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Client face sheet for mental health 2026
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- Click ‘Get Form’ to open the client face sheet in the editor.
- Begin by filling in the top section with the HOSP CODE, DMH ID NUMBER, ADMISSION DATE, UNIT PROGRAM CODE, WARD CODE, and TREATMENT PROGRAM CODE. These fields are essential for identification and tracking.
- Next, complete the client’s personal information including NAME, BIRTHDATE, SEX, RACE, and MARITAL STATUS. Use the provided codes for RACE and MARITAL STATUS to ensure accuracy.
- Fill in the ADDRESS, CITY, ZIP CODE, COUNTY OF RESIDENCE (Missouri only), RELIGION, SOCIAL SECURITY NO., and BIRTHPLACE. This information is crucial for demographic purposes.
- Provide details about family background such as FATHER’S NAME and MOTHER’S NAME along with their addresses and phone numbers. If deceased, write 'DECEASED'.
- Indicate any interested parties or best informants who can provide additional information about the client. Include their relationship to the client.
- Complete sections regarding legal guardianship if applicable. Check the appropriate box for LEGAL GUARDIAN or CONSERVATOR.
- Finally, fill in DIAGNOSES AND PROCEDURES using AXIS I through V codes as required. Ensure all necessary signatures are included before submission.
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Related links
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