Intake & Reentry Forms | Fairfield County, OH

description of resource

This resource is a set of coordinated intake, consent, and reentry planning forms used by the Fairfield County Overdose Response Team and Reentry Coalition to assess individual needs and facilitate service connections. It includes HIPAA authorization, service intake questions, and a structured reentry management tool covering domains such as housing, employment, health, substance use, and legal needs (see pages 1–3).

Who might use it

These forms are used by reentry coordinators, overdose response teams, case managers, and healthcare providers working with individuals impacted by substance use and justice involvement. They are completed by clients, often with staff support, to enable service coordination and information sharing across agencies.

How to use it

The forms should be administered at intake or prior to release to collect consent, identify service needs, and document planned referrals across key life domains. Staff then use the information to coordinate care, track referrals and outcomes (as shown in the reentry management tables on pages 3 and 5), and support ongoing case management and follow-up.