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How to use or fill out marc intake with our platform
- Click ‘Get Form’ to open the marc intake in the editor.
- Begin by entering your last name, first name, and middle initial in the designated fields. Ensure accuracy for proper identification.
- Select your gender and enter your date of birth, Social Security Number (SSN), and Document Control Number (DCN) as required.
- Fill in your address, city, phone number, and zip code. Choose your county from the provided options.
- Indicate whether you live alone by selecting 'Y' for Yes or 'N' for No.
- Provide details for your primary emergency contact, including their name, relationship to you, and contact numbers. Confirm if they are aware of their role as an emergency contact.
- Complete the marital status section by selecting the appropriate option that describes your current situation.
- Fill out eligibility criteria based on ethnicity and income sources. Mark all applicable boxes.
- Assess your nutritional status by answering the questions provided. Tally your score based on 'Yes' responses to determine risk level.
- Finally, sign the form as a client and include the date before submitting it through our platform for processing.
Start filling out your marc intake form today using our platform for free!
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