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He least restrictive referral consistent with sound clinical judgment. All items must be clearly documented in the Assessment Tool. This form must remain in the client file. Check the severity rating for each dimension and document the provider(s) who will meet the identified needs. Dimension I Intoxication/ Withdrawal II Biomedical III Emotional/ Behavioral/ Cognitive IV Readiness for Change V Relapse and Continued Use VI Recovery Environment Severity Rating  0  1  2  3  4 = Crisis  .

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How to fill out the MN DHS-2794-ENG online

Filling out the MN DHS-2794-ENG form online is an important step in documenting a client's assessment and placement summary effectively. This guide provides clear and detailed instructions to assist you in completing the form accurately.

Follow the steps to ensure accurate completion of the form.

  1. Click ‘Get Form’ button to obtain the form and open it in your preferred editor.
  2. Start by entering the client name in the designated field. Ensure that you spell the name correctly for accurate documentation.
  3. Fill in the PMI (Personal Identification Number) assigned to the client. This number is necessary for identifying the client within the system.
  4. Enter the name of the assessor in the appropriate field. This identifies the individual conducting the assessment.
  5. Record the assessment date, ensuring it reflects the date on which the assessment was completed.
  6. In the sections for each dimension (I to VI), select the corresponding severity rating for intoxication, biomedical, emotional/behavioral/cognitive, readiness for change, relapse and continued use, and the recovery environment.
  7. For each dimension, provide documentation of the provider(s) who will meet the identified needs based on the severity rating.
  8. Complete the service coordination and room and board sections if they are determined to be necessary based on the above assessments.
  9. Summarize the assessment findings, including rationale for the risk ratings, in the assessment summary section, ensuring it matches information gathered.
  10. After filling in all required sections, you can save the changes, download the form, print it for physical records, or share it if needed.

Start completing your MN DHS-2794-ENG form online today!

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Minnesota's largest state agency monitors day care centers. It oversees the Medical Assistance program and provides cash assistance and benefits. It runs mental health hospitals and specialty dental clinics. The sprawling Department of Human Services serves at least a quarter of the state's population.

B. Or call MN DHS - Licensing Division at 651-296-3971 and ask for the NETStudy Administrator.

The Department of Human Services provides economic assistance for qualifying families. It helps people go to or look for work, attend school, have nutritious food, and gain independence.

You can find information on the Background Study website at .DHS.state.mn.us, select General Public; Office of Inspector General; Background Studies. What if I have questions? If you have questions call (651) 431-6620.

The average time for the criminal background check (CBC) to be completed from the time the fingerprints and forms are received in the CBCP office until the CBC report is delivered to the board is five business days. However, it is not unusual for the process to take up to two weeks.

Violent, sexual, drug, and theft-related convictions disqualify you from working in the health care field. Some violent and sex-related crimes disqualify you forever. Most other felonies disqualify you for 15 years, gross misdemeanors for 10 years, and misdemeanors for 7 years.

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