Get Spoaa

This guide provides step-by-step instructions for completing the Spoaa form online. The Spoaa form is essential for referring individuals for case management and residential services in the mental health system.

Follow the steps to fill out the Spoaa form accurately and efficiently.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Enter the date of referral and the name of the referring person in the designated fields.
3. Specify the relationship of the referring person to the individual being referred, and fill in the agency name.
4. Provide basic contact information for the individual being referred. This includes last name, first name, any known aliases, gender, date of birth, and various phone numbers.
5. Fill in the address or living situation details, including whether the individual is an inpatient or residing in a temporary residence.
6. Indicate the living status and arrangements, including the length of time in these living conditions.
7. Document the diagnosis including relevant Axis codes and descriptions. Be mindful of the important note regarding supporting documentation for Axis I diagnoses.
8. Certify that the individual meets eligibility requirements and complete the section with your printed name, title, signature, and date.
9. Complete the sections regarding referral details, including the reason for referral and current treatment team.
10. Provide information regarding the individual’s current medical conditions, medications, and ability to self-administer medications.
11. Fill in demographic information, including ethnicity, language proficiency, and religious affiliation.
12. Complete the section on functional, medical, and daily living problems and elaborate on community survival skills.
13. Detail any forensic history and mental health/substance abuse treatment history.
14. In the educational and vocational section, include the highest level of education and current employment status.
15. Encourage the individual being referred to provide their statement relevant to the services requested.
16. Complete the final section where the individual and their advocate sign and date the form.
17. Once all sections are complete, save changes, and you have options to download, print, or share the completed form.

Complete your Spoaa form online to ensure timely processing and support for the individual in need.