Referral Form - Shawn Mcgill Msw Consulting Page 2

Shawn McGill MSW Consulting Inc.

448 Butler St.

Pittsburgh, PA 15223

Phone: 412-781-3829; Fax: 412-774-2240

Email:

; website:

DOB:

MA #

Is There a Legal Guardian?

Guardian’s Name & Contact Info:

YES

Actions Needed Prior to Service Start:

Notes/Additional Information:

Please note the following: once referrals are received by the Program Manager, careful review is

completed to determine whether or not the service can be fulfilled. Communication with the referring

party will occur to indicate the status of the referral. Within 3-5 business days our team will identify

whether or not we are able to accept the referral based on staffing availability. Services should not be

authorized until we have communicated whether or not we have accepted the referral. If referral

acceptance is communicated, our services will begin once the service authorization and/or service

contract is received.

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Parent category: Medical