Get Universal Pnmi Referral/application Form

Completing the Universal PNMI Referral/Application Form is a crucial step in accessing necessary services. This guide provides detailed instructions on how to effectively fill out the form online, ensuring that you gather all required information accurately and efficiently.

Follow the steps to complete the Universal PNMI Referral/Application Form online.

1. Press the ‘Get Form’ button to obtain the referral/application form and open it in your preferred online editor.
2. Begin by filling in the date at the top of the form. Make sure to enter the current date correctly.
3. Indicate whether the individual is an AMHI class member by selecting 'Yes' or 'No.'
4. Enter the consumer's name in the designated field, followed by their gender choice: Male, Female, or Transgender.
5. Fill in the current address of the consumer to ensure proper service delivery.
6. Select the marital status from the provided options: Single, Married, Domestic Partner, Divorced, or Widowed.
7. Record the consumer's date of birth in the specified format.
8. Complete the fields for Social Security Number, Income Source, and Amount, as well as the MaineCare Number.
9. Indicate the MaineCare status by choosing from the options available, and if applicable, note the Spend Down amount and deductible dates.
10. If the consumer has a housing subsidy, provide the necessary information. Otherwise, select 'No' or 'Applied-Pending' along with the date.
11. Fill in the referral source's name and contact details before specifying where the consumer wishes to live by selecting one of the CSN options.
12. State the primary and secondary referral program choices for the consumer.
13. Clearly explain the reason for the referral in the designated space, providing a comprehensive description.
14. Indicate if there are any special considerations or needs and provide detailed descriptions if applicable.
15. Discuss the consumer's prior living arrangements or periods of homelessness, noting what worked and what did not.
16. Continue with the current needs assessment by indicating if the consumer requires ADL assistance and explaining if necessary.
17. Complete all questions regarding guardianship, case management, and primary care physician appropriately.
18. Fill out sections related to current and past legal issues, diagnoses, symptoms, substance abuse history, and treatment experiences.
19. Provide medical history and details about medications, including any known allergies.
20. Conclude by having the consumer and guardian sign and date the form, ensuring that a copy of the referral has been provided to the consumer.
21. Once all sections are filled out, review the document for accuracy before saving the changes, and choose to download, print, or share the completed form as needed.

Complete your Universal PNMI Referral/Application Form online today to ensure timely access to necessary services.