Referrals

Brantwood Children’s Home welcomes children every day, 24-hours a day. There is limited space available, so please contact the Program Director or e-mail the required information to referral@brantwoodchildrenshome.org. Please review our programs to be certain Brantwood provides the services you need.

When sending a referral, at minimum please include the following documents:

  • CFA and/or current social summary
  • DHR placement application
  • Psychological if applicable
  • A.T. if applicable
  • School records

Documents needed for Referral

  • DHR Placement Application
  • Current Social Summary
  • Most Current psychological
  • Most Current Multidimensional Assessment (MAT)

Documents needed prior to admission

  • DHR Placement Application
  • Current Social Summary
  • Copy of recent EPSDT; 3 months prior to the date of placement or within 10 days of placement with TB results included (DHR –DFC 623)
  • DHR case number
  • Most Current psychological
  • Most Current Multidimensional Assessment (MAT)
  • Facts Printout-Placement Episodes/History
  • Cumulative Schools

Documents Needed at Intake

  • Client Resource Sheet
  • DHR Category of Eligibility
  • Youth in DHR custody; Most recent court order & Interagency Agreement (DHR-DFC 823)
  • Youth NOT in DHR custody; Boarding Home agreement & County-Agency agreement (DHR-DFC 750)
  • Medicaid card or letter authorizing to bill county DHR
  • Date of Last Dental Exam; Dentist name & address
  • Independent Living Assessment: Youth age 14 and older
  • Purchase Service Agreement (DHR-DFC 724)
  • Original Birth Certificate
  • Original Social Security Card
  • Original Blue Slip

Documents needed within 10 days of placement

  • ISP with authorizations within 10 days of placement
  • Alabama Medicaid Referral (Form 362) signed by EPSDT provider- (For Brantwood to provide Medicaid Rehab Services)