Get Form 02hm001e (ag-2, Part I) - Okdhs

Filling out the Form 02HM001E (AG-2, Part I) is an important step in accessing services provided by the Oklahoma Department of Human Services. This guide will assist users in navigating through each section of the form to ensure accurate completion.

Follow the steps to successfully complete the form online.

1. Click the ‘Get Form’ button to acquire the form and open it for editing.
2. In the applicant information section, indicate the use of the form by checking the relevant box. Then, provide the date completed in the format of month, day, and year.
3. List the source of referral to the Oklahoma Department of Human Services, including the name, source, and telephone number.
4. Provide consumer information, including the last name, first name, middle initial, and social security number of the individual.
5. Fill in the street address, city, state, zip code, and date of birth for the individual seeking services.
6. Gather additional sources of information by providing the name, address, and phone number of the individual you are referencing, and their relationship to the consumer.
7. Indicate whether the consumer knows about this assessment by selecting 'Yes' or 'No'.
8. Respond to the questions regarding current problems or needs that require assistance.
9. Select the marital status of the consumer and their living situation, indicating the household composition.
10. Provide details about whether the consumer requires assistance to leave their home and include primary doctor information.
11. Complete information regarding legal guardianship or power of attorney if applicable.
12. Fill out emergency contacts, including names, phone numbers, addresses, and their relationship to the consumer.
13. List financial sources, including any earnings, benefits, or assistance the consumer receives.
14. Answer questions about assets and whether any property has been transferred in the past five years.
15. Indicate health insurance coverage and complete any additional questions regarding the consumer's background and preferences.
16. Compile any additional information, referrals, or notes relevant to the consumer's situation.
17. Finally, once all information is completed, save the changes, and proceed to download, print, or share the form as needed.

Complete your documents online today and ensure your application is processed smoothly.