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Submit a Referral

Fill out the form below to submit a referral for services to Pine River Group Home, Inc.

Contact Information

Referral Information

Service(s) desired (check all that apply):
If Community Residential Services was selected, do they meet the residential support criteria as required in the CBSM effective 07/01/25 (as noted on their recent MN Choice Assessment?)
Yes – has updated MN Choice Assessment meeting criteria
Yes – is currently receiving services at a CRS setting
No – does not meet criteria
Does not have a MN Choice Assessment
Does not apply – not looking for CRS services
Unknown
Gender

Case Management

Additional Information

Housemate Preference:
Accessibility Needs (check all that apply):
Is verbal or physical assistance needed for any activities of daily living? (check all that apply):
Health and Medical Needs (check all that apply):
Behavioral Supports (check all options with a current support need or history of need):
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