Get Form 02ag002e (ag-2-a, Part I). Older Americans Act Assessment

This guide provides detailed, step-by-step instructions on how to effectively fill out the Form 02AG002E (AG-2-A, Part I), which is used for Older Americans Act assessments. Completing this form can help in assessing the needs of older individuals and ensuring they receive the appropriate services and support.

Follow the steps to fill out the form accurately and completely.

1. Press the ‘Get Form’ button to access the online version of the Form 02AG002E. This will allow you to fill it out directly within the digital platform.
2. Start with the initial date of contact. This date indicates when the assessment process begins and should be filled in at the top of the form.
3. Indicate whether this is an assessment or reassessment by selecting the appropriate option.
4. Next, provide the source of referral to your office by filling in the name of the agency or individual that referred the consumer, along with the agency case number.
5. Fill in the consumer information section, including the full name, Social Security number, address, date of birth, age, home phone number, county, and gender.
6. Check the box indicating if the consumer has any special eligibility needs, such as being under 60 years old. Also, specify the consumer's race and living arrangements.
7. Answer whether the consumer lives alone and provide details if they do not, including with whom they reside. This information is important for understanding the consumer's living situation.
8. Fill in the consumer's monthly income and indicate their poverty level, whether above, below, or refused.
9. Describe the consumer's current situation comprehensively, including health status, primary doctor, and any medical conditions.
10. List emergency contacts outside the home, including their name, relationship to the consumer, and phone number.
11. If applicable, indicate if the consumer participates in another similar program and provide the name of that program and its date.
12. Complete the section regarding referrals to additional services, including the agency, contact name, and case numbers where applicable.
13. Obtain signatures from the consumer and the interviewer, along with their printed names and contact information.
14. Evaluate the nutritional health section by following the checklist to determine any risks. Circle the relevant questions and total the nutritional score.
15. Finally, review the completed form for accuracy, save your changes, and choose to download, print, or share the form as needed.

Start completing your documents online today to ensure timely assessments and support.