Children Services Special Population Access Screening


Purpose: For Children Providers to submit Consumer Enrollment Packet to DWIHN Access Center for special population services.

 
 
 
Phone
 
 
 

Does your agency plan to complete the Screening Date the same day as the Intake Assessment Date?


If yes, email DWIHN Access Department representatives Tracy Mancini/tmancini@dwihn.org and Anthony Edwards/aedwards@dwihn.org requesting to provide MHWIN ID# the same day.

 
 
mm/dd/yyyy
 

Is this a COFR (County of Financial Responsibility) Case?

 

Provide explanation.

 

Select which children special population is applicable (can select more than one).

 
 
Drop your files here