DUKE UNIVERSITY HEALTH SYSTEM Division of Community Health Support Services Program Letter of Authorization The start date for counting the 14 days of services starts today, T ransportation Medication Delivery COVID-19 Supplies Food Box/Groceries Healthy Meals Medically-Tailored Meals There is/are ___ person/people in the household. This is _______________ ______ __ from the 'uke 'ivision of Community +ealth 5eferral Team working on the C29I'1 6upport 6ervices Program. This client needs _________________. 3riPary /aQJXaJe $ddress Phone Number/Email Client Name ________________________________________________ BBBBB _ B __ ________________________________________ BBBBBBBBBB BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB This clieQt is aXthori]ed to receiYe serYices beyoQd the iQitial -day Seriod 3lease asN the clieQt to QotiIy yoX ZheQ they Qo loQJer reTXire serYices If you have any questions, please do not hesitate to contact the 'uke 5eferral Team via 360 or email. Thank you!