Daas 6219-2026

1. Click ‘Get Form’ to open the daas 6219 in the editor.
2. Begin by filling out the Face Sheet section. Enter the client’s name, sex, race, date of birth (DOB), marital status, education completed, and social security number.
3. Next, provide the client's address details including city, state, and zip code. Indicate if this address is a facility and specify the level of care if applicable.
4. Fill in the client's phone numbers and any directions to their residence or potential dangers that may be relevant.
5. Complete the Emergency Contact section with their relationship to the client, address, and phone numbers.
6. List others in the client's household along with their names, year of birth, and relationship to the client.
7. Provide information about significant others not living with the client including their names and relationships.
8. Incorporate any additional notes or comments as necessary for clarity.

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