CHIP Online Referral Form (online submission available beginning 3/27/18)
Jefferson Area CHiP accepts referrals from anyone. Many of our referrals come from hospitals, social service agencies, or from families themselves.
Until then, you may continue to print the PDF version here and fax to (434) 964-4774.
We notify the referring source once we receive a referral on a family, again when the family is assigned to a CHiP team and ultimately let the source know whether the family has been opened to CHiP services. All of our services are voluntary. We will make our best effort to meet the family in person to introduce ourselves and our program. We strive to build relationships so families feel comfortable and confident about working with CHiP. Referral sources are welcome to call (434) 964-4700 if they have updates on or questions about their referral. If our caseload is full there may be a wait for services. We will try to communicate with the family and the referral source during this time on the waiting list.
Factors considered when prioritizing referrals
Medical Risk Factors
- Medical condition of mother
- Medical condition of child
- Mental Health
- Developmental Delays
- No medical home
- Out of date immunizations/ check-ups
Social/Parenting Risk Factors
- Domestic Violence
- Substance Abuse
- Teenage pregnancy or mother
- History of child abuse/ neglect
- Single parent
- Parenting challenges