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Documents: Department of Homeless Services

HS-14 (E) HCF-DHS REFERRAL FORM - Screening Tool for Referral from Health Care Facilities: SINGLE ADULT

This HCF-DHS Referral Form must be completed for each patient who is admitted to a healthcare facility (HCF) or a long-term care facility (LTCF) and is being referred to the DHS Single Adult Shelter or Street System. Completion of this form for each patient will help Department of Homeless Services (DHS) to determine if:
(1)The patient is medically appropriate to reside in a single adult DHS shelter or Safe Haven facility; and
(2)All efforts have been made first to discharge the patient to a non-shelter setting.



Created: 7/3/2018