Connecticut department of mental health and addiction servicesddap 2010 form-2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out the Client Information section. Enter the client's name, social security number, date of birth, provider client ID, and address details including street address, city, state, and zip code.
3. In the Admission section, input the admission date and program details. Ensure accuracy as this information is crucial for record-keeping.
4. Proceed to the Discharge section. Fill in the discharge date and select a reason from the provided options by checking the appropriate box.
5. On Page 2, enter clinical diagnoses under Axis I, II, and III. Provide detailed descriptions for each diagnosis listed.
6. For Axis IV, indicate any relevant psychosocial problems by selecting 'Yes' or 'No' for each item listed.
7. Finally, complete Axis V by entering a GAF score between 0 and 100 to assess overall functioning.

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