HIPAA & Consent Acknowledgment

By submitting this referral, the referring party confirms they have obtained appropriate consent to share the above information for the purpose of assessment, care coordination, and service eligibility determination in compliance with the Health Insurance Portability and Accountability Act (HIPAA).

Crisis & Safety Notice 

If the client is experiencing an emergency or is at immediate risk of harm: 

• Call 911 or go to the nearest emergency department 

• Call or text 988 – Suicide & Crisis Lifeline (available 24/7) 

Submission of this referral does not replace emergency services and does not guarantee 

immediate scheduling.