Get Rouven Frassek

Completing the Rouven Frassek form is essential for documenting a person's employability status regarding General Assistance. This guide provides clear instructions for filling out the form online, ensuring all necessary information is accurately recorded.

Follow the steps to fill out the Rouven Frassek online.

1. Click the ‘Get Form’ button to access the form and open it in the editor.
2. In the 'Case Identification' section, provide the applicant's full name, birthdate, social security number, address, telephone number, city, state, and zip code. Ensure that all information is legible and complete.
3. In Section I, briefly explain why the applicant remains unable to work despite the original assessment. Indicate whether a prescribed treatment plan was given and confirm if it was followed. If there were reasons for not following the plan, provide those details.
4. After completing Section I, arrange for an appointment with a qualified medical professional, as they must complete Section II.
5. In Section II, the medical provider must select the appropriate employability status (permanently disabled, temporarily disabled for 12 months or more, temporarily disabled for less than 12 months, or employable) based on their evaluation.
6. The medical provider must provide a diagnosis in the 'Examination Results' section, including both primary and secondary diagnoses, and outline the basis for their assessment by checking the applicable items.
7. The medical provider should sign the form, ensuring that the signature is original. It must include their printed name, telephone number, address, and medical assistance provider number.
8. Once all sections are complete, save any changes made to the form. Users can then download it for printing or sharing, as required by the county assistance office.

Complete your documents online to ensure a smooth submission process.