Get Nyc Dfta Blank Intake Form

Completing the Nyc Dfta Blank Intake Form online is an important step in ensuring that clients receive the appropriate services they need. This guide will provide you with detailed instructions on filling out each section of the form to help streamline the process.

Follow the steps to complete the form accurately and efficiently.

1. Press the ‘Get Form’ button to access the form and open it for editing.
2. Begin by filling in the client’s name, date of birth, and the dates of intake, assessment, and reassessment in the designated fields.
3. Indicate the sex of the client by selecting either 'Male' or 'Female', and specify their living arrangement by choosing 'Alone' or 'Other'.
4. Enter the case manager's name and the client's ethnicity in the respective sections.
5. If applicable, fill in information on who the client lives with if they are not alone.
6. Provide the referral source and describe the presenting problem clearly.
7. Indicate whether the client currently has Medicaid by selecting 'Yes' or 'No', and if 'Yes', enter their Medicaid number.
8. For informal supports, indicate 'Yes' or 'No' and explain who provides assistance to the client.
9. List the services requested by the client, along with any other services they may already be receiving from another agency.
10. Document the client’s IADLs and ADLs that they cannot perform, noting who will assist them with these needs.
11. Record all medication the client uses daily and their respective dosages.
12. Determine if the client has any chronic illnesses or impairments and document the findings.
13. Assess the client’s cognitive status and note any assistive devices they use.
14. Indicate whether a mental health evaluation is required and if the nutrition screening presented any risks.
15. List any housing or housing safety issues the client is facing.
16. Detail all sources of income and total income for the client.
17. Fill in emergency contact details, including name, address, and relationship.
18. Complete the client’s care plan by listing formal and informal services needed to address their needs.
19. Summarize the client’s in-home evaluation and confirm signatures from the case manager and social work supervisor.
20. Ensure all relevant assessments were signed and documented correctly, including the release of information form.
21. Conclude by saving the changes, downloading, printing, or sharing the form as necessary.

Take the next step in supporting clients by completing the Nyc Dfta Blank Intake Form online today.