Guidelines for Referral Submission

Cenpatico Guidelines for Referral Submission
Integrated Healthcare Recovery Support Specialist Institute (IHRSSI)

These requirements must be completed before person accepted into the Institute

1.   Specialty Provider Referral Checklist (Check Rehab/Support boxes)
2.   Application (Enter Current Training Site and Date from Flyer)
3.   Release of Information (ROI) for the University of Arizona, Workforce Development Program signed and dated by the member.
4.   Most Current Assessment with diagnosis (last 12 months), signed and dated by BHP. (Please use ICD-10 coding)
5.   Service Plan with the following:

  • Need - Employment
  • Objective - Learn to cope with stressors of my diagnosis, along with social, communication and workplace skills necessary to gain and maintain employment
  • Service - Attend University of Arizona (UA), Workforce Development Program (WDP) Institute for Rehabilitation Services (skills H2014-HQ) and Support Services (peer H0038-HQ)
  • Frequency - 1 to 10 days
  • Signed by BHP and member

6.   Complete Demographic (Most Current a requirement by Cenpatico)
7.   For an ART meeting please call Beverly McGuffin 520-203-1320 to schedule.

Once completed, please scan and submit to fcm-wdp@email.arizona.edu
Please use [secure] mail. Call 520-621-1642 with any questions.