Get Dane County Mental Health Consumer Status Data Form 2005

This guide provides clear and supportive instructions for completing the Dane County Mental Health Consumer Status Data Form 2005 online. Following these steps will help ensure that your information is accurately submitted for mental health services.

Follow the steps to successfully complete the form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by filling in your client information. Provide your County ID number, legal name (last name, first name, middle initial), and the agency’s name.
3. Enter your county program number and, if applicable, your county of residence if it is not Dane County. This ensures accurate service routing.
4. Indicate your legal or commitment status by circling the appropriate code that best represents your situation based on the provided options.
5. Detail your presenting problems by circling up to three codes that correspond to the issues you are currently facing. This helps in understanding your needs.
6. Specify the referral source by entering the indicated codes based on your current living situation and environment.
7. Select your employment status by circling one of the provided codes. This section helps assess your current economic engagement.
8. Mention your principal or primary diagnosis clearly, ensuring it aligns with the required diagnostic codes.
9. Circle up to three daily activity codes, indicating your current levels of engagement in activities.
10. Assess your psychosocial and environmental stressors by circling the code that best describes your current situation.
11. Evaluate your health status by circling the code that accurately depicts your health condition.
12. Determine your suicide risk by circling the appropriate code based on your assessment of risk factors.
13. Complete the sections regarding living arrangements, criminal justice system involvement, and any necessary additional information as requested.
14. Once you have filled out all necessary sections of the form, ensure all information is accurate. You can then save changes, download the form, print it, or share it as required.

Take the next step in your mental health journey by completing your documents online.