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STATE OF CONNECTICUT DEPARTMENT OF SOCIAL SERVICESELECTRONIC HEALTH SCREEN L I E N TD A T A Client Name(Last) (First) (M.I.) Sex DOB Social Security # DSS # Client Home Address(Street) (Town/City)
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The ELECTRONIC HEALTH SCREEN is a Word document needed to be submitted to the specific address to provide certain information. It has to be completed and signed, which can be done in hard copy, or with the help of a certain software e. g. PDFfiller. It lets you complete any PDF or Word document directly in your browser, customize it depending on your needs and put a legally-binding electronic signature. Right after completion, the user can easily send the ELECTRONIC HEALTH SCREEN to the appropriate person, or multiple ones via email or fax. The blank is printable too because of PDFfiller feature and options offered for printing out adjustment. In both electronic and in hard copy, your form should have a clean and professional appearance. You may also save it as the template to use it later, without creating a new blank form again. Just customize the ready document.

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Electronic health screen is a digital tool used to collect and analyze health information of individuals.
Healthcare providers and facilities are required to file electronic health screen.
Electronic health screen can be filled out online through a secure portal or software provided by the relevant health authority.
The purpose of electronic health screen is to track and monitor individuals' health status, identify potential health risks, and provide timely interventions.
Information such as medical history, current symptoms, medication usage, and lab test results must be reported on electronic health screen.
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