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State Plan Checklist - CERTIFICATION, ELIGIBILITY & COORDINATION OF SERVICES 8/14/2026 Page 22

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b. The referral methods used by local agencies to other health and social service programs include (check all that apply, and indicate whether the method selected is the primary method of referral):

Primary State agency-developed referral forms X Local agency-developed referral form Telephone call to referring agency Verbal referral to participants X X Automated client/participant information exchange Written literature on referral programs X Follow-ups by staff to monitor Maintain a list of local resources for drug and other harmful substance abuse X