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AFC23 9/09 INITIAL CONTACT/SCREENING FORM Date: Prospective Residents Name: Address Phone: Age: Height: Weight: Current Physical Health Condition: Diagnosis and Prognosis: Activities of Daily Living
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How to fill out initial contactscreening form
How to fill out the initial contact screening form:
01
Start by reviewing the form and familiarizing yourself with the required information. Look for sections such as personal details, contact information, medical history, and any specific questions related to the purpose of the screening.
02
Begin by providing your full name, date of birth, and any other requested personal information. Ensure that the details are accurately entered to avoid any confusion.
03
Move on to the contact information section and provide your current address, phone number, and email address. Make sure to update these details if there have been any recent changes.
04
If the form includes a section for medical history, carefully answer the questions related to any pre-existing medical conditions, allergies, or medications you may be taking. Be truthful and provide as much detail as possible to assist with the screening process.
05
Some forms may require additional information specific to the purpose of the initial contact screening. Answer these questions honestly and provide any requested details to the best of your knowledge.
06
Take the time to review your answers and make any necessary corrections or additions before submitting the form. Double-check that all required sections have been completed.
07
If you have any doubts or questions while filling out the form, seek clarification from the appropriate individual or organization. It's important to have a clear understanding of the information being requested.
Who needs the initial contact screening form:
01
Organizations or institutions conducting screenings for various purposes, such as healthcare facilities, schools, companies, or government agencies, may require individuals to fill out the initial contact screening form.
02
Individuals who are seeking medical assistance, participating in research studies, applying for a job, or enrolling in educational institutions may be asked to complete the initial contact screening form.
03
The form helps in evaluating the eligibility, health status, and potential risks associated with the person's involvement or inclusion in the specific activity or program.
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What is initial contact screening form?
The initial contact screening form is a document used to collect basic information about individuals who are initiating contact with a particular organization.
Who is required to file initial contact screening form?
Individuals who are initiating contact with a particular organization may be required to file the initial contact screening form.
How to fill out initial contact screening form?
The initial contact screening form can be filled out by providing the requested information accurately and completely.
What is the purpose of initial contact screening form?
The purpose of the initial contact screening form is to gather important information about individuals who are reaching out to a specific organization.
What information must be reported on initial contact screening form?
The initial contact screening form may require information such as contact details, reason for contact, and any relevant background information.
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