Get Pa Dbhids Integrated Intake Application Packet - City Of Philadelphia 2021-2025

Filling out the PA DBHIDS Integrated Intake Application Packet online is an essential step for users seeking behavioral health services in Philadelphia. This guide provides clear instructions to ensure your application is filled out accurately and efficiently, supporting you through the process.

Follow the steps to complete the application online effectively.

1. Press the ‘Get Form’ button to access the application, which you can then open in your preferred document editor.
2. Begin with the referral contact person section. Clearly enter the name and contact details of the individual handling queries relating to the application.
3. In the participant name field, enter the last, first, and middle name of the participant, ensuring there are no nicknames used.
4. Fill in the AKA type, choosing from options such as alias, former name, or birth name to identify any other names associated with the participant.
5. Provide the participant’s permanent address and specify their current living situation for accurate service mapping.
6. Indicate the participant's gender, ethnicity, and race, selecting the appropriate options from provided descriptions.
7. For the date of birth, ensure you enter the format correctly, including the full year.
8. Describe the participant’s insurance coverage details as required, using your agency’s access to verify the information.
9. List the participant’s income sources, and provide estimated monthly figures as well as names of any payees.
10. Document the participant’s veteran status and corresponding discharge details if applicable.
11. In the current hospitalization/institutionalization section, detail facility names, admit dates, and anticipated discharge dates.
12. Continue to outline the psychiatric assessment and medication regimens with accuracy, ensuring all required fields are completed to process the application.
13. Review all completed sections for clarity and correctness. Save your changes and proceed to download, print, or share the finalized form as needed.

Complete your application online to ensure timely processing and access to necessary services.