Get Az Dd-097-1-ff 2012-2025

The AZ DD-097-1-FF form is an essential document used by service providers and individuals receiving care services in Arizona. This guide will help you navigate through the process of completing the form online, ensuring that you provide the necessary information accurately and efficiently.

Follow the steps to fill out the AZ DD-097-1-FF form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor for further editing.
2. Begin by providing the provider's information in the designated fields. Enter the full name of the provider, including last name, first name, and middle initial. Additionally, include the employer tax number and the AHCCCS ID number.
3. Indicate whether any special training is required. Select 'Yes' or 'No,' and if applicable, provide a description of the necessary training.
4. Fill in the individual's information, including their full name, ASSISTS number, birthdate, address, and contact information. Ensure each section is completed accurately.
5. Document the guardian or responsible party's name and address in the respective fields. Also include any relevant emergency contact names and their phone numbers.
6. Specify the details of any current medications and historical medication issues, allergies, dietary needs, and any assistive devices. Fill in as much detail as possible to ensure quality care.
7. Complete the mobility and personal care skills sections by checking the applicable options that reflect the individual's capabilities, and provide special instructions for assistance if necessary.
8. If applicable, address any behavioral concerns and their recommended interventions. Indicate if a behavior treatment plan is available and describe the methods used to gather this information.
9. Once all fields are completed, you can save changes, download the form, print it, or share it as needed to ensure compliance and proper submission.

Start filling out your AZ DD-097-1-FF form online today to provide essential support for individuals in need.