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DTS Client Screening/Referral Form Client Name Date of Birth Insurance Information ? Medicaid ? Self-Pay ? Other Health Insurance Street Address City State and Zip Code Social Security Number Patient

How to fill out dts client screeningreferral form

How to fill out a DTS client screening/referral form:

1. Start by filling out the personal information section of the form. This includes your name, address, contact number, and any other required details.
2. Next, provide information about the referral source. This could be a social worker, counselor, or any other professional who is referring you to the DTS program.
3. Fill in the section that asks for a brief description of your current situation or the reason for seeking the DTS program. Be concise but provide enough information to give a clear understanding of your situation.
4. Provide details about any previous services or treatment you have received. This could include therapy, counseling, or any other relevant programs that you have participated in.
5. If you have any medical or mental health conditions, make sure to include them in the appropriate section. This will help the DTS program understand your specific needs and tailor their services accordingly.
6. Lastly, sign and date the form to indicate that the information provided is accurate and complete.

Who needs a DTS client screening/referral form:

1. Individuals who are seeking assistance or support from the DTS program.
2. Those who have been referred to the DTS program by a professional, such as a social worker or counselor.
3. Individuals who are experiencing challenges or difficulties in their lives and are in need of specialized services and support.

For pdfFiller’s FAQs

What is dts client screeningreferral form?

The DTS client screening/referral form is a document used to assess the needs of clients and refer them to appropriate services or programs.

Who is required to file dts client screeningreferral form?

Service providers or organizations working with clients who may benefit from additional services or programs are required to file the DTS client screening/referral form.

How to fill out dts client screeningreferral form?

The DTS client screening/referral form can be filled out by providing accurate information about the client's needs, current situation, and any services or programs they may require.

What is the purpose of dts client screeningreferral form?

The purpose of the DTS client screening/referral form is to ensure that clients receive the appropriate services or programs to meet their needs.

What information must be reported on dts client screeningreferral form?

Information such as client demographics, current situation, needs assessment, and recommended services or programs must be reported on the DTS client screening/referral form.

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