Housing Stabilization referral | WeCare

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Phone : 320-281-4449
Fax : 320-281-4819

Phone : 320-281-4449
Fax : 320-281-4819

Menu

Home
About Us
What we offer
Referrals
Careers
Contact Us

Menu

Home
About Us
What we offer
Referrals
Careers
Contact Us

Phone : 320-281-4449
Fax : 320-281-4819

Adult Day Service referrals

Behavioral Health services referrals

Housing Stabilization referrals

PCA referrals

Statement of Non-discrimination

Language

English (US)

WeCare Referral

Housing Stabilization Services
Patient name*

First NameLast Name
Patient's Address*

House name/no & street

CityState

Postcode
Patient's Mobile Phone*
Patient's Email address
example@example.com
Patient DOB*

MonthDayYear
Ethnicity
Disability*

YesNo
Gender Identification

MaleFemale
MA#*
Medicare

YesNo
My Client will need help finding housing*

YesNo
My Client has a housing subsidy*

YesNo
What type of Housing subsidy and how much?
Client Current Residence*

Nursing FacilityHospitalShelterOwn Apartment/HomeHomeless/No place to liveOther
Currently "at risk" of losing housing*

YesNo
Reason for referral/Brief Description of Participants circumstances*
Primary Diagnosis*
Recent History(Check all that apply over the past 12 months)

Self Injurious behaviorAggressiveee/Violent behavioursMedication non-complianceDrug/Alcohol abuseHigh medical needsOther
Insurance Type*

Blue CrossUcareMedicaHealth PartnersOther
Attachments*

Cancelof
Which of the following documents are attached to show proof of disability*

Professional Statement of NeedMedical Opinion FormProof if recipient SSI or SSDIOr over 65 years of age (65+ automatically qualifies ) shown through valid ID
Which of the following documents are attached to show proof that the person is facing housing instability*

Professional Statement of NeedMnCHOICES AssessmentCoordinated Entry Assesment
Referrer's information
Referrer's Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Case Manager

First NameLast Name
CM Phone Number
Please enter a valid phone number.
CM Email
example@example.com
Data protection*

Client understands and accepts that their information will be kept securely until it is no longer required to assist them or by law. Permission is granted to WeCare to contact the client by their identified preferred contact method.
Should be Empty:

WeCare Main Office

136 Division Street

Waite Park, Minnesota 56387

320-281-4449

WeCare Counseling and Housing Stabilization Services

110 2nd Street South, Unit 305 & 306

Waite Park, Minnesota, 56387

320-281-4454

WeCare Winona Office

350 Sarnia St E, Ste 4

Winona, Minnesota 55987

320-281-4383

Hours

Monday – Friday

8:00 am – 4:30 pm

Main Office: 136 Division Street, Waite Park, MN 56387 | info@wecaremn.org | Phone (320)-281-4449 | Fax (320)-281-4819

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