Get Eeu Delaware 2020-2025

Filling out the EEU Application for Services is a crucial step in accessing necessary support. This guide provides clear and comprehensive instructions on how to complete the form accurately and efficiently online.

Follow the steps to successfully complete your application.

1. Press the ‘Get Form’ button to obtain the application and open it for editing.
2. Begin with Section 1, Demographics and Status Request. Fill in the date, your last name, first name, middle initial, Social Security number, and date of birth. Ensure all information is accurate.
3. Continue with your age, gender expression, marital status, and ethnicity. Specify if you are a TASC client and fill in any applicable client identification numbers.
4. Provide your income sources and amounts, along with your Medicaid and Medicare numbers or other insurance information.
5. Indicate your current residence type and provide your complete street address, including city, state, and zip code.
6. List your primary and work phone numbers, as well as a cell phone number if applicable.
7. Provide details of a person to contact in case of an emergency, including their address and relationship to you.
8. Indicate your primary language spoken and whether you have a guardian or a representative payee.
9. Specify the level of care you are requesting, such as ICM, ACT, or substance use disorder residential care.
10. Sign and print your name in the application completion section and provide the referring agency's details if applicable.
11. Attach a recent psychiatric evaluation if you are applying for mental health services, ensuring it is signed by the clinician.
12. Proceed to Section 2 to answer questions regarding your current needs and history across several ASAM dimensions. Provide thorough responses based on your current situation.
13. In the areas provided, detail your treatment history, medication effectiveness, and any allergies you may have.
14. Conclude by reviewing all sections for accuracy, then save your changes. You can choose to download the application, print it, or share it as needed.

Start completing your EEU Delaware application online today for timely assistance.