Hudson House Referral Form

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Hudson House is located at 100 Leprechaun Lane, New Windsor NY. The program provides transportation at designated times in the Newburgh/New Windsor area. Participants who are in MCO Care Management programs can utilize medical transport IF socialization or psychosocial rehabilitation are a part of the participant's Care Plan. Connect with the individual's Care Manager if you're unsure if the participant's current Care Plan goals qualify them to utilize Medicaid transportation to Hudson House.
Referral Contact Information:

Please complete this section in full with your contact information so that we can reach you in the event that we have any follow up questions.
Referral Date: Referral Date: / MM / DD YYYY
Name: Name: First Last
Agency:
Job Title:
Office Phone: Office Phone: - ### - ### ####
Cell Phone: Cell Phone: - ### - ### ####
Email:
Reasons for Referral to Hudson House:

Please be as specific as possible. Please note that transportation is only available in the Newburgh/New Windsor area. Individuals throughout Orange County are welcome to participate in Hudson House, but will have have a means of transportation to and from program.
Agency:
Agency Phone: Agency Phone: - ### - ### ####
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