Get Department Of Intellectual And Developmental Disabilities - Tn

This guide provides comprehensive instructions for filling out the Department of Intellectual and Developmental Disabilities intake referral form online. By following these steps, users will be able to complete the form accurately and efficiently.

Follow the steps to successfully complete the form.

1. Press the ‘Get Form’ button to access the intake referral form and open it for editing.
2. Begin by entering the date at the top of the form. This indicates when the referral is being made.
3. Fill in the name of the staff person completing the form to provide accountability.
4. Indicate how the initial contact was made by selecting one of the options provided (telephone, fax, email, walk-in, etc.).
5. Specify who referred the individual needing services by checking the appropriate box, such as DCS, ICF/MR, or the Judicial System.
6. If the individual is currently receiving services, check the relevant boxes.
7. Provide the individual's information, starting with their last name, first name, and middle initial.
8. Enter the address, including street, city, state, and zip code. If there are special mailing accommodations, include instructions here.
9. Complete the county of residence, date of birth, age, and phone numbers (home, work, and cell).
10. Include the Social Security Number (SSN) and indicate if there is a diagnosis of mental retardation prior to age 18, along with the confirmation date if applicable.
11. Select the individual’s gender and race from the options provided.
12. Next, provide information about the primary contact person, such as their last name, first name, and relationship to the individual.
13. If their address is different from the individual's, enter it here, along with special mailing accommodations if needed.
14. Fill in the contact numbers for the primary contact person (home, work, cell).
15. If applicable, include the conservator or guardian's information and note that court orders must be included.
16. Once all sections have been completed, review the form for accuracy.
17. You can now save changes, download, print, or share the form as needed.

Complete and submit the Department of Intellectual and Developmental Disabilities intake referral form online today.