Columbus Severity of Service Needs Tool
You may only complete this form if you have been certified to administer this tool. Responses will be submitted only for clients who have been explicitly invited. Please ensure that all information submitted is accurate & true based on your training, professional knowledge and partner agency collaboration (where applicable).
Email address *
Client's First Name, First Letter of Last Name and CSP# (Example: Yolanda Z. #123456) *
Your answer
Physical Health *
Please select description that applies
Mental, Behavioral and Developmental Health *
Please select description that applies
Substance Use *
Please select description that applies
High Utilization of Crisis or Emergency Services to Meet Basic Needs... *
Please select description that applies
Vulnerability to Victimization *
Please select description that applies
Vulnerability to Illness or Death *
Please select description that applies
Barriers to Housing/Risk of Continued Homelessness *
Please select description that applies
Other Risk Factors Determined by the Community that are Based on Severity of Needs *
Please select description that applies
A copy of your responses will be emailed to the address you provided.
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