Get (please Submit Typed Form To Network Staff) - Illinois Department Of ... - Dhs State Il

Filling out the (Please Submit Typed Form to Network Staff) is an important step in accessing crisis funding services through the Illinois Department of Human Services. This guide provides clear, step-by-step instructions to help you complete the form accurately and efficiently.

Follow the steps to fill out the form online.

1. Press the ‘Get Form’ button to access the form, which will open in a suitable format for your input.
2. Begin by entering the 'Date of Request' at the top of the form, followed by the individual's name, network, date of birth, age, social security number, and active RIN/E-RIN number in the designated fields.
3. Fill in the details of the sending PAS/ISC agency and the contact information of the sending PAS/ISC worker, including both the fax and phone numbers.
4. Indicate the crisis service requested by selecting the appropriate option from the list provided, including CILA, 24 Hour/Host, Child Group Home, Adult HBS, and others.
5. Complete the Axis Diagnosis section, including Axis I, II, III, IV, and V along with any other conditions, and provide the date of the psychological evaluation completed by a licensed clinical psychologist.
6. Input the full-scale IQ and functioning level, along with the dates of ICAP or SIB evaluations and their respective scores.
7. Identify the guardian and their relationship to the individual receiving services, and note if they are receiving other government or community services, providing explanations if necessary.
8. Discuss the supports that were attempted or explored, detailing why these supports did not meet the individual's needs.
9. Describe the individual's behaviors, focusing on frequency, intensity, duration, and severity.
10. Write a detailed summary of the crisis needs and issues, ensuring to include any imminent risk of abuse, neglect, and/or homelessness.
11. Summarize any presenting medical issues of the individual and/or caregiver(s) as well as any other contributing factors.
12. Fill in provider details, including proposed community provider, contact person, phone number, fax number, and address of the residential site.
13. Provide the date services will be initiated and identify the proposed service facilitator.
14. If applicable, attach the service plan for AHBS or CHBS.
15. Lastly, obtain the necessary signatures: PAS/ISC signature with the date and ensure that they complete the DHS-DD use only section.

Complete your document submission today online to ensure timely access to crisis funding services.