Get Assessment Form (pas-61n, June 2007) - Office Of Alcoholism And ...

Filling out the Assessment Form (PAS-61N) is a crucial step in accessing services through the Office of Alcoholism and Substance Abuse Services. This guide will walk you through each part of the form, providing clear, concise instructions to help you complete it accurately and efficiently.

Follow the steps to successfully complete the Assessment Form.

1. Click the ‘Get Form’ button to obtain the form and open it in the appropriate online editor.
2. Begin by filling out the provider number field, ensuring that it accurately reflects your service provider's information. This is essential for tracking and service provision.
3. Indicate the respondent's sex by selecting either 'Male' or 'Female'. This information helps in appropriately tailoring support services.
4. Fill in the program number, ensuring it reflects the specific program you are applying to. This helps categorize your assessment under the right program.
5. Enter the birth date in the provided format (MM/DD/YYYY) to document the individual's age for eligibility purposes.
6. Input the client ID, a unique identifier for individuals receiving services. Ensure accuracy to avoid confusion in case files.
7. Provide the last four digits of the SSN and the last two letters of the birth name. This information may aid in verification.
8. Record the number of assessment visits; this indicates engagement in the assessment process.
9. Choose the appropriate admission disposition from the list provided. This indicates how the case will be processed following the assessment.
10. If applicable, answer the optional items regarding significant others, race, and veteran status. These details support demographic tracking but are not mandatory.
11. Register the residential information, including zip code, county, and type of residence. This provides insight into living conditions.
12. For clients under 19, complete the living arrangements section to give context to their environment.
13. Identify the principal referral source by checking the most applicable option, which helps in understanding how clients access services.
14. Continue filling out additional fields related to education, employment status, family history, and criminal justice status, providing thorough and truthful responses.
15. Input details regarding substance use, including primary, secondary, and tertiary substances, along with routes and frequencies of use.
16. If relevant, incorporate the health conditions section, detailing any physical or mental health issues to inform treatment options.
17. Finally, review all entered information, make any necessary corrections, and then save your changes, download, print, or share the completed form as needed.

Take the next step towards accessing support by filling out the Assessment Form online today.