Get Adolescent Eating Disorder Program Intake Form Adolescent

Filling out the Adolescent Eating Disorder Program Intake Form Adolescent online is a crucial step in initiating the necessary support for adolescents facing eating disorders. This guide provides a clear, step-by-step approach to ensure that you complete the form accurately and thoroughly.

Follow the steps to complete the intake form efficiently.

1. Press the ‘Get Form’ button to access the intake form and open it in the provided editing interface.
2. Begin by entering today's date in the designated field.
3. Provide the patient's full name and date of birth (DOB) in the respective sections.
4. Fill in the patient's address and postal code.
5. List the names of the parents or guardians in the appropriate field.
6. Input the residential phone number and the business phone numbers for each parent.
7. Specify the referring physician’s name, their billing number, and specialty.
8. Enter the referring physician's address and contact details, including phone and fax numbers.
9. Identify the family doctor or pediatrician and include their contact information.
10. Make sure to print or type all information legibly, as incomplete forms will be returned.
11. Document the presenting problems by listing them in the provided areas.
12. Complete the weight and height measurements, including current, highest, and lowest weights as well as corresponding dates.
13. Describe any weight loss duration and triggering factors in the specified section.
14. Indicate whether weight control methods are being used and detail their frequency.
15. Record information regarding menstrual history, including menarche and any occurrences of amenorrhea.
16. List recent lab work results including potassium, hemoglobin, and EKG details.
17. Detail any prescribed and non-prescribed medications.
18. Complete the section on medical stability by entering blood pressure and heart rate readings.
19. Document any prior medical and psychosocial treatments for the condition.
20. Finally, ensure that all sections are filled out completely, and then save your changes, print, or share the completed form as necessary.

Complete the Adolescent Eating Disorder Program Intake Form Adolescent online today to ensure timely support for those in need.