Module 51: Referral Form

A Module Used in The Measurement Group's Cross-Cutting Evaluation of the HRSA HIV/AIDS Bureau's Special Projects of National Significance on Innovative Models of HIV/AIDS Care

Purpose

• Codes referrals made to participating social service agencies.

Content Domain - Tracking of referrals for social services, mental health, substance abuse treatment, basic needs services, etc.

Operational Data Items - ID Letters/ID Numbers, Site, Sub-Provider, Referral Date, Staff Code, Gender, Generic list of referral agencies (to be customized for each site), List of Referral Categories, "Other" Referrals.

Citation - Huba, G. J., Melchior, L. A., Staff of The Measurement Group, and HRSA/HAB's SPNS Cooperative Agreement Steering Committee (1996). Module 51: Referral Form. Available: www.TheMeasurementGroup.com. Culver City, California: The Measurement Group.

Usage - Permission is granted for non-commercial use so long as form is not altered, the copyright is not removed, and a proper citation is made to the instrument. Non-commercial use is use by a not-for-profit organization in which the instrument is not sold. If you have questions about appropriate and proper uses, contact The Measurement Group.

Findings from Evaluating HIV/AIDS Programs

Reliability and Validity Studies