Get Intake Form - Baycrest - Baycrest

Completing the Intake Form for Baycrest is an important step in accessing the needed services. This guide will provide you with the necessary steps to ensure your submission is complete and accurate, helping to facilitate your intake process.

Follow the steps to successfully fill out the Intake Form - Baycrest online.

1. Press the ‘Get Form’ button to access the Intake Form and open it in your preferred editor.
2. Enter the date of referral in the designated fields, using the format day/month/year.
3. Provide your full name, including surname and given name, and select your gender by marking the appropriate box.
4. Fill in your full address, including street, apartment number (if applicable), city, and postal code.
5. Record your Meditech number and the name of the intake worker managing your case.
6. Indicate whether your residence falls within the catchment area by checking the corresponding box.
7. Input your phone number, including area code, and confirm whether you consent to share this information with family.
8. Provide your date of birth and calculate your age, ensuring this information is accurate.
9. If applicable, provide the name of your substitute decision-maker or power of attorney, indicating their consent.
10. Fill in your OHIP number and confirm whether you consent to contact your family.
11. List the family or caregiver contact's name, specify their relationship to you, and indicate if they speak an additional language.
12. Complete the section regarding interpretation needs, and furnish contact numbers for home, work, and cell, as appropriate.
13. Indicate if you have a hearing impairment and your marital status by checking the corresponding boxes.
14. In the Referral Information section, specify your living arrangement and name the individual referring you.
15. Indicate your accommodation type, whether you live in a private home, nursing home, retirement home, or other.
16. Fill in the phone and fax numbers for the referrer, and provide the address for this contact.
17. Mention any other Baycrest or community services that are currently involved with you.
18. Provide your family physician's details, confirming if they are aware of the referral.
19. Indicate any potential safety risks that may be present during visits by checking the relevant boxes.
20. Fill in the fields regarding your current psychiatrist involvement and past psychiatric history.
21. Indicate whether you can come to Baycrest if needed and provide a reason for referral.
22. Complete the Intake Outcome section as appropriate, marking your preference among the options listed.
23. Finally, fill in any administrative details concerning your case, and review the form thoroughly.
24. Once all fields are completed, save your changes, download, print, or share the form as needed.

Begin completing your Intake Form - Baycrest online today to ensure access to essential services.