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04mp001e 2026
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- Click ‘Get Form’ to open the 04mp001e in the editor.
- Begin by filling in the 'To' section with the appropriate recipient's details, followed by the date of referral.
- In the 'Identifying Information' section, enter the case name, county, and family's street address, including city, state, and ZIP code.
- Provide the KK number as it is essential for processing this referral.
- For the 'Client Referred for Services' section, input the client's first name, middle initial, last name, date of birth, gender, and race.
- Indicate eligibility by confirming that the client's income and resources are insufficient for services.
- In 'Reason for Referral', detail specific indicators of substance abuse and whether it is drug-related or alcohol-related. Include observable behaviors and any relevant history.
- Finally, ensure both referring CW/CHBS worker and supervisor sign and date the form before submission.
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Related links
Form 04MP001E is used in such situations. The release is available for use only when release of the confidential information is not otherwise prohibited byRead more
Navigate to Oklahoma Department of Human Services Homepage. Forms. Type the form name or number you are looking for in the search box below.Read more