Get Dhcs 5103

Filling out the Dhcs 5103 Health Questionnaire and Initial Screening Form is an essential step for individuals seeking assistance in the state of California. This guide will provide you with the necessary instructions to complete the form accurately and efficiently online.

Follow the steps to fill out the Dhcs 5103 effectively.

1. Click ‘Get Form’ button to access the document and open it in your online editor.
2. Begin by entering your name and date of birth in the designated fields at the top of the form.
3. Proceed to each health question, where you will indicate 'Yes' or 'No' for each item. If you answer 'Yes', provide the necessary details in the space provided.
4. For physical health questions, be specific about any past conditions, treatments, or medications. Include dates when relevant.
5. Continue through the mental and emotional health questions, providing details if you have experienced any related symptoms or received treatment.
6. If applicable, fill in the section regarding previous drug and/or alcohol treatment services, detailing the type of treatment and the name of the facility.
7. Once all sections are completed thoroughly, review your answers for accuracy.
8. After ensuring all information is correct, you can save the changes, download, print, or share the form as needed.

Start filling out the Dhcs 5103 online today to take the next step in your care.