Ohiofullcircle.com

Long-Term Recovery for You or a Loved One

WebThe completion of the Referral and Screening Form and the Authorization to Release and Exchange Information Form. Preset appointment through our Outreach Staff arranged by …

Actived: 7 days ago

URL: https://ohiofullcircle.com/treatment/

Full Circle Recovery Services Full Circle Recovery Services

WebJoshua H recommends Full Circle "Best treatment center in the area, hands down. Great case management, counseling, and guest housing. The staff go above and beyond to do …

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Full Circle Recovery Services

WebAre you currently linked with a provider for mental health treatment? If so, who? _____

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Full Circle Recovery Services

WebI understand that my records are protected under Federal regulations (42 CFR Part 2) and the Health Insurance Portability Accountability Act (HIPAA), 45 CFR, pts 160 & 164, and …

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Referral and Screening Form

Web7. Are you currently prescribed any mental health medications or any other medications? Medications: 8. Are you a Registered Sex Offender? Yes No

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Full Circle Recovery Services

Web4977 Northcutt Place, Dayton, Ohio 45414. Phone: 937-387-6395. Fax: 937-813-4105

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electronic, oral and/or written communication.

WebClinic Security & Logistics, Inc., dba FULL CIRCLE RECOVERY SERVICES 20 Livingston Ave., Dayton, OH 45403 Phone: (800) 829-5461 Fax: (937) 813-2757

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Referral and Screening Form

Web7. Are you currently prescribed any mental health medications or any other medications? Medications: 8. Are you a Registered Sex Offender? Yes No

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ohiofullcircle.com

WebAre you currently linked with a provider for mental health treatment? If so, who? _____

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electronic, oral and/or written communication.

WebClinic Security & Logistics, Inc., dba FULL CIRCLE RECOVERY SERVICES 4977 Northcutt Place, Dayton, OH 45414 Phone: (937) 387-6395 Fax: (937) 813-4105

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*Please DO NOT **Please place a strikethrough (as shown) …

Webthe authorization to be 1 year from the day I sign the authorization, the date will be 11/4/2021). 17. Please provide your signature. 18. Please provide date of signature.

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