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  • Mn Dhs-2794-eng 2013

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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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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232