Get Md Djs Intake Information Sheet 2020-2025

Filling out the MD DJS Intake Information Sheet online can be a straightforward process when you know what information to provide. This guide offers clear, step-by-step instructions to help users complete the form accurately and efficiently.

Follow the steps to complete the MD DJS Intake Information Sheet online.

1. Click ‘Get Form’ button to obtain the form and open it in the online editor.
2. Begin with today's date. Input the current date in the designated field at the top of the form.
3. Fill in the youth’s full legal name in the provided space, followed by their Social Security number (SS#).
4. Enter the youth’s nickname, date of birth, race/ethnicity, and gender identity in the respective fields.
5. Provide the youth's current address, including home and cell phone numbers.
6. Document the youth's school and grade level.
7. Include the place of employment for the youth, if applicable, as well as their place of birth (city and state).
8. If the youth was born outside the U.S., note when they moved to the country in the specified area.
9. Fill in the information for the first parent or guardian, including name, relationship to the youth, date of birth, Social Security number, race/ethnicity, and contact details.
10. Repeat step 9 for the second parent or guardian if applicable.
11. Indicate who the youth resides with and their relationship to the youth.
12. Clarify who has legal custody of the youth and check the parental status (single, married, divorced, separated, or other).
13. Note the number of children in the family, number living at home, and those over the age of 16.
14. Specify the primary language spoken by the family.
15. Provide information on the youth’s current medical insurance and any medications they are taking.
16. Enter any relevant mental or physical health diagnoses and answer the questions regarding allergies, runaway incidents, counseling/therapy, suicidal history, and prior emergency hospitalizations.
17. Once all sections are filled out, review the information for accuracy, then save changes, download, print, or share the completed form as needed.

Get started on completing the MD DJS Intake Information Sheet online today!