Get Aps Fax Number: 719-444-5780

Filling out the APS referral form online is an essential step in ensuring that necessary support and services are provided to individuals in need. This guide will walk you through the process, from accessing the form to completing each section accurately and efficiently.

Follow the steps to complete the APS referral form online.

1. Press the ‘Get Form’ button to access the referral form, which will open it in your online editor.
2. Begin by filling out the Client Info section. Enter the client's name, date of birth or approximate age, address, Social Security number, and phone number. Indicate the client's gender and residence details, specifying if they live at home or in a facility. Include the client's ethnicity and primary language, and indicate if an interpreter is needed.
3. In the Income Source section, select the applicable source(s) such as SSI, private pension, VA pension, etc. Next, under Health Insurance, mark all that apply, including options like Medicare, Medicaid, and private insurance.
4. Complete the Reporting Party Info section, entering your name, agency name, address, phone number, and email. Include your relationship to the client and remember that mandated reporters cannot remain anonymous.
5. Fill out the Alleged Perpetrator Info. Provide their name, date of birth, gender, ethnicity, language, address, phone number, email, and relationship to the client. Specify if the alleged perpetrator has access to the client.
6. In the Support Network Info section, provide details about any support organizations or individuals involved. Include their names, agency details, relationship to the client, and whether they have access to the client.
7. Identify any allegations by checking the applicable boxes, such as caretaker neglect or physical abuse, and indicate if the client has any diagnosed medical, cognitive, or physical disabilities.
8. Use the detailed fields to describe the care the client needs but is not receiving. Specify any financial or health care management issues.
9. Summarize any additional concerns regarding the client's safety, health, or living environment in the respective sections.
10. Finally, review the entire form for accuracy. Save your changes, and if necessary, download or print the document for submission. You can also share the form if required.

Complete the APS referral form online today to ensure timely support and services.