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Mental Health and Addictions Nursing Program Referral Form. To request the services of the Mental Health & Additions Nurse, the patient must be: 1. A student registered in school and who is no older than 21 years of age (may include home instruction) 2. In need of services or related treatment to an identified and/or suspected mental health and/or addictions issue 3. Aware of and consenting to the referral Additionally, there must be a clearly defined role for the Mental Health & Addictions Nurse