Get Adrc Options Counseling Intake Form Consumer Information 2020-2025

Completing the ADRC Options Counseling Intake Form Consumer Information is essential for accessing the resources and support you may need. This guide offers clear instructions on how to fill out the form online, ensuring you provide all necessary information accurately.

Follow the steps to fill out the ADRC Options Counseling Intake Form Consumer Information online

1. Click 'Get Form' button to obtain the form and open it for editing.
2. Enter the date in the designated field, ensuring the format is month/day/year (Mo. Day Year).
3. Under 'Method of contact', select the appropriate option for how the consumer will be contacted. Be sure to specify if 'Other'.
4. In the 'Consumer Name' section, clearly print the consumer’s full name.
5. Input the birth date and age of the consumer, following the prescribed format.
6. Provide the consumer's email address and residential address, including apartment number and city.
7. Fill in the county and township details as requested.
8. Optionally, you may enter the consumer's Social Security Number (SSN).
9. Input phone numbers, including TTY, ensuring accuracy for reliable communication.
10. Fill out the 'Race/Ethnicity' and 'Gender' sections by selecting the appropriate options.
11. Indicate if the consumer is a limited English speaker, and specify the language, if needed.
12. If the caller is not the consumer, enter the caller's information accurately. Be sure to describe their relationship to the consumer.
13. Provide details about the living arrangements of the consumer, including the type of housing and the support they provide to dependents.
14. In the 'Disability and Health Information' section, check all relevant types of disabilities and enter any current health conditions.
15. Complete the financial information, such as income and expenses, as accurately as possible.
16. Review the benefits the consumer is currently enrolled in and check the applicable options.
17. Note any referrals made for additional services.
18. Address any specific issues the consumer may have in the 'Issues to Address' section.
19. After thoroughly reviewing the completed form, save changes, download, print, or share the form as required.

Take the necessary steps to complete the ADRC Options Counseling Intake Form online today.