Get Nc Dss-5238 2004-2025

Filling out the NC DSS-5238 form is an essential step in accessing early intervention services for children who may need support. This guide provides detailed, step-by-step instructions to help users complete the form efficiently and accurately.

Follow the steps to fill out the NC DSS-5238 form online.

1. Click the ‘Get Form’ button to obtain the form and open it in the online editor.
2. Begin by entering the date of the DSS referral at the top of the form. Ensure this date is accurate as it is critical for tracking purposes.
3. Fill in the child's name and date of birth. Use the dropdown or selection format for gender, and select the appropriate option.
4. Complete the address section alongside a telephone number for easy communication.
5. Indicate if the parent or caretaker has any known physical or mental health issues.
6. Answer if there have been any prior assessments for medical or developmental needs, specifying by whom.
7. Provide the name and contact information for the child's primary medical provider.
8. Answer whether the child has Medicaid/HealthChoice or other insurance.
9. Include any additional information that may assist the Child Developmental Service Agency in understanding the family’s needs.
10. Provide directions to the family's home to aid in any necessary follow-up visits.
11. Once all fields are filled out, save your changes. You can download, print, or share the form as needed.

Begin filling out the NC DSS-5238 form online today to ensure timely access to early intervention services.