Get 12 Month Printable Form - Vanderbilt University Medical Center - Mc Vanderbilt

Filling out the 12 Month Printable Form for Vanderbilt University Medical Center is crucial for thorough documentation of health and demographic information. This guide provides step-by-step instructions on how to complete the form efficiently and accurately, supporting users through each section.

Follow the steps to complete the form correctly.

1. Press the 'Get Form' button to access the form and open it in your editing tool.
2. Begin by filling in the case number and home visitor number at the top of the form.
3. Record the date of your visit in the appropriate field.
4. Indicate the type of visit by checking one of the provided options: home, phone, or office.
5. Enter the child's date of birth in the designated format (mm/dd/yyyy).
6. Proceed to the demographics section (A-7) and enter the participant's date of birth.
7. In section A-8, answer whether you are of Hispanic, Latina, or Spanish origin, checking 'Yes' or 'No'.
8. For section A-9, select your race by checking the appropriate box or writing in other.
9. Complete section A-10 regarding your marital status.
10. Answer question A-11 about immigration status and provide your country of origin if applicable.
11. In section A-12, describe your employment status and, if unemployed, state the reason in A-12a.
12. Confirm if you are currently a student in section A-13.
13. If applicable, provide information on job training program enrollment in section A-14.
14. In section A-15, mark the highest level of education completed.
15. Indicate whether a father or father-figure resides in your home in A-16.
16. Input the number of children living in the home in section A-17.
17. Answer questions regarding childcare support in sections A-17a and A-17b.
18. Continue to the financial or housing section starting with B-1, noting the number of people living in the household.
19. Assess your health care coverage status in B-2 and indicate how many months you have been on your current plan.
20. Provide details in sections B-4 through B-7 regarding personal health care providers, housing stability, and access to internet/transportation.
21. Follow through sections B-8 to B-14 regarding monthly income and financial assistance received.
22. Proceed with health and emotional health assessments, and complete optional questions as applicable.
23. Lastly, fill out any optional comments and review the document for completeness.
24. Once completed, save your changes, download the form, print it, or share it as needed.

Begin filling out your form online today to ensure timely and accurate processing.