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1915 i assessment-2026
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- Click ‘Get Form’ to open the 1915 i assessment in the editor.
- Begin by filling out the Demographic Information section. Enter details such as SLA Number, Assessment Date, Recipient Name, Age, DOB, Ethnicity, Medicaid Number, Gender, and other relevant fields.
- Proceed to the Behavioral Health History section. Here, document the Chief Complaint in the recipient's own words and provide a detailed Presenting Problem/Historical context.
- In the Substance Abuse/Dependence section, check all applicable boxes regarding past substance use and treatment history. Be thorough in detailing any current substances used.
- Continue through each section methodically, ensuring that you complete Current Medical Conditions and Current & Past Medications accurately.
- Finally, review your entries for accuracy before saving or sharing the completed form using our platform’s features for easy distribution.
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| Versions | Form popularity | Fillable & printable |
|---|---|---|
| 2014 | 4.8 Satisfied (12404 Votes) |
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1915 i form
(1) Perform a face-to-face assessment of the individual by an agent who is independent and qualified as defined in 441.730, and with a person-centered processRead more
Jan 26, 2023 NC Medicaid, Division of Health Benefits 2501 Mail Service Center Raleigh, NC 27699-2501 NC Medicaid Contact Center Phone: 888-245-0179.Read more