Exhibit_D_-_Mainstream_Service_Referral_Log.xlsx

61 KB Posted

Attached to
Master Agreement AZ|CTR066286
Contract number
CTR066286
Issued by
Arizona

About this file

Written by GovTribe AI ·

The document is an Exhibit D Mainstream Service Referral Log from the Arizona Department of Economic Security, spanning monthly tracking periods from July 2023 through June 2024. It appears to be a standardized template for documenting service referrals, with consistent column headers including Agency Name, Program, Type of Service, HMIS Number, Name of Agency, Date Referred, Comments/Follow-Up, and Other sections.

While the specific log entries are blank, the document provides a structured monthly tracking mechanism for recording mainstream service referrals across different agencies and programs. The template suggests a systematic approach to tracking and monitoring service referral activities, with designated spaces for detailed documentation of each referral's progress and outcomes. The document covers a full annual cycle, indicating an ongoing administrative process for tracking social service referrals within the Arizona Department of Economic Security's operational framework.

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July 2023 Exhibit D Arizona Department of Economic Security Mainstream Service Referral Log

Agency Name:
Program:
Type of ServiceHMIS Number:Name of AgencyDate ReferredComments/Follow-UpOther

August 2023 Exhibit D Arizona Department of Economic Security Mainstream Service Referral Log

Agency Name:
Program:
Type of ServiceHMIS Number:Name of AgencyDate ReferredComments/Follow-UpOther

Sptember 2023 Exhibit D Arizona Department of Economic Security Mainstream Service Referral Log

Agency Name:
Program:
Type of ServiceHMIS Number:Name of AgencyDate ReferredComments/Follow-UpOther

October 2023 Exhibit D Arizona Department of Economic Security Mainstream Service Referral Log

Agency Name:
Program:
Type of ServiceHMIS Number:Name of AgencyDate ReferredComments/Follow-UpOther

November 2023 Exhibit D Arizona Department of Economic Security Mainstream Service Referral Log

Agency Name:
Program:
Type of ServiceHMIS Number:Name of AgencyDate ReferredComments/Follow-UpOther

December 2023 Exhibit D Arizona Department of Economic Security Mainstream Service Referral Log

Agency Name:
Program:
Type of ServiceHMIS Number:Name of AgencyDate ReferredComments/Follow-UpOther

January 2024 Exhibit D Arizona Department of Economic Security Mainstream Service Referral Log

Agency Name:
Program:
Type of ServiceHMIS Number:Name of AgencyDate ReferredComments/Follow-UpOther

February 2024 Exhibit D Arizona Department of Economic Security Mainstream Service Referral Log

Agency Name:
Program:
Type of ServiceHMIS Number:Name of AgencyDate ReferredComments/Follow-UpOther

March 2024 Exhibit D Arizona Department of Economic Security Mainstream Service Referral Log

Agency Name:
Program:
Type of ServiceHMIS Number:Name of AgencyDate ReferredComments/Follow-UpOther

April 2024 Exhibit D Arizona Department of Economic Security Mainstream Service Referral Log

Agency Name:
Program:
Type of ServiceHMIS Number:Name of AgencyDate ReferredComments/Follow-UpOther

May 2024 Exhibit D Arizona Department of Economic Security Mainstream Service Referral Log

Agency Name:
Program:
Type of ServiceHMIS Number:Name of AgencyDate ReferredComments/Follow-UpOther

June 2024 Exhibit D Arizona Department of Economic Security Mainstream Service Referral Log

Agency Name:
Program:
Type of ServiceHMIS Number:Name of AgencyDate ReferredComments/Follow-UpOther

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