Kentucky Personal Identifier Data Sheet (Mental Health-Disability/Incompetency)

State:
Kentucky
Control #:
KY-SKU-0151
Format:
PDF
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Description

Personal Identifier Data Sheet (Mental Health-Disability/Incompetency)

The Kentucky Personal Identifier Data Sheet (Mental Health-Disability/Incompetency) is a form used by the Kentucky Department of Mental Health and Substance Abuse Services to collect information about individuals with mental health disabilities or in competencies. The form is used to collect personal information such as name, address, contact information, date of birth, Social Security number, and other demographic information. It also requires individuals to provide information about their disability or incompetency and how it affects their ability to function in daily life. The form also includes questions about the individual's current living situation, mental health care, and any other relevant information. There are two types of Kentucky Personal Identifier Data Sheets (Mental Health-Disability/Incompetency): one for individuals who are currently receiving mental health services and one for those who have been evaluated by a mental health professional and determined to be incompetent or have a mental health disability. Both forms must be completed and signed by the individual in order to be used for program eligibility and services.

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Kentucky Personal Identifier Data Sheet (Mental Health-Disability/Incompetency)