Appendix 4 DOC-1336 RefToPurchOffenderSrvces.pdf

This document is a referral form for offender services issued by the Wisconsin Department of Corrections, Division of Community Corrections (DOC 1436 Rev. 10/17). The form is designed to facilitate referrals to purchase offender services and is distributed to the original DOC Offender Case File. The document serves as an intake and referral mechanism for connecting offenders with appropriate service providers within Wisconsin's correctional system.

The form captures comprehensive information for service placement including offender demographics, agent contact details, discharge and referral dates, and projected eligibility dates. It allows for selection of residential or non-residential program types by region and city, with provider information populated based on these selections. The form includes COMPAS risk level recommendations (Low, Medium, Medium with override consideration, High) and assessment tools including Static 99 and URICA scores. Service categories encompass various responsivity factors such as health problems, learning disabilities, physical disabilities, reading/writing assistance, transportation issues, employment conflicts, and residential instability. The form also tracks medication status, mental health concerns, and previous service participation history to ensure appropriate service matching and continuity of care.