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Baby Steps Recovery Program Referral

  1. Douglas County Georgia

  2. Douglas County Juvenile Programs Administrations

  3. Baby Steps Recovery Program Referral

  4. DFCS referral made:*

  5. Pregnant:*

  6. Married:*

  7. Please explain

  8. Have you referred client for substance use assessment prior to this referral?*

  9. Is case substantiated?*

  10. Child(ren) name(s) and DOB(s) Please list all children involved in case:

  11. Born drug free?*

  12. Born drug free?

  13. Born drug free?

  14. Born drug free?

  15. Leave This Blank:

  16. This field is not part of the form submission.