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How to fill out the Adrc Broward Referral Form online
Filling out the Adrc Broward Referral Form online is a crucial step for individuals seeking funded services through the Aging and Disability Resource Center of Broward County. This guide provides clear, step-by-step instructions to help you navigate the form effectively.
Follow the steps to complete the Adrc Broward Referral Form online.
- Click the ‘Get Form’ button to access the referral form and open it in your editing interface.
- Begin by entering the information of the person making the referral, including the referral date, agency or organization, their phone number, email, and fax number.
- Fill in the original referral source, selecting from options like self, relative, or case manager.
- Provide comprehensive consumer information, including their name, Social Security number, phone number, age, date of birth, address, city, and zip code.
- Indicate the consumer's Medicaid status by selecting 'Yes' or 'No' and note if they have a primary caregiver, along with the caregiver's contact information.
- Specify the consumer's relationship to the caregiver, if applicable, and complete additional fields about living arrangements.
- Complete the sections regarding program codes, caregiver names, and any relevant diagnoses or veteran status.
- Fill in the income and asset details for both individuals and couples, along with activity of daily living (ADL) and instrumental activities of daily living (IADL) counts.
- Identify any geographic preferences for different service options such as ADC, ALF, or NH.
- Ensure to complete all additional data requests, including any necessary HIPAA/consent forms and RFA data statuses.
- Enter screener information along with notes, if applicable, before detailing the funded services requested, including frequency and required units.
- After verifying all information is complete and correct, save changes and select your preferred action — download, print, or share the completed form.
Prepare and submit your documents online to ensure you receive the services you need.
ADRC Broward provides a variety of services designed to support older adults and disabled individuals. These include case management, information and referral services, and eligibility assessments for various community resources. By completing the ADRC Broward Referral Form, you can gain access to these comprehensive services, ensuring you receive the assistance that fits your unique needs effectively.