Service Coordination Case Management Individual Family History I - mh alabama 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out the Identifying Data section. Enter the individual's name, date of report, placement type, individual number, address, date of birth, age, home phone, work phone, sex, race, marital status, height, weight, religious preference, and legal status/guardianship appointed.
3. Proceed to the Referral Information section. Provide the reason for referral, referral source, and date of referral.
4. In the Assessment Information section, input details regarding IQ test name/date and FSIQ score/level.
5. Complete the Individual Financial Information section by detailing sources of income and Medicaid information.
6. Fill out the Family History/Relationships section. Include marital status of natural parents and detailed information about both parents.
7. Continue with Prenatal/Developmental/Health History by documenting pregnancy history and developmental milestones.
8. Finally, review all sections for accuracy before saving or sharing your completed form using our platform's features.

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