Items 20 - 28 ... if applicable). Send to Centralized Intake at the address list on page 2. ... Summary report and conclusions of physical examination (Attach Medical Documentation). 21. ... Or email.

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How to fill out the Client Intake Assessment Form - San Bernardino County - Sbcounty online

Completing the Client Intake Assessment Form is an essential step for accessing services provided by the Community Action Partnership of San Bernardino County. This guide will walk you through the process of filling out the form online, ensuring that you provide all necessary information accurately and efficiently.

Follow the steps to fill out the Client Intake Assessment Form online confidently.

  1. Press the ‘Get Form’ button to access the form and open it in your preferred editor.
  2. Begin by entering your household information. This includes your address, phone number, and type of housing (e.g., apartment, house). Specify whether you own, rent, or if you are currently homeless.
  3. Indicate your family type by selecting the appropriate category, such as single parent or two-parent household.
  4. For household composition, list each member of your household in the designated fields. Fill out their name, date of birth, gender, social security number, ethnicity, race, education level, health insurance status, and income.
  5. Complete the section on each household member’s characteristics, specifying if they are a veteran, disabled, or have limited English proficiency.
  6. Differentiate the income source for each adult household member aged 18 and older by selecting from the available options provided.
  7. Review your entries for accuracy before finalizing. Ensure all required fields are completed.
  8. Once complete, you can save your changes, download the document, print it, or share it as necessary.

Take the next step toward accessing vital services by completing your Client Intake Assessment Form online today.

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What is San Bernardino County Cares line?

(800) 968-2636.

Adult Full Service Partnership Program - Department of Mental Health.

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Valley Star's Full Service Partnership (FSP) is for adults ages 18 to 59 who have a mental illness or mental health condition, who have been hospitalized (or are at-risk of hospitalization), and those who need individualized mental health services and support accessing community services and resources.

5150/5585 Hold is the civil procedure under the Welfare and Institutions Code (WIC) for the involuntary detention and safe transport of an individual to an LPS designated facility within a reasonable period of time, when that individual is deemed to have a mental disorder that makes him or her a danger to him or her ...

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