Referral Program forms to print and use:  You will need Adobe Acrobat to open these files. If you do not have Acrobat and would like to download it now, click here to go to Adobe's site to download & install it.  If you DO have Adobe and you click on the file and it won't open, your Internet Explorer settings are probably the problem.  You can right click on the link above, then select "Save target as", and save it on your hard drive, then open Adobe Acrobat from your program files, then browse to the file where you saved it and open it within the program. 

Referral Program:   Format for all forms is Adobe Acrobat 4.0 (.pdf)
  1. Patient Consent Form
     
  2. Intake Form (Page 1) (revised 10/03/2003)
     
  3. Intake Page 2: Medical History (revised 10/03/2003)
     
  4. Intake Page 3: Medications record (revised 10/03/2003)
     
  5. Intake Page 4: Health Maintenance Screenings (revised 3/15/04)
     
  6. Intake Page 5: Patient Acuity Rating Form
     
  7. Intake Page 6: Zung Depression Screening tool
     
  8. Adherence Monitoring Tool (New, May, 2004)
     
  9. Referral Network Intake Checklist
     
  10. bd14568_.gif (91 bytes)   Adherence Monitoring Tool (1)
    bd14568_.gif (91 bytes)   Adherence Monitoring Tool (2)  

Document Format Definitions

.html  web page (HyperText Markup Language)
.doc Microsoft Word
.rtf Rich Text
.zip  Zipped (compressed) file. Unzip with Winzip utility
.jpg JPeg image format.  Can open with Internet Explorer or imaging software
.gif Gif image format.  Can open with Internet Explorer or imaging software.
.pdf Adobe Acrobat document.  Open with Adobe Reader, free for downloading.
Some 4.0 docs do not open with the 3.0 Reader.  If you get a blank screenwhen opening a pdf document, you need to download latest Reader.
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