.advancingstates.org/node/51507