6800 APPENDIX 4 RefToPurchOffenderSrvces (DOC-1336).pdf

This is a referral form for offender services issued by the Wisconsin Department of Corrections, Division of Community Corrections (DOC 1336, Rev. 10/17). The document serves as a standardized intake form for processing referrals to purchase offender services, with distribution designated as "Original - DOC Offender Case File."

The form facilitates referrals for various offender rehabilitation and support services including residential and non-residential programs. It captures comprehensive offender information including demographics, case details, and assessment data such as COMPAS risk level recommendations (Low, Medium, Medium with override consideration, High) and COMPAS Trailer Tools including Static 99 and URICA assessments. The form includes sections for identifying specific barriers and responsivity factors such as health problems, learning disabilities, physical disabilities, transportation issues, and residential instability. Key dates tracked include discharge date, referral date, and projected eligibility date, with options to specify reasons for referral including Alternative to Revocation (ATR), EBRV Recommended, or Identified Need.