Get Annual Consumer Reporting Form (crf) - Delaware Health And ... - Dhss Delaware

The Annual Consumer Reporting Form (CRF) is a crucial document for individuals receiving mental health and substance use services in Delaware. This guide provides you with step-by-step instructions to fill out the form accurately and effectively while navigating the online process.

Follow the steps to successfully complete the Annual Consumer Reporting Form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by selecting the modality of treatment. You can tick only one option among Mental Health, Alcohol/Drug, Co-occurring, or Gambling.
3. Enter your last name, first name, and middle initial. Provide your treatment unit name along with your address details, including street, city, state, and zip code, if applicable.
4. Select your home telephone number type and choose your residential arrangement from the various options provided, indicating your primary employment status for the past 30 days.
5. Indicate your primary health insurance provider and define your veteran status as relevant. Mark whether you have experienced homelessness at any time in the past 12 months.
6. Complete details about your gross income per year and how many dependents rely on your income. Input the highest grade of education you have completed.
7. Determine how many places you have lived in the last 90 days and compute on average how many hours you spent on your primary activity during that period.
8. In the sections regarding current legal involvement, indicate if you are currently pregnant and if you have ever used injection drugs.
9. Fill out your alcohol and drug use matrix, providing details about frequency of use, route of administration, and age of first use.
10. Finalize the form by printing your name and adding your signature alongside the date. Review all entries for accuracy before submission.

Complete your documentation online to ensure timely submission.