Follow the steps to effectively complete the interview form.

1. Click ‘Get Form’ button to obtain the form and open it in the online editor.
2. Begin by entering your name and certification details in the provided fields. Ensure to complete the 'QP First Initial & Last Name' and 'Date' fields accurately.
3. Provide the required consumer information, including the LME-MCO Assigned Consumer Record Number, Consumer Date of Birth, and Consumer County of Residence.
4. Indicate the Consumer's Gender by selecting the appropriate option, and fill in the first three letters of the consumer's last name and the first letter of the first name.
5. If relevant, answer the question regarding whether the consumer is being admitted to a specialty program for maternal, pregnant, perinatal, or post-partum services.
6. Select the applicable age/disability category for the services being received. Mark all that apply including Adolescent Mental Health and Adolescent Substance Use Disorder.
7. Record the admission date, which is the date of the first paid service for this episode of care.
8. Proceed to select all the services the consumer is currently receiving by checking the relevant boxes.
9. Answer the questions regarding the treatment primarily provided by qualified professionals and demographic information regarding ethnicity and sexual orientation.
10. Complete the mental health and substance use disorder sections by providing answers related to previous experiences and current conditions.
11. Assess and mark the frequency of any substance use in the past 12 months and provide detailed responses where necessary.
12. Once all sections are completed, review the entire form for accuracy and completeness.
13. Finally, save your changes and utilize options to download, print, or share the completed form as required.

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