Get Dbhr Target Detox Short Form - Dshs Wa

Filling out the DBHR Target Detox Short Form is an essential step in the process of seeking detoxification services. This guide provides step-by-step instructions on how to complete the form effectively online, ensuring that all necessary information is accurately provided.

Follow the steps to complete the form accurately.

1. Press the ‘Get Form’ button to access the DBHR Target Detox Short Form and open it in the editing environment.
2. Begin by providing client identification details. Fill in the last name, first name, middle name, and other last name if applicable. Next, select the appropriate gender option and enter the date of birth. This information is crucial for accurate identification.
3. Enter the Washington driver's license or ID number followed by the social security number, which is required for public assistance programs. Proceed to identify your race/ethnicity by checking a maximum of four options that are applicable.
4. Specify if you identify as Spanish/Hispanic/Latino by checking one box from the relevant options provided.
5. Complete the treatment information section by entering the begin date and time, as well as the end date and time. Make sure to use the appropriate AM/PM option to clarify the time.
6. Indicate the frequency of substance use along with peak use per month. Select coding options based on how often the substances were used within the specified time frame.
7. List the substances that were used by checking the corresponding boxes for each substance. Describe substance use details in the provided table, which includes options for peak use frequency and amount taken/comments.
8. Proceed to the agency identification section. Fill in the agency number, staff identification, and then select the relevant treatment contract and fund source.
9. Indicate the insurance payment information and any current public assistance status, selecting the applicable boxes based on your situation.
10. In the referral section, check all that apply to outline how the individual was referred to detox services. This section helps provide context for the case management.
11. Complete the detox end referral and discharge or closure type sections by checking the relevant options. This information is necessary for tracking treatment outcomes.
12. Finally, review all entered information for accuracy. Once you've confirmed that all fields are filled out correctly, save changes, download your completed form, print it, or share as needed.

Start completing the DBHR Target Detox Short Form online today to facilitate your detox process.