Get Universal Residential Services Bapplicationb

Filling out the Universal Residential Services Application online can streamline the process of receiving necessary services. This guide will provide step-by-step instructions to ensure that you complete the form accurately and efficiently.

Follow the steps to complete the application effectively.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by filling out the consumer information section. This includes the consumer’s name, nickname, social security number, date of birth, age, sex, Medicaid number, county, weight, and height. Make sure to input all required details accurately.
3. Proceed to the guardian information section. Provide the legal guardian's name, relationship to the consumer, county of legal custody, guardian’s address, and phone number. Ensure accuracy and completeness.
4. In the consumer's primary referral source section, indicate the referring agency and fill in the provider agency name, phone number, and contact person. Make sure this information is current.
5. Continue to the clinical/diagnostic information section. List any diagnoses according to the DSM IV-TR, as well as any history of abuse. Include details about medications and relevant prescribing physicians.
6. Fill out the medical information section with allergies, special dietary needs, and a list of medical conditions. Provide names and addresses of healthcare providers and details about insurance.
7. Detail strengths, abilities, and preferences of the consumer. Include social relationships, religious beliefs, cultural considerations, and goals for independent living.
8. Document presenting problems or reason for referral in the designated section.
9. Complete the previous treatment interventions, placement history, and current emotional/behavioral problems sections with as much detail as possible.
10. Finalize by reviewing all information for completeness. Once satisfied, save your changes. You may download, print, or share the filled form as needed.

Start completing your application online to ensure timely processing of your request.