Get Aging-information Assistance Referral Consent Form - Gnrc

Completing the Aging-Information Assistance Referral Consent Form - Gnrc online is a straightforward process that helps facilitate important referrals for individuals in need of assistance. This guide will walk you through each section of the form to ensure you provide all necessary information clearly and accurately.

Follow the steps to complete the form online effectively.

1. Press the ‘Get Form’ button to access the form and open it in your chosen editor.
2. Begin by providing your referral source information in the designated section, including your name, referring agency, relationship to the consumer, and contact numbers.
3. In the consumer information section, enter the consumer’s last name, first name, middle initial, address, city, zip code, date of birth, and social security number.
4. Fill in the primary and secondary phone numbers of the consumer. If applicable, indicate if the consumer has dementia or any other condition that might prevent them from participating in the screening, and provide a contact person's information if necessary.
5. In the consent for referral and release of information section, the consumer or their legal representative must sign, indicating their consent for the referral and release of their personal and medical information.
6. Include the relationship of the signatory to the consumer and the date of signing.
7. If you assisted the consumer or legal representative in completing the form, fill in your name, agency (if applicable), and the date.
8. Once all sections of the form are completed and reviewed for clarity, you can save your changes, download the completed form, or print it for submission.

Start completing your Aging-Information Assistance Referral Consent Form - Gnrc online today!