Get Dbhids Integrated Intake

Completing the DBHIDS Integrated Intake form online is an essential step in accessing behavioral health services in Philadelphia. This comprehensive guide will walk you through each component of the form, ensuring that you can submit your application accurately and efficiently.

Follow the steps to complete your application seamlessly.

1. Press the ‘Get Form’ button to access the DBHIDS Integrated Intake form and open it for editing.
2. Begin with the Referral Contact Person section. Provide the name and contact details of the individual who will address any questions related to this application.
3. Next, input the Participant Name as Last, First, and Middle names. Ensure there are no nicknames.
4. For the AKA Type field, specify any alias, former name, maiden name, birth name, married name, or other relevant identities.
5. State the Participant's permanent address clearly, indicating if they are currently residing in the community or their most recent location.
6. Select the Gender by marking the appropriate option from Male, Female, Transgender, Male to Female, Female to Male, Intersex, or Genderqueer.
7. Fill in the Ethnicity Code with either Hispanic or Non-Hispanic, and provide the Race by selecting one of the provided options.
8. Indicate the individual’s Sexual Orientation by selecting one of the predefined categories.
9. Record the Date of Birth in the format mm/dd/yyyy, including the complete year.
10. If applicable, enter the BSU Status and CIS# for the participant if they are registered with relevant community services.
11. Provide Insurance information, specifying Primary Coverage Type and, if applicable, Physical Health Coverage details.
12. Identify the Income Source(s), ensuring to list a monthly figure for any declared income sources.
13. Conclude the personal information section by ensuring all personal identification forms and emergency contact details are completed.
14. As you proceed, provide details regarding Current Hospitalization or Incarceration status, including the facility's name and contact information.
15. List any Psychiatric Assessments and the associated ICD-10 Codes through the application.
16. Detail the current Medication Regimen, ensuring to include Medication Names, Dosages, Frequency taken, and Prescription durations.
17. Continue completing the Medical Issues or Physical Disabilities section, indicating the severity and recent treatment status.
18. If applicable, address any Substance Use/Abuse issues experienced in the last year, providing necessary details.
19. Fill in the Family Status section, indicating if the participant has children and providing family-related information as needed.
20. Assess Behavioral Risk Factors, detailing any concerns and the level of assistance required.
21. Document Meaningful Life Activities, indicating current and desired activities under various categories.
22. Finally, describe your Housing Preferences, specifying desired living situations and areas within Philadelphia.

Start filling out your DBHIDS Integrated Intake application online today to ensure timely access to services.