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MI Adult Intake Assessment Form 2020-2025 free printable template

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ADULT INTAKE ASSESSMENT FORM Jason G. Stenosis, Pay. D., Licensed Psychologist 4572 S. Hag adorn, Suite 2B, East Lansing, MI 48823 Please answer all the following questions to the best of your ability
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How to fill out MI Adult Intake Assessment Form

01
Begin by obtaining a copy of the MI Adult Intake Assessment Form.
02
Fill in the client's personal information such as name, date of birth, and contact details.
03
Provide details about the client's medical history, including any current medications and medical conditions.
04
Answer questions regarding the client's mental health history, including previous diagnoses and treatments.
05
Include information on the client's substance use history, if applicable.
06
Document the client's social history, including family background, living situation, and support systems.
07
Assess the client's current functioning across various domains (e.g., employment, relationships).
08
Review the risk assessment section and note any potential safety concerns.
09
Conclude with the client’s goals for treatment and any additional remarks.
10
Ensure the form is signed and dated by both the client and the assessor.

Who needs MI Adult Intake Assessment Form?

01
Individuals seeking mental health services or assessments.
02
People undergoing treatment for substance use disorders.
03
Clients referred to mental health professionals for comprehensive evaluations.
04
Social workers or case managers coordinating care for individuals.
05
Any organization providing mental health or substance use treatment services.
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The MI Adult Intake Assessment Form is a document used to gather comprehensive information about an individual's mental health and social history to assess their needs and eligibility for services.
Individuals seeking mental health services for adults within the Michigan Department of Health and Human Services system or related providers are required to file the MI Adult Intake Assessment Form.
To fill out the MI Adult Intake Assessment Form, individuals should provide accurate personal information, medical history, current mental health status, and any relevant behavioral or social information. It is recommended to follow the form's guidelines and seek assistance if needed.
The purpose of the MI Adult Intake Assessment Form is to evaluate the needs of the individual, guiding the development of a personalized treatment plan and ensuring appropriate services are provided.
The MI Adult Intake Assessment Form must report personal demographics, medical and psychiatric history, current medications, substance use history, social history, and any immediate needs or concerns related to mental health.
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