• Screening Packet

    Screening Packet

  • Please carefully answer the following questions and provide the required documentation.

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    Pick a Date
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    Pick a Date
  • Visit StAR Council's Other Resources page for information on appling for Medicaid. 

  • Case Management Form

  • Please answer the following questions to help your counselor provide beneficial referrals at your intake.

  • Section A:

  • Section B

    If you have no dependent children, skip to Section C.
  • Section C:

    In an effort to provide continuity of care and to not provide unnecessary referrals to you, please provide the following information, if applicable.
  • *Please note, this does not authorize us to contact these providers or release information to them.

    If you would like for us to contact them, please let your counselor know and a consent can be completed.*

  • Screening Instrument for Infectious Diseases

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  • Visit STAR Council's Other Resources page for information testing locations and free services related to the above topics. 

  • Should be Empty: