Get Odhs 1653 (996), Page 1 Of 2

This guide provides a clear and supportive overview of how to fill out the ODHS 1653 (996), Page 1 Of 2 online. By following these steps, users can ensure that they complete the form accurately and efficiently.

Follow the steps to complete the ODHS 1653 (996) form online.

1. Click the ‘Get Form’ button to access the form electronically and open it in your preferred online editor.
2. In the first section, enter the name of the applicant in the format of last name, first name, and middle initial.
3. Provide the date of birth in the specified format, ensuring accuracy.
4. Fill out the address field with your complete street address, including city, state, and ZIP code.
5. Answer the questions regarding serious or chronic illnesses, hospitalization, mental health services, and substance abuse by selecting 'YES' or 'NO' as applicable.
6. If you answered 'YES' to any of the preliminary questions, provide a brief explanation in the space provided.
7. Check the relevant health history options regarding family medical issues, such as arthritis or heart disease, and indicate who in the family has experienced these issues.
8. Confirm if there is a history of other hereditary diseases and provide explanations where necessary.
9. In the authorization section, affirm that the information provided is accurate by signing and dating the form.
10. Once you have completed all fields, save your changes, and consider downloading, printing, or sharing the form as per your needs.

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