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EAP ASSESSMENT FORM NAME OF PATIENT NAME OF EMPLOYEE REFERRED BY PRIMARY CARE PHYSICIAN INSURANCE REASON FOR EAP REFERRAL DATE OF INITIAL EAP ASSESSMENT PROBLEM ANALYSIS AND SUMMARY ESTIMATE OF ADDITIONAL

How to fill out eap form

How to fill out an EAP form:

1. Start by reading the instructions provided with the form to familiarize yourself with the requirements and purpose of the EAP form.
2. Begin by completing the personal information section of the form, which typically includes your name, contact details, and employee identification number if applicable.
3. Move on to the section where you will provide details about the nature of the emergency. This may include explaining the incident or situation that has occurred and prompted the need for assistance.
4. Next, you may be required to provide information about any individuals involved in the emergency, such as their names, contact information, and their relationship to you if applicable.
5. If there were any witnesses to the emergency, mention their names and contact information in the provided section.
6. Advise any immediate actions or steps you have taken to address the emergency. This could include notifying authorities, seeking medical attention, or ensuring the safety of others.
7. Finally, carefully review the form to ensure all information has been accurately provided and make sure to sign and date the form if required.
8. Submit the completed form to the designated person or department as instructed by your organization.

Who needs an EAP form?

1. Employees seeking assistance during times of personal or work-related emergencies can benefit from completing an EAP form.
2. Employers or organizations may require employees to complete an EAP form to ensure a clear and documented record of emergencies.
3. EAP forms are often used in workplace settings to facilitate prompt and appropriate responses to emergencies, ensuring the well-being and safety of individuals involved.
4. Individuals who have experienced an emergency and require assistance or support from their employer or organizational resources may be asked to fill out an EAP form.
5. EAP forms can be applicable in various situations, including accidents, incidents, health emergencies, workplace violence, natural disasters, or any other unforeseen circumstances that require immediate attention and intervention.

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