Get Mn Dhs-5704a-eng 2014-2025

Filling out the MN DHS-5704A-ENG form is a critical step in ensuring that a child receives appropriate mental health assessments and services. This guide aims to provide a clear and concise walkthrough of the form, helping users navigate each section with confidence.

Follow the steps to complete your online form accurately.

1. Press the ‘Get Form’ button to access the form and view it in your chosen editor.
2. In Part 1, provide the child’s name, client number, date, referral source, and the reason for referral. Ensure that all information is accurate and clearly stated.
3. Identify the person completing the form and their relationship to the child. This is important to establish context for the provided information.
4. Complete the living situation section. Indicate whether the child lives with parents, guardians, fosters, or in residential care. If applicable, provide details about multiple households.
5. Move to the developmental issues section and mark any relevant concerns regarding pregnancy, birth, or early childhood experiences that may have impacted the child’s development.
6. Detail any childhood health issues the child has experienced, such as seizures, asthma, or other significant health conditions.
7. In the functioning section, check any problems observed that may affect the child’s daily living, such as sleep disturbances or difficulty with behavior.
8. Provide information regarding the child’s school functioning, including whether they have an Individualized Education Program (IEP) and any educational challenges they face.
9. Fill out the child’s legal and trauma history, noting any legal charges, probation details, or experiences of trauma, while ensuring to describe any significant instances.
10. Compile the child's mental health treatment history, including any previous treatments and current medications, and provide the name of their primary care physician.
11. Conclude by reviewing the family environment and relationships section, addressing parent-child relationships and any additional family concerns.
12. Once all sections are filled out, make sure to save any changes made to the form. You can then download, print, or share the completed document as necessary.

Start completing the MN DHS-5704A-ENG form online today to ensure your child's mental health needs are effectively addressed.