Get Doh 5151

The Doh 5151 form, also known as the childhood medical disability report, is an essential document used for determining disability eligibility for children. This guide provides clear and detailed instructions on how to fill out the form online, ensuring a smooth and efficient process.

Follow the steps to complete the Doh 5151 form online

1. Click ‘Get Form’ button to acquire the Doh 5151 form and open it in the designated editor.
2. Enter the child's name in the format of Last, First, Middle in the provided field. This information is crucial for identification purposes.
3. Fill in the case number assigned to the child. This number helps track the application status.
4. Provide the date of birth of the child. Ensure the format is consistent with the requirements.
5. Input the agency name that corresponds to the disability review, as well as the client ID and disability ID numbers if applicable.
6. Select the sex of the child by marking either Male or Female.
7. Enter the worker's name and their phone number for any follow-up communication.
8. Document the dates of treatment. Start by entering the first and last treatment dates, along with the frequency of treatment.
9. List the diagnosis(es) relevant to the child’s condition in the appropriate section.
10. Provide a comprehensive history that includes the date(s) of diagnosis, earliest symptoms, etiology, initial findings, and any treatments administered.
11. Complete the section regarding the last examination details, including the date, height without shoes, weight, and pertinent physical findings.
12. Indicate whether the child's function/behavior is age-appropriate by marking Yes or No for fine/gross motor skills, sensory abilities, communication skills, cognitive skills, and social-emotional skills. If not appropriate, specify the actual age level and describe the basis for observation.
13. Provide the physician's signature and printed name, along with the office address, specialty if applicable, telephone number, and the date signed.
14. Final review of the completed form should be conducted. Once verified, you can save changes, download, print, or share the form as needed.

Complete your Doh 5151 form online today for a streamlined process.