Pfi form 2026

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The document is a client information form from the Los Angeles County Department of Mental Health, which collects confidential personal and financial details of clients seeking mental health services. It includes sections for client identification, payor financial information, income sources, asset valuation, and verification of eligibility for various assistance programs. The form also outlines the process for determining financial liability and payment plans related to mental health treatment.

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Click ‘Get Form’ to open the pfi form in the editor.
Begin by entering the CLIENT NAME and CLIENT ID # in the designated fields. Ensure that all personal information is accurate.
Fill out the CONFIDENTIAL CLIENT INFORMATION section, including SS #, DOB, and MARITAL STATUS. Select the appropriate marital status option.
In the PAYOR FINANCIAL INFORMATION section, indicate if there is a third party involved by selecting YES or NO. If applicable, provide details about any insurance coverage.
Complete the LIQUID ASSETS section by entering amounts for savings, checking accounts, and other assets. Calculate total liquid assets and net asset valuation as instructed.
Review all entries for accuracy before signing. Ensure that you affirm the statements made are true and correct.

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