Get Ca Universal Intake Form - Los Angeles County 2021-2026

The CA Universal Intake Form is an essential document for individuals seeking services from the Los Angeles County Area Agency on Aging. This guide will walk you through the process of filling out the form online, ensuring that you provide all necessary information effectively.

Follow the steps to fill out the CA Universal Intake Form online.

1. Click ‘Get Form’ button to download the CA Universal Intake Form and open it in your preferred document editor.
2. Begin by filling in the agency name and your name at the top of the form along with the date.
3. In the 'Identification' section, provide your last name, first name, middle name, date of birth, age, and optional social security number. Complete your home address and, if different, your mailing address.
4. Fill out the contact information by entering your home phone, work phone, cell phone, and email address.
5. Indicate your rural designation (rural or urban) and provide information regarding your sex at birth as well as your current gender identity.
6. Complete the 'Demographics' section by indicating your racial and ethnic identification as well as your sexual orientation.
7. In the 'Emergency Contacts' section, you will need to provide the names and contact information of individuals who can be reached in case of an emergency.
8. Answer the questions regarding your current benefits, including whether you receive social security, health insurance, or participate in CalFresh.
9. Fill out the 'Nutritional Risk Factors' section by selecting the factors that apply to your situation.
10. Complete the 'Activities of Daily Living' section by indicating your level of assistance required for daily activities.
11. Review all your entries for accuracy and completeness before submitting.
12. Finally, save your changes, and proceed to download, print, or share the completed CA Universal Intake Form as required.

Start completing the CA Universal Intake Form online today to access the support you need.