Oakland Community Health Network Veteran Navigator Referrals

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Reason for referral

Individual's Demographic Information

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If homeless, please put N/A

If homeless, please specify what city they are primarily staying in at this time.

If homeless, please specify the zip code for the city they are primarily staying in at this time.

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If none, please enter 0

Military Involvement

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If so, please list below.

Insurance Information

What type of insurance does the individual have?

ROI, DD-214, and other supporting documents

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