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9.5 Availability and Use of Referrals Sample Policy Template

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Linkages to Primary Care and Other Services

Title X grantees are expected to have a written policy that requires subrecipients and service sites to have policies for providing needed referrals, per the Program Requirements 9.5. This sample policy template can be modified with agency or site-specific information.

This tool is part of “Establishing and Providing Effective Referrals for Clients: A Toolkit for Family Planning Providers” which supports Title X grantees’ ability to provide effective referrals to meet the needs of their clients.