Get Ok 04af017e 2012-2025

The OK 04AF017E form is essential for collecting important family health history information within the Oklahoma Department of Human Services framework. This guide will provide clear, step-by-step instructions to assist you in completing the form accurately and efficiently, especially if you are filing online.

Follow the steps to complete the form successfully.

1. Click the ‘Get Form’ button to access the form and open it in the online editor.
2. Begin by filling out the applicant's details. This includes the names of the applicant father and applicant mother, their address, and county of residence.
3. In the designated section, check all applicable boxes regarding treatments for various health conditions such as arthritis, asthma, and diabetes. Make sure to indicate whether the applicant father or mother has been treated for these conditions.
4. Next, indicate if you or your partner have ever had surgery, been hospitalized, or received any psychological or psychiatric counseling. Check the applicable boxes.
5. If there are children in the household who have received specific treatments, check the relevant boxes and provide the child’s name if applicable.
6. For each health condition you checked earlier, complete the additional information section. Indicate the condition, dates of treatment, and results.
7. List all current prescribed and over-the-counter medications taken by the applicant father and mother. Include the medication name, dosage, frequency, and the related condition for each.
8. Finally, both the applicant father and applicant mother must provide their signatures and the date to finalize the form.
9. Once all fields are completed, save your changes to the document. You can then download, print, or share the form as needed.

Complete your OK 04AF017E form online today!