MDOC Referrals - Stakeholders
MDOC Referrals: Requesting a Substance Use Screening
Why Submit a Referral?
A formal referral ensures individuals referred by MDOC receive priority access across all levels of substance use treatment. It also connects both the individual and referring agent with the SUD Care Navigator for support in:
- Screening, referral, and treatment recommendations
- Addressing barriers to accessing treatment
- Ongoing communication, treatment updates, and coordination, with consent
- Resources to support treatment engagement and recovery
Required Referral Forms
To support priority status and coordination of services, the following forms must be submitted:
- CFJ-306 – Substance Abuse Treatment Referral Form:
- MDHHS 5515 – Consent for Communication (signed release form): To obtain a blank copy of the MDHHS 5515 consent form, visit Michigan’s Department of Health and Human Services
Ways to Submit a Referral
Option 1: Email Submission
Send completed referral documents to: MDOCreferrals@midstatehealthnetwork.org
Option 2: Online Submission
Use the online submission option to:
- Complete an electronic CFJ-306 form, with the option to attach the MDHHS-5515 consent form
- Complete an electronic MDHHS-5515 consent form
After submission, an automated confirmation email will be sent with a copy of the form for your records. Please download submitted forms, as access will expire after 14 days.
Please note, when using the online submission option, you will be prompted to enter and confirm your email address and consent to electronic use of the forms.
Screening Process
Once a referral is received, the SUD Care Navigator coordinates completion of the screening by contacting the individual using the phone number provided and, coordinating with the referring agent or facility, as needed, for individuals who are incarcerated.
Following the screening, the referring agent receives communication regarding the screening outcome. If screening indicates a need for treatment, a referral and warm transfer will be completed to the receiving provider, followed by ongoing coordination to facilitate admission and continuity of care.
Get Connected
We are committed to providing timely, coordinated access to treatment through responsive communication and person-centered care. For referrals or support, contact:
Christina Romero, LMSW, CAADC
517-299-0089
Christina.Romero@midstatehealthnetwork.org
Resources
- Get Help Now MSHN Access Center 844-405-3095