ARMHS referrals | WeCare

Menu

Home
About Us
What we offer
Referrals
Careers
Contact Us

Phone : 320-281-4449
Fax : 320-281-4819

Phone : 320-281-4449
Fax : 320-281-4819

Menu

Home
About Us
What we offer
Referrals
Careers
Contact Us

Menu

Home
About Us
What we offer
Referrals
Careers
Contact Us

Phone : 320-281-4449
Fax : 320-281-4819

Adult Day Service referrals

ARMHS service referrals

Housing Stabilization referrals

PCA referrals

Statement of Non-discrimination

ARMHS Referrals

This section is intended for medical and mental health providers. If you are looking for information for you or a family member, please call our office at 320-281-4449.

If you are a provider looking for more information on how to refer clients to our programs you will find information about referrals for each of our programs on the following pages:

Who is eligible?

Patients ages 18 or older
Patients who have received a recent diagnostic assessment by a qualifed mental health professional that indicates ARMHS services are medically necessary
Patients who have substantial disability and functional impairment in three or more areas, thus markedly reducing self-sufficiency
Patients who have the cognitive capacity to engage in and benefit from rehabilitative services techniques and methods
Patients who have Medical Assistance or a Prepaid Medical Assistance Product

Referrals forms

Consent for Release of Information

Medical History Form

Language

English (US)

WeCare Referral

ARMHS/Outpatient Therapy
Patient name*

First NameLast Name
Patient's Address*

House name/no & street

CityState

Postcode
Patient's Mobile Phone*
Patient's Email address
example@example.com
Patient DOB*

MonthDayYear
Ethnicity
Disability*

YesNo
Gender Identification

MaleFemale
MA#*
Medicare

YesNo
Primary Diagnosis*
Recent History(Check all that apply over the past 12 months)

Self Injurious behaviorAggressiveee/Violent behavioursMedication non-complianceDrug/Alcohol abuseHigh medical needsOther
Services Interested in

ARMHSOutpatient/Individual TherapyOther
Does this individual have a DA dated within the last 12 months?*

YesNo
Documents to Upload eg Completed DA,FA or ITP*

Cancelof
Insurance Type*

Blue CrossUcareMedicaHealth PartnersPrimeWestOther
Referrer's information
Referrer's Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email
example@example.com
Case Manager

First NameLast Name
CM Phone Number
Please enter a valid phone number.
CM Email
example@example.com
Data protection*

Client understands and accepts that their information will be kept securely until it is no longer required to assist them or by law. Permission is granted to WeCare to contact the client by their identified preferred contact method.
Should be Empty:

WeCare Main Office

136 Division St
Waite Park, Minnesota 56387
USA

320-281-4449

WeCare Housing Stabilization Services

110 2nd Street South, Unit 138
Waite Park, Minnesota 56387
USA

320-281-4454

Hours

Monday – Friday

8am – 4:30 pm

Main Office: 136 Division Street, Waite Park, MN 56387 | info@wecaregroupmn.com | Phone (320)-281-4449 | Fax (320)-281-4819

©2018 – 2023 by WeCare. All rights reserved