Get Application For Residential Rehabilitation Services - Go-getters Inc

This guide provides comprehensive instructions on how to complete the Application For Residential Rehabilitation Services by Go-Getters Inc. Designed to be user-friendly, this step-by-step guide ensures that all necessary information is accurately conveyed for the application process.

Follow the steps to successfully complete your application.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin filling out the applicant’s name at the top of the form. Ensure to include the last name, first name, and middle initial.
3. Provide the address of the applicant, including street, city, state, and zip code, along with a contact phone number.
4. Input the applicant’s date of birth and social security number in the corresponding fields.
5. Indicate the gender and race of the applicant, followed by their marital status information.
6. Fill out the current entitlements and income sections, including benefits like SSI and SSDI, along with insurance details.
7. In the referral source section, include the name of the referring agency, agency phone number, and psychiatrist name with their contact details.
8. Document any current psychiatric diagnoses and the respective DSM-IV code. Fill out the various axes by providing detailed information.
9. List all current medications alongside their dosages and frequency of administration. Include any comments on the applicant's ability to manage their medication.
10. Answer questions related to legal history and substance abuse thoroughly, providing details as required.
11. Proceed to fill out sections regarding activities of daily living and previous RRP involvement, specifying support needs.
12. Conclude the application by detailing the rationale for services, the recommended level of placement, and confirming the applicant's agreement with the referral.
13. Finally, ensure all signatures and dates are completed accurately for both the applicant and the witness before saving changes, downloading, or printing the form.

Complete your application online to access residential rehabilitation services today.