Get Program Application - Price County

This guide provides a comprehensive overview of how to accurately complete the Program Application for Price County. Whether you are applying for yourself or on behalf of someone else, this step-by-step instruction will help ensure that you provide all necessary information clearly and effectively.

Follow the steps to successfully complete the Program Application.

1. Press the 'Get Form' button to access the Program Application and open it in the online form editor.
2. Begin by entering the applicant's name in the designated field at the top of the form.
3. Fill out the Family/Caregiver Information section, including the name, relationship to the applicant, and your authority to enroll the individual in Project Lifesaver®.
4. Provide the home address, fax number, and contact details for both home and work.
5. In the Applicant Information section, enter the full legal name, nickname, specific diagnosis, date of diagnosis, date of birth, current age, height, weight, eye color, hair color, and any distinguishing physical characteristics.
6. Indicate how long the individual has been living at the current address.
7. For Medical Information, answer whether there is any history of becoming lost or wandering, and if so, provide detailed descriptions and dates.
8. List the physician’s contact details who provides treatment to the applicant, and ensure that the physician signs to verify that the applicant may be at risk for wandering.
9. Read through the Liability Release Information section carefully, ensuring you understand the terms before signing.
10. Finally, submit the application by pressing the 'Submit by Email' button at the end of the form, and remember to print a copy for your records.

Complete your Program Application online today to ensure timely processing.