GRAT Online Referral

Geriatric Regional Assessment Team Referral
We currently have a high number of referrals pending.

The wait time for follow-up is over five weeks.

We recommend trying other support services and resources in the meantime.
Hello,

GRAT has temporarily paused taking any new referrals while we work through our waitlist.

If you are seeking resources for a client, consider contacting Pathways Information & Assistance at 206-448-3110. Their team, also at Sound Generations, can assist you or your client in determining options for support services and make referrals accordingly.

Thank you – we look forward to working with you soon!
Before completing this form, you attest to the best of your knowledge that the person being referred:
- is not actively stating a plan and intent for suicide or assault on another person
- is not in need of emergency medical or behavioral health care
- is not currently receiving behavioral health or inpatient services
This referral form is intended for professional use only. If you are a concerned community member, family member, friend, or neighbor, please contact Pathways Information and Assistance at 206-448-3110.
I acknowledge and agree with the above statement
If your client is experiencing a medical or behavioral health emergency, immediately call 9-1-1 or seek help for them at the nearest Emergency Room.

For greater success in our ability to coordinate support and services for the referred person, please complete the following information to the best of your knowledge.
Power of Attorney
POA
Name
Phone
Please enter a valid phone number.Format: (000) 000-0000.
Relationship to referred person
More POA contacts can be added at the bottom of this page
Family/Other Support (Only include identified member of support system)
Name
Phone
Please enter a valid phone number.Format: (000) 000-0000.
Relationship to referred person
More Family/Support contacts can be added at the bottom of this page
Primary Physician (more can be added at end of form)
Name and title
Phone
Please enter a valid phone number.Format: (000) 000-0000.
Hospital or clinic
Physician Fax
Please enter a valid phone number.Format: (000) 000-0000.
More Physician contacts can be added at the bottom of this page
Other Healthcare Provider (including behavioral healthcare)
Name and title
Phone
Please enter a valid phone number.Format: (000) 000-0000.
Hospital or clinic
More Healthcare Provider contacts can be added at the bottom of this page
Other Providers
Please complete if referred person is receiving services from any other social service agencies
Name and title
Phone
Please enter a valid phone number.Format: (000) 000-0000.
Relationship to referred person
Organization
Submission Date

MonthDayYear
Date
Additional contacts (POA, Family/Supportive, Physician, Healthcare Providers, Other Providers)
Use button to enter a contact
Upload supporting documents:

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Geriatric Regional Assessment Team Referral

Person referred for outreach and assessment

Residential Address of Referred Person

Additional information

Primary outreach contact

Reason for referral

Safety concerns for the outreach team

Referring source

Power of Attorney

Family/Other Support (Only include identified member of support system)

Primary Physician (more can be added at end of form)

Other Healthcare Provider (including behavioral healthcare)

Other Providers

Additional contacts (POA, Family/Supportive, Physician, Healthcare Providers, Other Providers)