Baltimore City Health Department Office of Aging
Baltimore City Health Department Office of Aging and Care Services MAP Resource and Client Referral
Resource Referral Presentation
Please select the resources needed and the amount:
Accessible Homes_______ Adult Day Care _________ Assisted Living Directory__ Benefits Check Up _________ Caregiver's Application____ Community First Choice
Fact Sheet ____________ Employment ______________ Energy Assistance ______ Home Repair ______________ Housing List _______________ Housing Application _________ Legal Services _____________ Medigap ______________ Mobility MD Property Tax Credit _______ Qualified Medicare Beneficiary
(QMB)/Specified Low Income Medicare Beneficiary( SLMB) __________________________ Resource Directory __________ Senior Care Fact Sheet _______ Senior Centers______________ Senior Prescription Drug Assistance Program (SPDAP)_______ Taxi Card
Waiver Fact Sheet Other ______________ Presentation: Overview of Ser-
vices offered by OACS MAP Client referral: complete info.
MAP Client Referral.
Date: Client Name: Street Address: City: Phone Number: Alternate Contact: Agency Making the referral: Phone Number of the Referring Agency: Additional Information / Reason for Referral:
Age:
State:
Zip Code:
Male Female
Contact person for the Agency:
417 E. Fayette St. 6th Floor Baltimore, MD 21202 Tel: 410-396-2273 Fax : 410.727.6654
E-mail at MAP.BCHD@
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