Get Attachment A-1 - Delaware Health And Social Services - State Of ... - Dhss Delaware

This guide provides a clear and supportive overview of how to complete the ATTACHMENT A-1 form required by Delaware Health and Social Services. It is designed for users with varying levels of document management experience, ensuring a straightforward process.

Follow the steps to effectively complete the form online.

1. Click the ‘Get Form’ button to obtain the ATTACHMENT A-1 form and open it in an online editor.
2. Begin filling out the section labeled 'INFORMATION ABOUT YOU'. This includes entering the applicant's name, address, date of birth, phone number, and email address. Ensure accuracy for each piece of information.
3. Complete the 'Health Insurance' section. Provide details regarding the insurance company, policy holder, and Medicaid or Medicare numbers. If applicable, indicate whether the applicant is a blood bank member.
4. In the 'INFORMATION ABOUT YOU & PEOPLE WHO KNOW AND CARE FOR YOU' section, list primary support persons, family members, and emergency contacts. Include the necessary details such as names and relationships.
5. Fill out the 'ABOUT YOUR BIRTH' and 'ABOUT YOUR DEVELOPMENT' sections with relevant details regarding birth difficulties and developmental milestones.
6. Move on to the 'SCHOOL HISTORY' section to input the name and address of the last school attended. Indicate whether special education services were received and specify any qualifications earned.
7. Address the 'CRIMINAL HISTORY' and 'WORK HISTORY' sections. Affirm whether any criminal offenses have occurred and provide relevant work history information.
8. Complete the 'SERVICE HISTORY' to indicate any services received from specified organizations. Note the dates and locations of these services.
9. Fill in medical and psychiatric histories, including current diagnoses and treatment received. Ensure to provide all medications being taken, along with their purposes and any required assistance.
10. In the financial section, enter all income sources and provide necessary financial documentation such as bank statements or verification of benefits.
11. Review all sections for completeness. Make any necessary edits and ensure all required signatures are included at the end of the form.
12. Finally, once the form is entirely completed, users can save changes, download, print, or share the ATTACHMENT A-1 form as needed.

Start filling out your ATTACHMENT A-1 form online today and ensure all necessary services are accessible.