Daas 6218-2026

1. Click ‘Get Form’ to open the daas 6218 in the editor.
2. Begin by entering the client's name and date at the top of the form. If applicable, include the assigned case number and ID number.
3. Fill in the date of birth and type of contact, selecting from options such as Office Visit, Phone Call, or Home Intake.
4. Indicate any persons involved in the initial referral by checking relevant boxes for family members, friends, physicians, or agencies.
5. Detail the client's level of involvement in the referral/contact by selecting one of the provided options and providing explanations where necessary.
6. Describe presenting problems and additional history regarding duration, efforts, and outcomes.
7. Specify expectations for services requested during the intake interview and indicate if it is urgent.
8. Complete preliminary information across functional domains: Social, Environmental, Mental Health, Physical Health, ADL/IADL, and Economic.
9. Check all applicable dispositions based on your assessment during intake.
10. Finally, ensure to sign and date at the bottom of the form before submitting it via email.

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