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Itasca County Rule 79 Child Mental Health Referral

  1. Itasca County Rule 79 Children's Mental Health Intake Form

  2. Hispanic

  3. Please Check Appropriate Insurance:

  4. Instructions

    Enclose a current diagnostic assessment that has been completed within the last 180 days.

  5. Children's mental health case management is based upon eligibility criteria outlined in MN Statute 245.4871, Subd. 6.

  6. Screenings for case management eligibility are completed twice weekly.

  7. Incomplete referral forms will be returned for completion to the referring agency.

  8. Itasca County Health and Human Services

    1209 SE Second Avenue, Grand Rapids, MN, 55744-3983

  9. Phone: 218-327-2941, TDD: 218-327-5549

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