The administrative office of the trial court shall establish a statewide universal system for referral processes to specialty courts, including a referral form that probation officers and other relevant parties shall use to evaluate an individual’s eligibility for the program. The universal referral form shall include, but is not limited to, the following:

A.Court Information;

B.Eligible Offenses;

C.Criminal History;

D.Demographics, including age, race or ethnicity, sex or gender identity;

E.Medical History, including any prior mental health or substance use disorder diagnoses, mental health treatment, substance use disorder treatment and, if applicable, type of substances abused;

F.Government Benefits;

G.Insurance;

H.Employment and Educational History; and

I.Services Needed