Get Ag-095

The AG-095 form, known as the Arizona Standardized Client Assessment Plan (ASCAP), is a critical document used by the Arizona Department of Economic Security to evaluate client needs. This comprehensive guide provides step-by-step instructions for completing the AG-095 online, ensuring that users have the necessary information to navigate each section of the form effectively.

Follow the steps to complete the AG-095 online.

1. Click the 'Get Form' button to access the AG-095 online. This allows you to download the form and open it in your preferred editor.
2. Begin by filling out Part I: Intake Information. Provide your first and last name, social security number, date of birth, and contact details including phone numbers and email addresses.
3. In this section, specify your home or residence address, including the street number, city, state, and ZIP code. If you have a mailing address that differs from your residential address, include that as well.
4. Indicate whether the client needs emergency evacuation assistance and provide details about the referral source. List the name and contact number of the referral source, and describe your location at the time of referral.
5. Proceed to the Demographics section. Specify your race, relationship status, and educational background, as well as any disabilities or health conditions present.
6. For Part II: Caregiver Information, indicate whether you have a primary caregiver. If yes, provide their name, contact information, and relationship to you.
7. Complete Part III: Nutritional Status, by answering questions regarding dietary needs and nutritional screenings that may apply.
8. Part IV: Basic Functional Assessment requires you to evaluate your orientation and communication abilities, as well as your performance in daily living activities.
9. In Part V: Additional Functional Assessment, check any environmental problems or mental/behavioral health issues that apply, providing comments as needed.
10. Finally, review all sections for accuracy. Once completed, you can save changes, download a copy, print the AG-095, or share it with the necessary parties.

Complete your documents online for a smoother submission process.