Get the free 104d-3 Adolescent Initial LOC Assessment Form (pdf). Revised December 2020

Clear Formulaic Name: Client ID: ADOLESCENT Initial Level of Care Assessment Staff completing the form: Date of screening:Place of interview: Referral source (Name & Phone #): (if Referral is from

How to fill out 104d-3 adolescent initial loc

How to fill out 104d-3 adolescent initial loc

1. Step 1: Begin by reading the instructions provided with form 104d-3 adolescent initial loc.
2. Step 2: Gather all the necessary information required to fill out the form, such as the adolescent's personal details, contact information, and any relevant medical or legal history.
3. Step 3: Start filling out the form by providing the adolescent's full name, date of birth, and social security number.
4. Step 4: Proceed to provide the adolescent's current address, including the street, city, state, and zip code.
5. Step 5: If applicable, include the name and contact information of any legal guardian or parent responsible for the adolescent.
6. Step 6: Fill in any additional details required in the form, such as the reason for the initial placement, any previous placements, or any notable medical or behavioral information.
7. Step 7: Once you have completed filling out all the necessary sections of the form, review it for accuracy and make any necessary corrections.
8. Step 8: Sign and date the form as required, providing your name and relationship to the adolescent.
9. Step 9: Submit the completed form as instructed, whether by mail or electronically.

Who needs 104d-3 adolescent initial loc?

1. 104d-3 adolescent initial loc is needed by professionals working in the field of adolescent care, such as social workers, case managers, or healthcare practitioners. It is used to document the initial placement of an adolescent in a particular facility or program, and to gather important information regarding their background, needs, and legal guardianship.

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What is 104d-3 adolescent initial loc?

104d-3 adolescent initial loc refers to an initial location report that must be filed for adolescents under a specific code section.

Who is required to file 104d-3 adolescent initial loc?

The individual or entity responsible for the care of the adolescent is required to file the 104d-3 adolescent initial loc.

How to fill out 104d-3 adolescent initial loc?

To fill out the 104d-3 adolescent initial loc, the responsible individual or entity must provide specific information regarding the adolescent's initial location.

What is the purpose of 104d-3 adolescent initial loc?

The purpose of the 104d-3 adolescent initial loc is to ensure that the appropriate authorities have accurate information regarding the initial location of the adolescent.

What information must be reported on 104d-3 adolescent initial loc?

The 104d-3 adolescent initial loc must include information such as the name, date of birth, and current location of the adolescent.