Get Client Information Form - Boston Public Health Commission - Bphc

The Client Information Form for the Boston Public Health Commission is an essential document for users seeking HIV/AIDS services. This guide will provide step-by-step instructions for completing the form online, ensuring that each section is filled out accurately and efficiently.

Follow the steps to fill out the form correctly.

1. Press the ‘Get Form’ button to retrieve the Client Information Form and open it for completion.
2. Indicate whether you are a new or existing client by selecting the appropriate checkbox.
3. Enter the client's full name and the last four digits of their Social Security Number.
4. Provide the client's birth date and mother’s first name.
5. Select the sex at birth and current gender from the provided options.
6. Fill in the street address, state, and city if available, leaving the street address optional.
7. Identify how the client was initially referred to the agency for HIV services by selecting one of the listed options.
8. Specify the client's activity status, choosing from options like peer or inactive.
9. If inactive, select the appropriate reason for discharge.
10. Indicate the client’s race and select all applicable identities.
11. Select the primary language spoken by the client.
12. Provide diagnostic information regarding the client's HIV status and history.
13. If applicable, indicate whether the client has an HIV/AIDS medical provider.
14. Complete sections related to income, housing status, and medical insurance.
15. Fill out any additional required medical case management information, if the client is HIV positive.
16. Review all filled-out sections to ensure accuracy and completeness.
17. Once satisfied, users can save changes, download, print, or share the form as necessary.

Take the first step towards accessing essential health services by completing the Client Information Form online.