Get the free Shelter Intake-Medical History Form - futureswithoutviolence

24 Hour Intake Interview The Haven Shelter and Services, Inc. Date: Time: Staff/Interviewer: Participant Code: Gender: Race: Age: Locality: Disability Yes No If yes, is it a result of domestic or

How to fill out shelter intake-medical history form

1. To fill out a shelter intake-medical history form, start by gathering all relevant personal and medical information. This includes your full name, contact information, date of birth, and any previous medical conditions or allergies you may have.
2. Next, provide information about your current living situation. This includes your current address, whether you are homeless or at risk of homelessness, and any specific concerns or needs you may have related to housing.
3. The form will likely ask for details about your medical history. Provide information about any past surgeries or hospitalizations, chronic illnesses or conditions you currently have, and any medications you are currently taking. Be sure to include any mental health conditions or substance abuse issues as well.
4. In addition to medical history, the form may ask about your social history. This can include information about your employment status, education level, and any previous or current involvement with the criminal justice system.
5. It's important to be honest and thorough when filling out the form. Providing accurate information will help healthcare professionals assess your medical needs and provide appropriate care.
6. The shelter intake-medical history form may be required for individuals seeking shelter or housing assistance, particularly those experiencing homelessness or at risk of homelessness. It helps service providers gather important information that can inform their decision-making and tailor services to individual needs.

Remember, each shelter or organization may have slightly different versions of this form, so it's important to carefully read and follow the instructions provided. If you have any questions or need assistance, don't hesitate to ask the staff or volunteers at the shelter or organization you are working with.

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What is shelter intake-medical history form?

Shelter intake-medical history form is a document that collects information about a person's medical history upon entering a shelter.

Who is required to file shelter intake-medical history form?

Any individual seeking shelter services is required to file a shelter intake-medical history form.

How to fill out shelter intake-medical history form?

To fill out the shelter intake-medical history form, one must provide accurate and detailed information about their medical history as requested on the form.

What is the purpose of shelter intake-medical history form?

The purpose of the shelter intake-medical history form is to ensure that shelter staff have a comprehensive understanding of an individual's medical needs and history in order to provide appropriate care.

What information must be reported on shelter intake-medical history form?

The shelter intake-medical history form typically requires information about past illnesses, allergies, medications, surgeries, and other relevant medical information.