Follow the steps to successfully complete the form online.

1. Click ‘Get Form’ button to access the form and open it in your preferred online editor.
2. Begin by filling in the community services board or behavioral health authority information. Ensure you include the correct name as it pertains to your situation.
3. Input the date and time as specified. Make sure to differentiate between any court-ordered time and time not under court order.
4. Complete the consumer ID number and emergency custody order section, marking yes or no, and provide details regarding the order.
5. Fill in personal information including first name, middle initial, last name, date of birth, and social security number. Also, indicate the individual’s gender and ethnicity.
6. Provide the complete address and contact information, including home or cell phone number.
7. Outline the individual's marital status and any relevant education information, especially for minors.
8. Identify family members or legal guardians and provide their contact information.
9. Fill in the emergency contact details, ensuring that the relationship to the person is clear.
10. Provide information on the community service board of residence and any pertinent insurance coverage, including Medicaid and Medicare.
11. Address the collateral sources and the presenting crisis situation. Document all necessary referral sources and reasons clearly.
12. Detail the individual’s mental health and substance use history, ensuring to answer all relevant assessments.
13. Complete the medical history section including primary care provider details and current medications.
14. If applicable, provide legal data including any pending charges or relevant legal status.
15. At the end of the form, review all sections for accuracy and completeness. Once satisfied, you can save changes, download, print, or share the form as necessary.

Take the next step towards securing the necessary services by completing the Dbhds preadmission screening form online.