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Advantages
Application for Services
Referral Information Needed:
Consumers Name
Application for Services
Social History
Guardianship Information
Criminal History
Funding/Tier Level
SSI + Payee Information "if applicable"
Critical Incident Reports
Medication List (MARS)
Reason for Discharge/Placement
Signed Release of Information
Placement/Service History
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Please fill out this document and return to Jennifer.roberts@advantagesinlife.com
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