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CAC WMD/Unified Clinics 1000 Oakland Dr. Kalamazoo, MI 49008Phone: 269.387.7073 Fax: 269.387.7050 Email: chhsctac@wmich.edu CTACAssessmentIntakeForm Name of Child:Child's Initials:DOB: Age Category:
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Start by entering your personal information such as name, address, date of birth, and contact information.
02
Fill out information about your medical history, including any allergies, current medications, and past surgeries or medical procedures.
03
Provide details about your current health status, including any symptoms or concerns you may have.
04
Answer questions about your lifestyle habits such as diet, exercise, smoking, and alcohol consumption.
05
Review the form for accuracy and completeness before submitting it to the CTAC assessment team.

Who needs ctac assessment intake form?

01
Individuals who are seeking comprehensive health assessments and care planning from the CTAC (Comprehensive Transitional Care for Acutely Ill Patients) program.
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The ctac assessment intake form is a form used to gather information about an individual's needs and abilities in order to determine the appropriate level of care and support.
Anyone seeking assistance or services from the Community Treatment and Assistance Center (CTAC) is required to file the ctac assessment intake form.
The ctac assessment intake form can be completed online or in person at the CTAC office. It requires basic personal information, medical history, and details about the individual's needs.
The purpose of the ctac assessment intake form is to assess an individual's needs and determine the level of care and support they require.
The ctac assessment intake form requires information about the individual's medical history, current health status, daily living activities, and any support services they are already receiving.
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