If the interested applicant meets the criteria noted above for their desired program, please proceed with the following steps to activate an application with Hiawatha Valley Adult Residential Services:
1. Complete the application, including both the Referring Agent and Client Questionnaires.
2. Submit a current Diagnostic Assessment (DA), which has been completed and signed within the last 180 days.
3. Submit a signed Professional Statement of Need; located on the MN DHS website, or by clicking here: https://edocs.dhs.state.mn.us/lfserver/Public/DHS-7122-ENG
4. Submit a current med list (MAR).
5. Submit collateral information connected to the applicant’s mental health/legal status (i.e. Civil Commitment/Jarvis Order, LOCUS, Functional Assessment, probation/parole documents).
6. Releases of Information (Referring Agent, County of Financial Responsibility, and Guardian, if applicable).
7. Return the completed application/referral and supporting documentation to the following:
Via Mail: Adult Residential Services c/o Residential Coordinator
1433 W Service Drive, Winona, MN 55987
Via Fax: (507) 474-4004 c/o Residential Coordinator
Via Email: ResidentialLiving@hvmhc.org