Post on 27-Aug-2019
3008 Report
PSA: ALL Start Date: 01/01/2017 End Date: 12/31/2017
PSA: 02B
3008 3008 Date Incomplete 3008 Date Incomplete 3008 Staffing Info Initial Re-Assm StaffingClient Name Client ID Received Complete Received by CARES Returned by CARES Received Date Date Requested Instr
1001141852 N 07/03/2017
1001141823 Y Y 04/11/2018
4061818230 Y Y 11/16/2017
1001141370 N 01/01/2017
TEST, NAMETEST, NAMETEST, NAMETEST, NAMETEST, NAME 1001141127 N 02/10/2017
Total # of Clients Total # of Clients Total # of Clients Total # of Clients Total # of Clients with anTotal # of with a Yes in 3008 with a No in 3008 with a Yes in 3008 with a No in 3008 entry in Date IncompleteClients
Received field Received field Complete field Complete field 3008 Returned by CARES
5 2 3 2 0 0
PSA: 03A
03/01/2017 07/01/2017 U
05/31/2017 U
11/09/2017 U
01/01/2017 V
01/01/2017 02/02/2017 P
Total Days from Incomplete 3008 Returned to Staffing Info Received
Date when Staffing Instrument=U
0
Client Name Client ID 3008 Received
3008 Complete
Date Incomplete 3008 Received by CARES
Date Incomplete 3008 Returned by CARES
Staffing Info Received Date
Initial Date
Re-Assm Requested
Staffing Instr
4062083024 Y Y 10/07/2017 10/07/2017 U
4062107449 Y Y 12/29/2017 12/29/2017 O
4061958559 Y Y 11/12/2017 11/12/2017 P
4062616126 Y Y 12/29/2017 12/23/2017 U
4062088038 Y Y 12/29/2017 12/23/2017 U
4062756188 Y Y 12/15/2017 12/15/2017 P
4062697501 Y Y 11/06/2017 09/09/2017 11/16/2017 U
4062213150 Y Y 10/22/2017 10/05/2017 U
4061819129 Y Y 11/23/2017 11/19/2017 U
4062471871 Y Y 09/18/2017 09/17/2017 V
4061478850 Y Y 12/30/2017 12/15/2017 U
4061819102 Y Y 10/23/2017 09/26/2017 U
4062171383 Y Y 10/09/2017 10/09/2017 U
4061828183 Y Y 11/11/2017 11/11/2017 U
TEST, NAMETEST, NAMETEST, NAMETEST, NAMETEST, NAMETEST, NAMETEST, NAMETEST, NAMETEST, NAMETEST, NAMETEST, NAMETEST, NAMETEST, NAMETEST, NAMETEST, NAME 4062400544 Y Y 12/30/2017 12/30/2017 U
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Aging Network Provider Information Report PSA: ALL
Address PSA Provider Loc Provider Name Type Provider Address Telephone #
01 1147 B
1147
0072 Provider Name
0073 Provider Name B
1147
1147
0100 Provider Name
0179 Provider Name B
1271 B
1271 B
1271
0000 Provider Name
0001 Provider Name
0002 Provider Name B
1271 B
1271
0003 Provider Name
0004 Provider Name B
1271 B
1271
0072 Erovider Name
0073 Provider Name B
1271 0100 Provider Name B
1271 B
1271 B
1271 B
1271 B
1271
0101 Provider Name
0138 Provider Name
0179 Provider Name
0286 Provider Name
0287 Provider Name B
123 Test CALICO DRIVE, STAYTON, FL 59255
123 TestCOTTA STREET, DARRINGTON, FL 57399
123 TestROAD, DARRINGTON, FL 57399
123 Test LANE, Bonum integritas corporis: misDARRINGTON, FL 58398
123 Test SUNNYVALE, MO 83407
1123 Test STREET, DARRINGTON, FL 58398
123 Test STREET, DARRINGTON, FL 68396
123 Test WAY, MORRISONS CROSSROADS, AL 33165
123 Test DRIVE, MIDVILLE, FL 93176 2545 PIKE
123 Test, BELLOWS FALLS, FL 48405
123 Test STREET, SUSSEX, FL 78170
123 Test DRIVE, SUSSEX, FL 18398 4939
123 Test BLYTHEVILLE, FL 14027
123 Test STREET, SUSSEX, FL 78170 3564
LAKE FLOYD CIRCLE, SUSSEX, FL 78170
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Aging Network Provider Information Report PSA: ALL
PSA Provider Loc Provider Name Address Type Provider Address Telephone #
11 1952 B
1952 B
1952 B
1952 B
1952 B
1952 B
1952 B
123 Provider 3789 WHITE RIVER WAY, OHATCHEE,
FL 45235
123 Provider LANE, WHITE CLOUD, FL 46226
123 Provider DRIVE, NEOSHO, FL 06231
123 Provider DRIVE, WHITE CLOUD, FL 16168 3678
123 Provider LANE, WHITE CLOUD, FL 06231 184 123
Provider VIEW DRIVE, WHITE CLOUD, FL 93236
1952
1955
1956
B 123 Provider WHITE CLOUD, FL 70226
1957
0112 Provider Name
0114 Provider Name
0116 Provider Name
0117 Provider Name
0407 Provider Name
1828 Provider Name
1829 Provider Name
2167 Provider Name
0072 Provider Name
0072 Provider Name
0072 Provider Name B 123 Provider STREET, Sed ad rem redeamus; Comprehen WHITE CLOUD, FL 38227
1957
1958
Count:
0474 Provider Name
0072 Provider Name
427
B 123 Provider BRANCH ROAD, Quid ergo hoc loco intellegit WHITE CLOUD, FL 25224
Count Total: 3,117
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Assessment Delay Report Start Date: 01/01/2017 End Date: 01/01/2017
PSA: 02 Initial
Client Name Client ID Contact Date Assessment Delay
Assessment Delay Reason Assessment Date #Days Initial Contact to Assm Date
1001141670
1001141617
TEST, NAMETEST, NAMETEST, NAME 1001141666
01/01/2017
01/01/2017
01/01/2017
Total # of Total # of Clients Total # of Clients Clients with Assessment with Assessment
Delay of No Delay of Yes
3 0 0
Total # of Clients with Assessment Delay Reason of CLU
0
Total # Days Delay from Total # of Clients Total # Days Delay from Initial Contact Date to with Assessment Initial Contact Date to Assessment Date for Delay Delay Reason of Assessment Date for Delay Reason of CLU CRU Reason of CRU
0 0 0
PSA: 02B Initial
Client Name Client ID Contact Date Assessment Delay
Assessment Delay Reason Assessment Date #Days Initial Contact to Assm Date
1001141718
1001141496
1001141170
1001141273
1001141425
1001141370
TEST, NAMETEST, NAMETEST, NAMETEST, NAMETEST, NAMETEST, NAMETEST, NAME 1001141503 TEST, NAME 1001141608
01/01/2017
01/01/2017
01/01/2017
01/01/2017
01/01/2017
01/01/2017
01/01/2017
01/01/2017
Total # of Total # of Clients Total # of Clients Clients with Assessment with Assessment
Delay of No Delay of Yes
8 0 0
Total # of Clients with Assessment Delay Reason of CLU
0
Total # Days Delay from Total # of Clients Total # Days Delay from Initial Contact Date to with Assessment Initial Contact Date to Assessment Date for Delay Delay Reason of Assessment Date for Delay Reason of CLU CRU Reason of CRU
0 0 0
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Cases By Zipcode PSA: ALL Start Date: 01/01/2017 End Date: 12/31/2017
Zip Code Count
07960 1
10065 1
28732 1
30078 1
30725 1
31537 1
31548 1
31562 1
31606 1
32003 17
32008 6
32011 12
32024 20
32025 41
32033 3
32034 25
32038 7
32040 4
32043 26
32044 4
32046 20
32052 23
32053 17
32054 13
32055 33
32058 3
32060 44
32061 1
32062 3
32063 27
32064 45
32065 23
32066 12
32068 42
32071 7
32073 50
32079 1
32080 21
32081 2
32082 11
32084 54
32085 1
32086 68
32087 2
32091 39
32092 19
32094 1
32095 6
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Client List for Diversion Report on Hospital-Based Clients Assessed by CARES
PSA: ALL Start Date: 01/01/2017 End Date: 12/31/2017
Client Name Client ID Staffing Date
Followup Completed Date
Placement Recom
Program Recom
Living Arrangments
Closing Date Reason
4061739420 11/11/2017 HOSP NONE HOSP 11/12/2017 IH
PSA: 03A
TEST, NAME
Total Clients: 1
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Client List for Diversions Report on Clients Assessed by CARES PSA: ALL Case Worker: ALL
Start Date: 01/01/2017 End Date: 12/31/2017
Client Name Client ID Staffing Date
Followup Completed Date
Placement Program Living Recom Recom Arr.
Closing Date
Closing Reason
Assignment Caseworker
Assessment Caseworker
Staffing Caseworker
PSA: 02B
TEST, NAME 4061818230 11/18/2017 NHTR NONE NUHO
12/11/2017 PRRE ADHC PRRE
02/28/2018 PRRE NONE PRRE
05/31/2018 PRRE NONE PRRE
PSA: 03A
TEST, NAME, 4062083024 11/04/2017 NUHO NONE NUHO 11/05/2017 IN TEST, NAME TEST, NAME, 4062616126 12/30/2017 NUHO NONE NUHO 12/30/2017 IN TEST, NAMETEST, NAME, 4062088038 12/30/2017 NUHO NONE NUHO 12/30/2017 IN TEST, NAME TEST, NAME 4062697501 10/14/2017 OTHR NONE ALFE 12/11/2017 IN
11/10/2017 OTHR NONE ALFS
TEST, NAME 4062697501 11/25/2017 NUHO NONE ALFS 12/11/2017 IN
12/11/2017 NUHO NONE NUHO
PRRE LTCP PRRE 04/07/2018 IN
12/07/2017 PRRE LTCP PRRE
01/08/2018 NUHO NONE NUHO
NHTR ALFW NUHO 01/07/2018 WA
01/07/2018 ALFE ALFW ALFE
NUHO NONE NUHO 11/06/2017 IN
NHTP NONE NUHO 04/13/2018 CC
TEST, NAME 4062213150 10/28/2017
TEST, NAME 4061819129 11/25/2017
TEST, NAME 4061819129 10/28/2017
TEST, NAME, 4061478850 12/30/2017 01/25/2018 NHTP NONE NUHO
04/04/2018 NHTP NONE NUHO
04/13/2018 OTHR NONE OTHR
TEST, NAME 4061819102 10/28/2017 NUHO NONE NUHO 10/28/2017 IN
TEST, NAME 4062171383 11/04/2017 NUHO NONE NUHO 11/05/2017 IN
NUHO NONE NUHO 11/26/2017 IN TEST, NAME, 4061828183 11/25/2017 TEST, NAME 4062082124 11/13/2017
OTHR NONE NUHO 04/11/2018 IN
12/21/2017 NHTP NONE NUHO
01/20/2018 NHTP NONE NUHO
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Client List for Diversions Report on Clients Not Assessed by CARES PSA: ALL Start Date: 01/01/2017 End Date: 12/31/2017
Client Name Client ID
Followup Staffing Completed Date Date
Placement Program Living Closing Assignment Assessment Staffing Recom Recom Arr. Date Reason Caseworker Caseworker Caseworker
1001141852 07/03/2017 SHNH NONE TRAN
1001141330 01/01/2017 OTHR OTHR NUHO
4061958559 11/25/2017 PRRE PACW PRRE 11/26/2017 NN
4062756188 12/23/2017 PRRE PACW PRRE 01/01/2018 NN
4062471871 09/30/2017 PRRE ADAW PRRE 10/05/2017 NN
4061904133 12/02/2017 PRRE ADAW PRRE 01/04/2018 NN
4061922624 12/02/2017 PRRE PACW PRRE 01/04/2018 NN
4062693005 10/14/2017 ALFE ALFW ALFE 10/15/2017 NN
4061679724 11/04/2017 PRRE ADAW PRRE 11/13/2017 NN
4062105797 11/25/2017 PRRE BSCW PRRE 01/01/2018 NN
PSA: 02B
TEST, NAME
TEST, NAME
PSA: 03A
TEST, NAME
TEST, NAME
TEST, NAME
TEST, NAME
TEST, NAME
TEST, NAME
TEST, NAME
TEST, NAME
TEST, NAME 4062396239 12/02/2017 PRRE ADAW PRRE 02/20/2018 NN
4062278452 10/19/2017 PRRE ADAW PRRE 10/22/2017 NN
4061911034 10/28/2017 PRRE ADAW PRRE 11/06/2017 NN
4062242835 11/25/2017 PRRE ADAW PRRE 11/30/2017 NN
4062771450 12/09/2017 OTHR NONE PRRE 01/01/2018 GA
4062331214 10/19/2017 PRRE ADAW PRRE 10/22/2017 NN
4062523428 12/23/2017 PRRE PACW PRRE 12/24/2017 NN
4062530819 12/11/2017 ALFS LTCP ALFS 01/22/2018 NN
4061855257 11/19/2017 PRRE ADAW PRRE 11/20/2017 NN
4061997366 12/23/2017 PRRE ADAW PRRE 01/01/2018 NN
4061866567 12/16/2017 PRRE ADAW PRRE 12/17/2017 NN
TEST, NAME
TEST, NAME
TEST, NAME
TEST, NAME
TEST, NAME
TEST, NAME
TEST, NAME
TEST, NAME
TEST, NAME
TEST, NAME
TEST, NAME 4061416950 11/25/2017 PRRE ADAW PRRE 01/01/2018 NN
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Client List for Temporary Nursing Home Diversion PSA: ALL Start Date: 01/01/2017 End Date: 12/31/2017
Client Name Client ID
Followup Staffing Completed Date Date
Placement Program Living Closing Recom Recom Arrangements Date Reason
PSA: 03A
TEST, NAME 4061478850
4061733196
12/30/2017
01/25/2018
04/13/2018
04/04/2018
09/30/2017
NHTP NONE NUHO 04/13/2018 CC
NHTP NONE NUHO
OTHR NONE OTHR
NHTP NONE NUHO
NHTP NONE NUHO 10/06/2017 IN
4062432224 09/17/2017 NHTP NONE NUHO 01/06/2018 CD
4061512840
TEST, NAMETEST, NAMETEST, NAMETEST, NAMETEST, NAME
TEST, NAME 4062222339
06/10/2017
09/30/2017
NHTP NONE NUHO 03/29/2018 IN
NHTP NONE PRRE 11/06/2017 IN
TEST, NAME 4062769539
TEST, NAME 4061813883
TEST, NAME 4061847760
4062433674
12/09/2017
01/04/2018
12/16/2017
01/20/2018
06/02/2018
03/22/2018
12/09/2017
01/04/2018
09/30/2017
NHTP NONE NUHO 01/04/2018 CC
PRRE NONE PRRE
NHTP NONE NUHO 06/02/2018 IN
NHTP NONE NUHO
NUHO LTCN NUHO
NHTP LTCN NUHO
NHTP NONE NUHO 01/04/2018 IN
NUHO NONE NUHO
NHTP NONE NUHO 10/26/2017 CC TEST, NAME
TEST, NAME 4061729827
TEST, NAME 4062614175
TEST, NAME 4061917292
4062268628
4062433676
09/30/2017
11/09/2017
12/21/2017
08/12/2017
09/12/2017
12/09/2017
01/20/2018
12/09/2017
01/20/2018
09/30/2017
NHTP NONE NUHO 12/21/2017 LC
PRRE NONE PRRE
PRRE NONE PRRE
NHTP NONE NUHO 03/14/2018 WA
NHTP NONE NUHO
NHTP NONE HOSP 01/20/2018 LC
PRRE NONE PRRE
NHTP NONE NUHO 03/02/2018 LC
PRRE NONE PRRE
NHTP NONE NUHO 10/06/2017 IN
4062784976
4062093750
4062091720
4061726089
09/30/2017
12/30/2017
03/02/2018
03/22/2018
12/09/2017
03/03/2018
02/05/2018
12/30/2017
NHTP NONE NUHO 10/06/2017 IN
NHTP NONE NUHO 03/22/2018 LC
PRRE NONE PRRE
PRRE NONE PRRE
NHTP NONE NUHO 03/03/2018 IH
HOSP NONE HOSP
NHTP NONE NUHO
NHTP NONE NUHO 01/25/2018 CC
TEST, NAME
TEST, NAME
TEST, NAMETEST, NAME
TEST, NAME
TEST, NAME
TEST, NAME
4062442660 11/11/2017 NHTP NONE NUHO 11/11/2017 NN
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CODE DESCRIPTIONS Category: MEDICAID_ELIGIBILITIES
Code Description Active Available To Code Category
A01 COMMUNITY AGED SSI-DA Y CIRTS MEDICAID_ELIGIBILITIES
A50 COMMUNITY AGED CHANNELING ICP Y CIRTS MEDICAID_ELIGIBILITIES
A51 COMMUNITY AGED ICP/HCBS Y CIRTS MEDICAID_ELIGIBILITIES
A54 AGED HOSPICE Y CIRTS MEDICAID_ELIGIBILITIES
A65 INSTITUTIONAL AGED SSI Y CIRTS MEDICAID_ELIGIBILITIES
A66 INSTITUTIONAL AGED ICP Y CIRTS MEDICAID_ELIGIBILITIES
A68 INSTITUTIONAL AGED MEDS-AD Y CIRTS MEDICAID_ELIGIBILITIES
A78 COMMUNITY AGED MEDS-AD Y CIRTS MEDICAID_ELIGIBILITIES
B01 COMMUNITY BLIND SSI-DA Y CIRTS MEDICAID_ELIGIBILITIES
D01 COMMUNITY DISABLED SSI-DA Y CIRTS MEDICAID_ELIGIBILITIES
D50 COMMUNITY DISABLED CHANNEL ICP Y CIRTS MEDICAID_ELIGIBILITIES
D51 COMMUNITY DISABLED ICP/HCBS Y CIRTS MEDICAID_ELIGIBILITIES
D54 DISABLED HOSPICE Y CIRTS MEDICAID_ELIGIBILITIES
D65 INSTITUTIONAL DISABLED SSI Y CIRTS MEDICAID_ELIGIBILITIES
D66 INSTITUTIONAL DISABLED ICP Y CIRTS MEDICAID_ELIGIBILITIES
D68 INSTITUTIONAL DISABLED MEDS-AD Y CIRTS MEDICAID_ELIGIBILITIES
D78 COMMUNITY DISABLED MEDS-AD Y CIRTS MEDICAID_ELIGIBILITIES
L02 QUALIFIED MEDICARE BENEFICIARY Y CIRTS MEDICAID_ELIGIBILITIES
M61 MEDICALLY NEEDY AGED Y CIRTS MEDICAID_ELIGIBILITIES
M62 MEDICALLY NEEDY DISABLED Y CIRTS MEDICAID_ELIGIBILITIES
R01 AGED REFUGE DIRECT ASSIST-SSI Y CIRTS MEDICAID_ELIGIBILITIES
S01 BLIND REFUGE DIRECT ASSIST-SSI Y CIRTS MEDICAID_ELIGIBILITIES
U01 DISABLED REFUGE DIR ASSIS-SSI Y CIRTS MEDICAID_ELIGIBILITIES
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Count of All PAC Cases by Case Closed Reason
PSA: ALL Start Date: 01/01/2017 End Date: 12/31/2017
NO LONGER NEEDED Total
03A 44 44
03B 74 74
04A 273 273
04B 35 35
Total 426 426
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates With CIRTS - Open Case Report
PSA: ALL
The Vital Statistics Data for: 07/19/2002 - 09/11/2014
PSA Client ID Cirts Name Vital Statistics Name Vital Stat DOD CIRTS DOB Vital Stat DOB
02B 1001141746
1001141747
Count for PSA: 2
TEST, NAME
TEST, NAME
TEST, NAME
TEST, NAME
07/21/2006
11/20/2005
10/29/1928
08/12/1946
10/29/1928
08/12/1946
Report Count: 2
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Diversion (Alternative Placements) on Clients Assessed by CARES Start Date: 01/01/2017 End Date: 12/31/2017 CaseWorker: ALL
PSA: 02B Statistical Summary By Placement Recommendations
Total Clients: 1
Community
Initial 30-day 90-day
1 1 1
Annual
0
Temprary NH 0 0 0 0
Nursing Home 0 0 0 0
Terminated 0 0 0 0
Not Done or Due 0 0 0 1
Statistical Summary By Living Arrangements
Community
Initial 30-day 90-day
0 1 1
Annual
0
Nursing Home 1 0 0 0
Terminated 0 0 0 0
Not Done or Due 0 0 0 1
Diversion Rate: 100 %
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Diversion Report based on Care Level, PR and Living Arrangement at 30 Days Staffing
Start Date: 01/01/2017 End Date: 12/31/2017
Report on Cases Assessed by CARES
PSA: 03A
Total Clients Community Placement Recommedation at Staffing Community Living Arrangement 30 days from Staffing
Number Percent Number Percent
338 50 14.79% 26 7.69%
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Diversion Report on Hospital-based (Upstreaming) Clients Assessed by CARES
PSA: ALL Start Date: 01/01/2017 End Date: 12/31/2017
PSA: 03A
Total Clients: 1
Community
Temprary NH
Nursing Home
Terminated
Not Done or Due
Community
Nursing Home
Terminated
Not Done or Due
Statistical Summary By Placement Recommendations
Initial 30-day 90-day
0 0 0
0 0 0
0 0 0
0 0 0
1 1 1
Statistical Summary By Living Arrangements
90-dayInitial 30-day
0 0 0
0 0 0
0 0 0
1 1 1
Diversion Rate: 0 %
Annual
0
0
0
0
1
Annual
0
0
0
1
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DIVERSION BARRIER REPORT Start Date: 01/01/2017 End Date: 01/01/2017
Code Description Code 01 02A 02B 03A 03B 04A 04B 05A 05B 06A 06B 07A 07B 08 09A 09B 10 11A 11B Total
WTL WAITLIST ASSISTIVE CARE/OSS WLAC 0 0 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3
Sub-Total: 0 0 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3
Total Diversion Barriers by PSA: 0 0 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3
*CRR Transition Barriers from separate report
Total Diversion & Transition Barriers:
Total Number of Clients served: 0 0 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3
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Imminent Risk Referral Disposition Report
Case Worker: ALL Start Date: 01/01/2017 End Date: 12/31/2017
PSA: 02B
NH Referral Imm Response Response Referral Disposition Denial Admit Transition
Client Name Client ID Referred To Provider Name Date Risk Date Type Disposition Date Reason Date Referral
TEST, NAME 4061818230 ARC or ADRC 11/19/17 Y 11/26/17 WRITTEN/CASE APPROVED NO DATA 09/02/2017Y MGR ENTERED
PSA 02B Total: 1
PSA: 03A
NH Referral Imm Response Response Referral Disposition Denial Admit Transition
Client Name Client ID Referred To Provider Name Date Risk Date Type Disposition Date Reason Date Referral
4061512840 MANAGED CARE TEST, NAMEORG
TEST, NAME 4062003243 MANAGED CARE ORG
4061561263 ARC or ADRC TEST, NAMETEST, NAME
4061934899 ARC or ADRC
PSA 03A Total: 4
PSA: 03B
NORTHERN VITAGREY 07/22/17 Y 07/28/17 TELEPHONE APPROVED NO DATA 01/02/2015Y CALL/CARES ENTERED
12/25/17 Y 03/15/18 WRITTEN/CASE APPROVED NO DATA 09/07/2017Y MGR ENTERED
09/24/17 Y 12/10/17 WRITTEN/CASE DENIED NOT 05/29/2017Y MGR ELIGIBLE
07/15/17 Y 12/10/17 TELEPHONE APPROVED NO DATA N CALL/CARES ENTERED
NH Referral Imm Response Response Referral Disposition Denial Admit Transition
Client Name Client ID Referred To Provider Name Date Risk Date Type Disposition Date Reason Date Referral
TEST, NAME 4061596018 MANAGED CARE WESTERN LOCOST 11/17/17 Y 12/18/17 TELEPHONE APPROVED NO DATA 05/05/2017Y ORG ACCESSORIES CALL/CARES ENTERED
TEST, NAME, 4062729611 MANAGED CARE SOUTHWESTERN 11/25/17 Y 12/29/17 TELEPHONE APPROVED NO DATA 08/02/2017Y ORG MACROSERVE CALL/CARES ENTERED
CENTRAL REALTY 10/20/17 Y 12/29/17 TELEPHONE APPROVED NO DATA 08/17/2017Y TEST, NAME 4062437031 ARC or ADRCZONE CALL/CARES ENTERED
11/17/17 Y 12/29/17 WRITTEN/CASE DENIED OTHER 12/25/2016Y TEST, NAME 4062011609 MANAGED CARE SOUTHWESTERN MACROSERVE ORG MGR
TEST, NAME 4062605037 MANAGED CARE WESTERN CHERRY & 10/27/17 Y 11/20/17 TELEPHONE APPROVED 11/20/17 NO DATA 07/28/2017Y ORG WEBB CALL/CARES ENTERED
TEST, NAME 4062607105 ARC or ADRC CENTRAL REALTY 10/27/17 Y 12/29/17 TELEPHONE APPROVED NO DATA 07/24/2017Y ZONE CALL/CARES ENTERED
Report run on: 08/31/2018 09:34 AM Page 1 of 8 imm_risk_disp.rdfReport run by: RSHQALL Dispose of this report so that it cannot be read or reconstructed
Test D
ata
Incomplete Assessments Report
PSA: ALL
PSA: 02A
Client ID Client Name Asmt Date User Added Date Added Caseworker
1001141824 01/20/2017 RSSUPERVISOR02A 01/20/2017
1001141851 08/02/2017 RSSRCARESCW02A 08/08/2017
1001141822 01/20/2017 RSSUPERVISOR02A 01/20/2017
1001141283 09/14/2014 RSSUPERVISOR02A 09/08/2015
4061599457
TEST, NAMETEST, NAMETEST, NAMETEST, NAMETEST, NAME 03/20/2017 RSSRCARESCW02A 03/20/2017
Count: 5
PSA: 02B
Client ID Client Name Asmt Date User Added Date Added Caseworker
4062390682 02/05/2015 RSSUPERVISOR02B 06/02/2015
1001141613 01/01/2017 RSSUPERVISOR02B 04/25/2017
1001141586 05/05/2015 RSSUPERVISOR02B 09/21/2015
1001141303 01/01/2017 RSSUPERVISOR02B 05/24/2017
1001141486 02/07/2012 SUPERVISOR02B 03/12/2015
1001141815 10/20/2017 RSSRCARESCW02B 11/30/2017
1001141357 09/09/2014 SUPERVISOR02B 12/05/2014
1001141585 01/01/2017 RSSUPERVISOR02B 05/26/2017
1001141797 10/01/2017 RSSRCARESCW02B 10/24/2017
1001141389 01/01/2017 RSSUPERVISOR02B 05/26/2017
1001141525 01/01/2017 RSSUPERVISOR02B 05/02/2017
1001141576 01/04/2015 RSSUPERVISOR02B 08/12/2015
4061858409 02/03/2017 RSSUPERVISOR02B 03/23/2017
4062648638 04/05/2016 RSSUPERVISOR02B 04/26/2016
4061988826 04/05/2015 RSSUPERVISOR02B 05/12/2015
1001141289 01/01/2017 RSSUPERVISOR02B 05/24/2017
1001141424 03/02/2015 SUPERVISOR02B 03/12/2015
1001141330 02/01/2017 RSSUPERVISOR02B 10/05/2017
4062435692 03/28/2017 RSSRCARESCW02B 03/29/2017
1001141223 01/01/2014 SUPERVISOR02B 09/12/2014
1001141425 02/01/2017 RSSUPERVISOR02B 10/05/2017
1001141297 01/01/2015 SUPERVISOR02B 03/11/2015
1001141127
TEST, NAMETEST, NAMETEST, NAMETEST, NAMETEST, NAMETEST, NAMETEST, NAMETEST, NAMETEST, NAMETEST, NAMETEST, NAMETEST, NAMETEST, NAMETEST, NAMETEST, NAMETEST, NAMETEST, NAMETEST, NAMETEST, NAMETEST, NAMETEST, NAMETEST, NAMETEST, NAME 03/01/2017 RSSUPERVISOR02B 05/19/2017
Report run on: 08/30/2018 04:52 PM Page 1 of 2 cares_incom_assm.rdf
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Test D
ata
Incomplete Assessments Report
PSA: ALL
PSA: 02B
1001141485
Count: 24
TEST, NAME 02/05/2015 SUPERVISOR02B 03/12/2015
PSA: 05A
Client ID Client Name Asmt Date User Added Date Added Caseworker
4061417625
Count: 1
TEST, NAME 08/04/2017 RSSRCARESCW05A 08/09/2017
PSA: 07A
Client ID Client Name Asmt Date User Added Date Added Caseworker
4062430497
4062661377
Count: 2
TEST, NAMETEST, NAME
07/08/2015
07/08/2015
RSSUPERVISOR07A
RSSUPERVISOR07A
08/03/2015
08/03/2015
PSA: 07B
Client ID Client Name Asmt Date User Added Date Added Caseworker
4061425860
1001141726
Count: 2
TEST, NAMETEST, NAME
04/01/2014
04/15/2016
RSSUPERVISOR07B
RSSUPERVISOR07B
04/19/2016
04/19/2016
PSA: 11A
Client ID Client Name Asmt Date User Added Date Added Caseworker
1001141684
4062577564
4062003293
TEST, NAMETEST, NAMETEST, NAME
02/01/2016
02/02/2016
03/28/2017
RSSUPERVISOR11A
RSSUPERVISOR11B
RSSUPERVISOR11A
03/09/2016
02/22/2016
03/29/2017
Count: 3
Count Total: 37
Report run on: 08/30/2018 04:52 PM Page 2 of 2 cares_incom_assm.rdf
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Test D
ata
Incomplete PASRR PSA: ALL
Case Worker: ALL
Level I Screener Screening Received Client Name Client ID Level 1 Level II MI Level II MI Level II ID Level II ID Date Ref. Date Ref. Date Date Indicator Exclusion/ Due Date Exclusion/ Due Date SAMH APD
Exemption Exemption
1001141290 INTELLECTUAL DISABILITY EXEMPTED 09/26/2014 HOSPITAL/30 DAYS
4061701682 MENTAL ILLNESS
09/01/2014 09/01/2014 TEST, NAME
09/09/2014 09/09/2014 TEST, NAME
09/01/2014 09/01/2014 TEST, NAME 1001141281 BOTH EXEMPTED HOSPITAL/30 09/26/2014 EXEMPTED RESPITE/14 09/15/2014 DAYS DAYS
1001141274 MENTAL ILLNESS EXEMPTED HOSPITAL/30 09/26/2014 DAYS
09/01/2014 09/01/2014 TEST, NAME
09/01/2014 09/01/2014 TEST, NAME 1001141273 MENTAL ILLNESS EXEMPTED HOSPITAL/30 09/26/2014 DAYS
1001141528 BOTH NO EXEMPTION NO EXEMPTION 09/04/2014 09/02/2014
1001141383 INTELLECTUAL DISABILITY NO EXEMPTION 02/01/2015
09/01/2014 09/04/2014 TEST, NAME
02/01/2015 02/01/2015 TEST, NAME
03/01/2015 03/01/2015 TEST, NAME 1001141391 BOTH NO EXEMPTION NO EXEMPTION 04/01/2015 04/01/2015
1001141302 MENTAL ILLNESS NO EXEMPTION 01/01/2015
1001141232 MENTAL ILLNESS NO EXEMPTION 09/18/2014
1001141291 MENTAL ILLNESS NO EXEMPTION 09/06/2014
1001141522 MENTAL ILLNESS NO EXEMPTION 09/01/2014
01/01/2015 01/01/2015 TEST, NAME09/17/2014 09/18/2014 TEST, NAME
09/01/2014 09/01/2014 TEST, NAME
09/01/2014 09/01/2014 TEST, NAME
09/09/2014 09/10/2014 TEST, NAME 1001141292 MENTAL ILLNESS EXEMPTED HOSPITAL/30 10/04/2014 DAYS
1001141468 MENTAL ILLNESS EXEMPTED HOSPITAL/30 09/26/2014 DAYS
1001141224 MENTAL ILLNESS NO EXEMPTION
1001141228 INTELLECTUAL DISABILITY EXEMPTED 10/04/2014 HOSPITAL/30 DAYS
1001141359 MENTAL ILLNESS EXEMPTED HOSPITAL/30 11/25/2014 DAYS
1001141233 INTELLECTUAL DISABILITY NO EXEMPTION 09/11/2014
1001141229 MENTAL ILLNESS NO EXEMPTION 09/04/2014
1001141225 MENTAL ILLNESS NO EXEMPTION 09/01/2016
1001141265 BOTH NO EXEMPTION NO EXEMPTION 09/01/2014 09/01/2014
4062612492 BOTH NO EXEMPTION NO EXEMPTION 05/01/2015 05/01/2015
4062357248 MENTAL ILLNESS NO EXEMPTION 01/01/2015
4062731354 INTELLECTUAL DISABILITY NO EXEMPTION 10/10/2015
1001141827 BOTH NO EXEMPTION NO EXEMPTION 01/01/2016 01/01/2016
4062533061 BOTH NO EXEMPTION NO EXEMPTION 02/01/2015 02/01/2015
4062346022 MENTAL ILLNESS NO EXEMPTION 02/01/2015
1001141826 INTELLECTUAL DISABILITY NO EXEMPTION 01/01/2016
09/01/2014 09/01/2014 TEST, NAME
09/03/2014 09/05/2014 TEST, NAME
09/09/2014 09/10/2014 TEST, NAME
10/31/2014 11/01/2014 TEST, NAME
09/08/2014 09/10/2014 TEST, NAME
09/04/2014 09/05/2014 TEST, NAME
09/09/2014 09/09/2014 TEST, NAME
09/01/2014 09/01/2014 TEST, NAME
05/01/2015 05/01/2015 TEST, NAME
01/01/2015 01/01/2015 TEST, NAME
10/10/2015 10/10/2015 TEST, NAME
01/01/2016 01/01/2016 TEST, NAME
02/01/2015 02/01/2015 TEST, NAME
02/01/2015 02/01/2015 TEST, NAME
01/01/2016 01/01/2016 TEST, NAME
01/01/2016 01/01/2016 TEST, NAME 4062003811 MENTAL ILLNESS NO EXEMPTION 01/01/2016
Report run on: 08/31/2018 10:06 AM Page 1 of 2 incomplete_pas.rdf
Report run by: RSHQALL Dispose of this report so that it cannot be read or reconstructed
Test D
ata
Incomplete PASRR PSA: ALL
Case Worker: ALL
Level I Screener Screening Received Client Name Client ID Level 1 Level II MI Level II MI Level II ID Level II ID Date Ref. Date Ref. Date Date Indicator Exclusion/ Due Date Exclusion/ Due Date SAMH APD
Exemption Exemption
1001141409 MENTAL ILLNESS DELIRIUM/7 DAYS 11/19/2014
1001141294 MENTAL ILLNESS EXEMPTED HOSPITAL/30 11/12/2014 DAYS
1001141410 INTELLECTUAL DISABILITY NO EXEMPTION 11/01/2014
1001141455 INTELLECTUAL DISABILITY EXEMPTED 10/03/2014 11/11/2014 HOSPITAL/30 DAYS
1001141486 BOTH EXEMPTED HOSPITAL/30 09/28/2016 EXEMPTED 09/28/2016 09/03/2016 09/03/2016 DAYS HOSPITAL/30 DAYS
1001141452 MENTAL ILLNESS EXEMPTED HOSPITAL/30 10/04/2016 09/09/2016 DAYS
4061748533 BOTH PROTECTIVE SERVICES/7 09/16/2016 PROTECTIVE 09/16/2016 09/09/2016 09/09/2016 DAYS SERVICES/7 DAYS
1001141590 BOTH EXEMPTED HOSPITAL/30 09/26/2016 EXEMPTED 09/26/2016 09/01/2016 09/01/2016 DAYS HOSPITAL/30 DAYS
1001141268 MENTAL ILLNESS NO EXEMPTION 09/01/2014
1001141414 INTELLECTUAL DISABILITY PROTECTIVE 07/10/2015 SERVICES/7 DAYS
1001141530 MENTAL ILLNESS NO EXEMPTION 05/20/2015
1001141285 INTELLECTUAL DISABILITY EXEMPTED RESPITE/14 11/06/2014 DAYS
1001141278 MENTAL ILLNESS NO EXEMPTION 09/09/2014
1001141283 BOTH NO EXEMPTION NO EXEMPTION 09/08/2016 09/08/2016
4062348035 INTELLECTUAL DISABILITY NO EXEMPTION 05/30/2015
1001141241 INTELLECTUAL DISABILITY NO EXEMPTION 09/09/2014
1001141473 BOTH EXEMPTED HOSPITAL/30 09/26/2014 EXEMPTED 09/26/2014 DAYS HOSPITAL/30 DAYS
1001141469 MENTAL ILLNESS DELIRIUM/7 DAYS 09/08/2014
1001141481 INTELLECTUAL DISABILITY PROTECTIVE 09/08/2014 SERVICES/7 DAYS
1001141480 INTELLECTUAL DISABILITY EXEMPTED RESPITE/14 09/15/2014 DAYS
1001141476 INTELLECTUAL DISABILITY DELIRIUM/7 DAYS 09/16/2014
1001141472 BOTH DELIRIUM/7 DAYS 09/08/2014 DELIRIUM/7 DAYS 09/08/2014
1001141470 MENTAL ILLNESS EXEMPTED RESPITE/14 09/15/2014 DAYS
11/12/2014 11/14/2014 TEST, NAME
10/18/2014 10/19/2014 TEST, NAME
11/01/2014 11/01/2014 TEST, NAME
09/08/2014 09/09/2014 TEST, NAME
09/03/2016 09/03/2016 TEST, NAME
09/09/2016 09/09/2016 TEST, NAME
09/09/2016 09/09/2016 TEST, NAME
09/01/2016 09/01/2016 TEST, NAME
09/01/2014 09/01/2014 TEST, NAME
07/03/2015 07/03/2015 TEST, NAME
05/19/2015 05/19/2015 TEST, NAME
10/23/2014 10/23/2014 TEST, NAME
09/06/2014 09/08/2014 TEST, NAME
09/08/2016 09/08/2016 TEST, NAME
04/04/2015 05/27/2015 TEST, NAME
09/09/2014 09/09/2014 TEST, NAME
09/01/2014 09/01/2014 TEST, NAME
09/01/2014 09/01/2014 TEST, NAME
09/01/2014 09/01/2014 TEST, NAME
09/01/2014 09/01/2014 TEST, NAME
09/09/2014 09/09/2014 TEST, NAME
09/01/2014 09/01/2014 TEST, NAME
09/01/2014 09/01/2014 TEST, NAME
09/01/2014 09/01/2014 TEST, NAME
1001141471 MENTAL ILLNESS PROTECTIVE SERVICES/7 09/08/2014 DAYS
Grand Total: 53
Report run on: 08/31/2018 10:06 AM Page 2 of 2 incomplete_pas.rdf
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Test D
ata
Information Only Case Summary Report PSA: ALL
Start Date: 01/01/2017 End Date: 12/31/2017
PSA County Employee Name Client Name Request Date Contact Type Time Spent Recommended Action
Report run on: 08/31/2018 09:36 AM Page 1 of 1 info_only_sum.rdf
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Test D
ata
Level 1/Resident Review Evaluation Returned to Screener
PSA: ALL
Client Name Client ID Type of Received Provider Reviewed By Returned Evaluation Date Name Date
TEST, NAMETEST, NAMETEST, NAMETEST, NAMETEST, NAMETEST, NAMETEST, NAMETEST, NAMETEST, NAMETEST, NAMETEST, NAMETEST, NAMETEST, NAMETEST, NAMETEST, NAMETEST, NAMETEST, NAMETEST, NAMETEST, NAMETEST, NAMETEST, NAMETEST, NAMETEST, NAMETEST, NAMETEST, NAMETEST, NAMETEST, NAMETEST, NAMETEST, NAMETEST, NAMETEST, NAMETEST, NAMETEST, NAME
4061738971
1001141606
1001141654
1001141660
1001141659
1001141658
1001141661
1001141622
1001141657
1001141603
1001141663
1001141613
1001141579
1001141585
1001141591
1001141234
1001141592
1001141586
1001141576
1001141611
1001141417
1001141494
4062664704
1001141425
1001141443
1001141461
1001141662
1001141284
1001141239
1001141617
1001141267
1001141279
LEVEL I
LEVEL I
LEVEL I
LEVEL I
RESIDENT REVIEW
LEVEL I
RESIDENT REVIEW
LEVEL I
RESIDENT REVIEW
LEVEL I
LEVEL I
LEVEL I
LEVEL I
LEVEL I
LEVEL I
LEVEL I
LEVEL I
LEVEL I
LEVEL I
LEVEL I
LEVEL I
RESIDENT REVIEW
LEVEL I
LEVEL I
LEVEL I
LEVEL I
LEVEL I
RESIDENT REVIEW
LEVEL I
LEVEL I
LEVEL I
RESIDENT REVIEW
05/01/2017
12/14/2015
12/12/2015
12/12/2015
12/07/2015
12/04/2015
12/01/2015
12/01/2015
11/17/2015
11/11/2015
10/12/2015
10/10/2015
08/07/2015
07/15/2015
07/01/2015
05/01/2015
05/01/2015
04/04/2015
03/08/2015
03/03/2015
01/23/2015
01/01/2015
01/01/2015
01/01/2015
01/01/2015
12/15/2014
12/12/2014
10/08/2014
10/01/2014
09/25/2014
09/12/2014
09/01/2014
Provider Name
Provider Name
05/01/2017
12/15/2015
12/13/2015
12/15/2015
12/15/2015
12/17/2015
12/15/2015
12/14/2015
11/20/2015
12/01/2015
10/20/2015
12/12/2015
09/30/2015
07/22/2015
07/02/2015
05/01/2015
06/01/2015
05/01/2015
04/01/2015
04/04/2015
01/23/2015
01/01/2015
01/01/2015
01/01/2015
01/02/2015
12/20/2014
01/15/2015
10/09/2014
10/01/2014
09/30/2014
09/15/2014
09/01/2014
Report run on: 08/31/2018 10:06 AM Page 1 of 2 levelonereview.rdf
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Test D
ata
Level 1/Resident Review Evaluation Returned to Screener
PSA: ALL
Client Name Client ID Type of Evaluation
Received Date
Provider Name
Reviewed By Returned Date
TEST, NAME
TEST, NAME1001141264
1001141574
LEVEL I
LEVEL I
09/01/2014
09/01/2014
09/01/2014
02/03/2015
Report run on: 08/31/2018 10:06 AM Page 2 of 2 levelonereview.rdf
Report run by: RSHQALL Dispose of this report so that it cannot be read or reconstructed
Test D
ata
Level II Due Date for 30 Day Hospital Exemption PSA: ALL
Case Worker: ALL
Level I Screener Screening Received Client Name Client ID Level 1 Level II MI Level II MI Level II ID Level II ID Date Ref. Date Ref. Date Date Indicator Exclusion/ Due Date Exclusion/ Due Date SAMH APD
Exemption Exemption
1001141290 INTELLECTUAL DISABILITY EXEMPTED 09/26/2014 HOSPITAL/30 DAYS
1001141281 BOTH EXEMPTED HOSPITAL/30 09/26/2014 EXEMPTED RESPITE/14 DAYS DAYS
1001141274 MENTAL ILLNESS EXEMPTED HOSPITAL/30 09/26/2014 DAYS
1001141273 MENTAL ILLNESS EXEMPTED HOSPITAL/30 09/26/2014 DAYS
1001141292 MENTAL ILLNESS EXEMPTED HOSPITAL/30 10/04/2014 DAYS
1001141468 MENTAL ILLNESS EXEMPTED HOSPITAL/30 09/26/2014 DAYS
1001141228 INTELLECTUAL DISABILITY EXEMPTED 10/04/2014 HOSPITAL/30 DAYS
1001141359 MENTAL ILLNESS EXEMPTED HOSPITAL/30 11/25/2014 DAYS
1001141294 MENTAL ILLNESS EXEMPTED HOSPITAL/30 11/12/2014 DAYS
1001141455 INTELLECTUAL DISABILITY EXEMPTED 10/03/2014 11/11/2014 HOSPITAL/30 DAYS
1001141486 BOTH EXEMPTED HOSPITAL/30 09/28/2016 EXEMPTED 09/28/2016 09/03/2016 09/03/2016 DAYS HOSPITAL/30 DAYS
1001141452 MENTAL ILLNESS EXEMPTED HOSPITAL/30 10/04/2016 09/09/2016 DAYS
1001141590 BOTH EXEMPTED HOSPITAL/30 09/26/2016 EXEMPTED 09/26/2016 09/01/2016 09/01/2016 DAYS HOSPITAL/30 DAYS
09/01/2014 09/01/2014 TEST, NAME
09/01/2014 09/01/2014 TEST, NAME
09/01/2014 09/01/2014 TEST, NAME
09/01/2014 09/01/2014 TEST, NAME
09/09/2014 09/10/2014 TEST, NAME
09/01/2014 09/01/2014 TEST, NAME
09/09/2014 09/10/2014 TEST, NAME
10/31/2014 11/01/2014 TEST, NAME
10/18/2014 10/19/2014 TEST, NAME
09/08/2014 09/09/2014 TEST, NAME
09/03/2016 09/03/2016 TEST, NAME
09/09/2016 09/09/2016 TEST, NAME
09/01/2016 09/01/2016 TEST, NAME
09/01/2014 09/01/2014 TEST, NAME 1001141473 BOTH EXEMPTED HOSPITAL/30 09/26/2014 EXEMPTED 09/26/2014 DAYS HOSPITAL/30 DAYS
Grand Total: 14
Report run on: 08/31/2018 10:07 AM Page 1 of 1 hospexemp_pas.rdf
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Test D
ata
Level Of Care Approvals PSA: ALL For staffing dates between 01/01/2017 and 12/31/2017
Approvals Approvals Approvals by Approvals by other Total Number of Cases Total Number of Cases Total Number of Cases with PSA by RN by MD/DO other PSA RN PSA MD/DO Approved by Other PSA with Approver LOC Approver Blank
01A 0 0 0 0 0 0 0
02A 0 0 0 0 0 0 0
02B 0 0 11 0 11 11 0
03A 282 415 52 3 55 752 0
03B 818 582 1 56 57 1457 0
04A 1157 465 1 80 81 1703 0
04B 740 351 0 0 0 1091 0
05A 0 1 0 0 0 1 0
06A 0 0 0 0 0 0 0
06B 0 1 0 0 0 1 0
07A 1 0 1 0 1 2 0
07B 0 0 0 0 0 0 0
08A 0 0 0 0 0 0 0
09A 0 0 0 0 0 0 0
09B 0 0 0 0 0 0 0
10A 1 0 0 0 0 1 0
11A 1 1 0 0 0 2 0
Total: 3,000 1,816 66 139 205 5,021 0
Report run on: 08/31/2018 10:16 AM Page 1 of 169 approval_loc.rdf
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Test D
ata
Level Of Care Approvals PSA: ALL For staffing dates between 01/01/2017 and 12/31/2017
Staffing Staffing Program Level PSA Client ID Date Recomm Caseworker Level of Care Approved By of Care Notes
03A 4061909797 10/14/2017 NONE SKD
03A 4062265818 12/02/2017 NONE SKD
03A 4061821428 12/02/2017 NONE SKD
03A 4062327758 12/16/2017 NONE SKD
03A 4062131445 10/28/2017 LTCP INO
03A 4062530930 11/04/2017 NONE WHL
03A 4061726949 10/28/2017 LTCP INO
03A 4062258484 10/07/2017 NONE SKD
03A 4062091720 12/09/2017 NONE SKD
03A 4061818027 09/18/2017 NONE SKD
03A 4062003243 12/02/2017 LTCP SKD
03A 4062301932 11/11/2017 LTCP INO
03A 4061813883 12/16/2017 NONE SKD
03A 4062606635 12/02/2017 NONE WHL
03A 4062200250 12/02/2017 NONE WHL
03A 4062556074 12/09/2017 NONE SKD
03A 4062533477 12/30/2017 PACW ROH
03A 4062771131 12/02/2017 LTCP INO
03A 4062552323 12/02/2017 NONE WHL
03A 4061740682 12/02/2017 NONE SKD
03A 4062727142 10/14/2017 NONE SKD
03A 4061514839 12/02/2017 NONE SKD
03A 4062136608 12/02/2017 LTCP SKD
03A 4061562007 12/23/2017 LTCP INO
03A 4062527714 10/14/2017 NONE SKD
03A 4061468034 09/30/2017 NONE SKD
03A 4062521508 09/17/2017 NONE SKD
03A 4062082369 11/18/2017 NONE SKD
03A 4062375225 12/02/2017 LTCP INO
03A 4062434498 10/21/2017 LTCP INO
03A 4061827366 11/04/2017 NONE SKD
03A 4062314274 11/04/2017 NONE SKD
Report run on: 08/31/2018 10:16 AM Page 2 of 169 approval_loc.rdf
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Test D
ata
List of Open Cases by Case Manager Report
PSA: ALL
PSA Employee Name Current Home Zip Code Case Open Date Client ID
01A 32433
32439
32455
32464
32531
32539
32541
32547
32548
32563
32569
32578
32535
32435
32501
32506
32507
32514
32536
32539
32547
32548
32566
32570
32578
32514
32526
12/06/2013
05/12/2014
12/02/2013
03/03/2014
05/13/2014
05/07/2014
05/23/2014
05/19/2014
05/08/2014
08/06/2013
05/15/2014
05/02/2014
05/14/2014
05/05/2014
04/17/2014
03/07/2014
05/01/2014
04/24/2014
04/09/2014
01/22/2014
11/26/2013
05/12/2014
04/03/2014
05/20/2014
05/12/2014
05/09/2014
05/20/2014
05/12/2014
02/14/2014
05/23/2014
05/13/2014
04/04/2014
05/21/2014
02/27/2014
03/19/2014
05/07/2014
05/21/2014
05/12/2014
05/21/2014
05/02/2014
01/23/2014
12/02/2013
4061498718
4062499725
4062211976
4061452874
4061621366
4061961015
4061779999
4061741779
4062531079
4061652691
4062504174
4062003934
4061849685
4062443552
4062531055
4062155866
4062398489
4061864999
4062520869
4062589953
4062535940
4061476531
4062616604
4061454884
4062355704
Count: 25
4062092657
Count: 1
4062420529
4062652104
4062285628
4061535275
4062660292
4061903719
4062333607
4062773862
4061960441
4062066978
4061629733
4062092039
4062500559
4061567005
4061476181
Count: 15
4062091870
4061977026
4062430352
Report run on: 08/31/2018 09:58:36 Page 1 of 191 open_case_list.rdfReport run by: RSHQALL Dispose of this report so that it cannot be read or reconstructed
Test D
ata
Diversion Barrier Report PSA: ALL Start Date: 01/01/2017 End Date: 12/31/2017
* Indicates multiple entries for a client.Multiple entries are not marked if different barriers were identified for a client.
Counts of clients for each barrier category and the grand total are unduplicated counts.
PSA: 02B
Diversion Barrier: SECURE ALF NOT AVAILABLE
Client ID Client Name Nursing Home Admit Date Identification Date
1001141823
1001141853
TEST, NAMETEST, NAME
Number of Clients with SECURE ALF NOT AVAILABLE: 2
03/02/2017
09/30/2017
04/20/2017
07/20/2018
Diversion Barrier: WAITLIST ASSISTIVE CARE/OSS
Client ID Client Name Nursing Home Admit Date Identification Date
1001141370
1001141170
1001141330
1001141425
TEST, NAMETEST, NAMETEST, NAMETEST, NAME
Number of Clients with WAITLIST ASSISTIVE CARE/OSS: 4
PSA: 03A
Diversion Barrier: INELIG HEALTH/FUNCTION DECLINED
01/01/2017
01/01/2017
01/01/2017
01/10/2017
10/12/2017
10/05/2017
10/05/2017
10/05/2017
Client ID Client Name Nursing Home Admit Date Identification Date
4061908516 12/24/2017 02/20/2018
4062524555 09/17/2017 11/17/2017
4062180869 11/26/2017 12/10/2017
4062171551 09/22/2017 12/09/2017
4061566635 11/29/2017 04/05/2018
4062621353 08/06/2017 12/18/2017
4062182834 12/11/2017 01/14/2018
4062017195 03/23/2017 12/29/2017
4062091315 08/25/2017 11/12/2017
4062180427 09/13/2017 03/16/2018
4061652633 10/12/2017 02/13/2018
4062006478 10/10/2017 01/14/2018
4062621786 12/07/2017 04/04/2018
4061653883 11/23/2017 12/11/2017
4062521528 08/14/2017 09/17/2017
4062622741 11/21/2017 01/19/2018
4062454929 09/22/2017 10/01/2017
4062734299 10/27/2017 02/12/2018
4062759641 09/11/2017 01/22/2018
4061725676 09/30/2017 10/21/2017
4062268888 11/17/2017 12/10/2017
4062093949 11/13/2017 01/01/2018
4062439741
TEST, NAMETEST, NAMETEST, NAMETEST, NAMETEST, NAMETEST, NAMETEST, NAMETEST, NAMETEST, NAMETEST, NAMETEST, NAMETEST, NAMETEST, NAMETEST, NAMETEST, NAMETEST, NAMETEST, NAMETEST, NAMETEST, NAMETEST, NAMETEST, NAMETEST, NAMETEST, NAMETEST, NAME 10/20/2017 02/20/2018
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Non-imminent Risk Referral Disposition Report PSA: ALL Case Worker: ALL Start Date: 01/01/2017 End Date: 12/31/2017
PSA: 02B
Client Name Client ID Referred To Provider Name Referral Imminent Response Date Risk Date
Response Referral Type Disposition
Disposition Denial Date Reason
1001141379 OTHER 01/25/2017 N NO DATA NO DATA ENTERED ENTERED
NO DATA ENTERED
TEST, NAME
Count for 02B: 1
PSA: 03A
Client Name Client ID Referred To Provider Name Referral Imminent Response Date Risk Date
Response Referral Type Disposition
Disposition Denial Date Reason
TEST, NAME 4062213150 MANAGED CARE ORG
TEST, NAME 4061819129 ARC or ADRC
4061408607 ARC or ADRC TEST, NAME
TEST, NAME 4061537270 MANAGED CARE ORG
TEST, NAME 4062434498 MANAGED CARE ORG
TEST, NAME 4062782324 MANAGED CARE ORG
TEST, NAME 4062263716 ARC or ADRC
TEST, NAME 4061726091 MANAGED CARE ORG
TEST, NAME 4062657941 ARC or ADRC
TEST, NAME 4062698534 ARC or ADRC
TEST, NAME, 4062699929 MANAGED CARE ORG
10/30/2017 N 12/31/2017
11/27/2017 N 01/07/2018
12/10/2017 N 03/14/2018
10/29/2017 N 01/20/2018
10/23/2017 N 02/27/2018
10/21/2017 N 10/27/2017
11/27/2017 N 03/08/2018
12/08/2017 N 05/21/2018
10/16/2017 N 11/24/2017
11/27/2017 N 03/28/2018
11/27/2017 N
WRITTEN/CASE DENIED MGR
TELEPHONE APPROVED CALL/CARES
WRITTEN/CASE DENIED MGR
TELEPHONE APPROVED CALL/CASE MGR
TELEPHONE DENIED CALL/CARES
WRITTEN/CASE DENIED MGR
TELEPHONE DENIED CALL/CASE MGR
NO DATA NO DATA ENTERED ENTERED
WRITTEN/CASE DENIED MGR
TELEPHONE APPROVED CALL/CARES
NO DATA NO DATA ENTERED ENTERED
OTHER
NO DATA ENTERED
REFUSED MEDICAID
01/20/2018 NO DATA ENTERED
CLIENT DIED
NOT ELIGIBLE
REFUSED MEDICAID
05/21/2018 NO DATA ENTERED
NOT ELIGIBLE
01/21/2018 NO DATA ENTERED
NO DATA ENTERED
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Number of Assessments by Caseworker, Site and Instrument Report
PSA: ALL
Assessment Start Date: 01/01/2017 End Date: 01/01/2017
PSA Employee Site Instrument Assessor Count
STATE MENT HOSPITAL
Sub-Total by Case worker: 1
STATE MENT HOSPITAL CASEWORKR
Sub-Total by Case worker: 2
Sub-Total by Case worker: 1
NURSING FACILITY
STATE MENT HOSPITAL
TELEPHONE SCREEN
Sub-Total by Case worker: 4
Sub-Total by PSA: 8
Report Total: 8
Total by Assessor
PSA Assessor
701B COMPREHENSIVE ASSESSMENT INSTRUMENT
701B COMPREHENSIVE ASSESSMENT INSTRUMENT
NONE
701B COMPREHENSIVE ASSESSMENT INSTRUMENT
701B COMPREHENSIVE ASSESSMENT INSTRUMENT
701B COMPREHENSIVE ASSESSMENT INSTRUMENT
SCREENING FORM
Count
VOCATIONAL REHABILITATION 1
VOCATIONAL REHABILITATION 1
VOCATIONAL REHABILITATION 1
VOCATIONAL REHABILITATION 1
VOCATIONAL REHABILITATION 1
VOCATIONAL REHABILITATION 2
VOCATIONAL REHABILITATION 1
02B VOCATIONAL REHABILITATION 8
Total by Instrument
PSA Instrument Count
02B 701B COMPREHENSIVE ASSESSMENT INSTRUMENT 6
SCREENING FORM 1
NONE 1
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Number of Assessments by Caseworker, Site and Instrument Report
PSA: ALL
Assessment Start Date: 01/01/2017 End Date: 01/01/2017
PSA Employee Site Instrument Assessor Client Name
STATE MENT HOSPITAL
STATE MENT HOSPITAL
701B COMPREHENSIVE ASSESSMENT INSTRUMENT VOCATIONAL REHABILITATIONATES TEST, NAME
701B COMPREHENSIVE ASSESSMENT INSTRUMENT VOCATIONAL REHABILITATIONOH TEST, NAME
STATE MENT HOSPITAL NONE VOCATIONAL REHABILITATIONLINK NARF
STATE MENT HOSPITAL
NURSING FACILITY
STATE MENT HOSPITAL
STATE MENT HOSPITAL
701B COMPREHENSIVE ASSESSMENT INSTRUMENT VOCATIONAL REHABILITATION TEST, NAME
701B COMPREHENSIVE ASSESSMENT INSTRUMENT VOCATIONAL REHABILITATION TEST, NAME701B COMPREHENSIVE ASSESSMENT INSTRUMENT VOCATIONAL REHABILITATION TEST, NAME 701B COMPREHENSIVE ASSESSMENT INSTRUMENT VOCATIONAL REHABILITATION TEST, NAME
TELEPHONE SCREEN SCREENING FORM VOCATIONAL REHABILITATION TEST, NAME
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Number of Assessments Completed VS. Number of Assessments Entered in CIRTS By Caseworker Report
PSA: ALL
Start Date: 01/01/2017 End Date: 12/31/2017
Number of Assessments Number of Desk Review Number of Assessments Number of Desk Review Assessor / Employee Completed Assessments Completed Entered in CIRTS Assessments Entered in CIRTS
1 0 0 0
1 0 0 0
1 0 0 0
1 0 0 0
1 0 0 0
1 0 0 0
1 0 0 0
0 0 1 0
2 0 1 0
0 0 22 0
0 0 1 0
16 0 0 0
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Number of Cases by Referral Source PSA: ALL Start Date: 01/01/2017 End Date: 12/31/2017
PSA: 02A
Referral Source Number of Cases FAM 1
MCO 1
SEFA 2
VOC 1
Employee Name Referral Source Number of Cases
1
FAM 1
1
VOC 1
1
MCO 1
2
SEFA 2
Total from PSA 02A : 5
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Nursing Home Diversion EMS Summary Report PSA: ALL EMS Release Date Between: 01/01/2017 And 12/31/2017 Caseworker: ALL
# EMS Released Clients
Release Total Left Pipeline
Dates PSA Count or Referred to Provider % Complete
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Nursing Home Diversion Enrollment Management System Report PSA: ALL Caseworker: ALL
EMS Release Date Between: 01/01/2017 and 12/31/2017
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Nursing Home Diversion Enrollment Management System Report PSA: ALL Caseworker: ALL
EMS Release Date Between: 01/01/2017 and 12/31/2017
Report Count: 0
Report Summary:
0 have left the pipeline.
0 have been assessed after their enter pipeline date.
0 have been assessed after the release date.
0 have a FOC given date.
0 have been referred to a provider on NHD screen as Medicaid Pending OR have a referral to MCO (AND have not left the pipeline).
0 are enrolled in NHD.
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Open Cases whose clients have moved Report PSA: ALL
Case PSA Case Open Date Client ID Address PSA County Date Added
02B 03/01/2014 1001141496 02 BAY 04/29/2015
02B 04/01/2015 1001141490 02 BAY 04/01/2015
02B 04/01/2015 1001141491 02 BAY 04/01/2015
02B 10/01/2014 1001141297 02 BAY 03/29/2015
02B 02/01/2015 1001141460 02 BAY 04/02/2015
02B 03/03/2015 1001141501 02 BAY 04/06/2015
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PAS Name List PSA: ALL Screening Date: 01/01/2017 To 12/31/2017
PSA
02A
Client ID
4061738971
Name
TEST, NAME
Screening Date
05/01/2017
MI/ID Indicator
MENTAL ILLNESS
Total Mental Retardation/Intellectual Disability:
Total Mental Illness:
Total Both:
Total Number of Screenings:
0
1
0
1
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PAS Report
PSA: 11A Start Date: 01/01/2017 End Date: 12/31/2017
SMI=Serious Mental
Illness (MI)
ID=Intellectual Disability (MR & ID)
Both SMI & ID(BO)
No Indication of SMI or
ID(NO)
Total
Level 1 Evaluation Indicator: Resident Review Evaluation Indicator: SMI=Serious
Mental Illness (MI)
ID=Intellectual Disability (MR & ID)
Both SMI & ID(BO)
No Indication of SMI or
ID(NO)
Total
Number of Level I Evaluations (including Returned Number of Level I Evaluations/Resident Review Evaluations to Sender) Completed By: Returned to Screener:
Hospital Nursing Home
CARES Total Level I Resident Review
Total
Level II MI Exclusions/Exemptions:
*Conv.Care/30
Day
*ChronicMI
Delirium/7 Days
Exempted Hospital/ 30 Days
Exempted Respite/ 14 Days
*ExcludedRespite/14 Days
*NotExcluded
No Exemption Protective Services/7Days
*Severity ofIllness
*TerminalIllness
Total
*This denotes a PAS exclusion used prior to August 1, 2007. This exclusion is not valid for a PASRR screening effective August 1, 2007.
Level II ID Exclusions/Exemptions:
*Conv.Care/30
Day
Delirium/7 Days
Exempted Hospital/ 30 Days
Exempted Respite/ 14 Days
*ExcludedRespite/14 Days
*NotExcluded
No Exemption Protective Services/7Days
*Severity ofIllness
*TerminalIllness
Total
*This denotes a PAS exclusion used prior to August 1, 2007. This exclusion is not valid for a PASRR screening effective August 1, 2007.
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PAS Report
PSA: 11A Start Date: 01/01/2017 End Date: 12/31/2017
Number of Level II MI Evaluations Not Needed: Number of Level II ID Evaluations Not Needed:
Never Admitted
Deceased Stay Not Extended
Medical Documentation
Review
Client Discharged
Prior to Level II
Total Never Admitted
Deceased Stay Not Extended
Medical Documentation
Review
Client Discharged
Prior to Level II
Total
Psychiatric Evaluations: MI Dispositions:
Scheduled Completed Need Specialized Services/Can't
Provide in Nursing Home
*PsychiatricEvaluation
Not Received
(NP-Old PAS)
Psychiatric Evaluation
Not Received
(NR-New PAS)
No Specialized
Services Needed
Excluded Level II
Psychiatric Evaluation
Need Specialized
Services
Total
*This denotes a PAS disposition used prior to August 1, 2007. This disposition is not valid for a PASRR screeningeffective August 1, 2007.
SAMH Disposition:
#Referred to SAMH
#Received from SAMH
Excluded by Psychiatrist
Nursing Facility
Inappropriate
Need Specialized Services/Cannot
Provide in Nursing Home
Need Specialized
Services
No Specialized Services Needed
*Out ofCompliance
Total
*This denotes a PAS disposition used prior to August 1, 2007. This disposition is not valid for a PASRR screening effective August 1, 2007.
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PAS Report
PSA: 11A Start Date: 01/01/2017 End Date: 12/31/2017
SAMH Placement Recommendation for Specialized Services:
Adult Family
Care Home
ALF with
Extended Congregate
Care
ALF with
Limited Mental Health
Services
ALF with
Limited Nursing Services
Assisted Living Facility
Adult Geriatric
Residential Treatment
Facility
Group Home
Hospital Facility For Intellectual
Disability (MRDD)
Temporary Nursing Home
*NursingHome
Transition
Nursing Home
Other Prison Nursing Home
Private Residence
Psych Facility
Rehab Hospital
Supervised Apartment
State Mental
Hospital/ Nursing Home Unit
State Mental Hospital
Total
*Placement recommendation obsolete effective March 1, 2014.
SAMH Actual Placement:
Adult Family
Care Home
ALF with
Extended Congregate
Care
ALF with
Limited Mental Health
Services
ALF with
Limited Nursing Services
Assisted Living Facility
Adult Geriatric
Residential Treatment
Facility
Group Home
Hospital Facility For Intellectual
Disability (MRDD)
Temporary Nursing
Home
*NursingHome
Transition
Nursing Home
Other Prison Nursing Home
Private Residence
Psych Facility
Rehab Hospital
Supervised Apartment
State Mental
Hospital/ Nursing
Home Unit
State Mental Hospital
Total
*Placement recommendation obsolete effective March 1, 2014.
Level II ID Disposition:
#Referred to APD
#Received from APD
Needs Specialized Services/Cannot Provide in
Nursing Home
Excluded Level II APD Evaluation
*EvaluationNot Received
No Specialized Services Needed
Need Specialized Services
Total
#Received from
*This denotes a PAS disposition used prior to August 1, 2007. This disposition is not valid for a PASRR screening effective August 1, 2007.
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PAS Statewide
Start Date: 01/01/2017 End Date: 12/31/2017
Level 1 Evaluation Indicator: Resident Review Evaluation Indicator: SMI=Serious
Mental Illness (MI)
ID=Intellectual Disability (MR & ID)
Both SMI & ID(BO)
No Indication of SMI or
ID(NO)
Total
1 0 0 1 2
SMI=Serious Mental
Illness (MI)
ID=Intellectual Disability (MR & ID)
Both SMI & ID(BO)
No Indication of SMI or
ID(NO)
Total
Number of Level I Evaluations (including Returned Number of Level I Evaluations/Resident Review Evaluations to Sender) Completed By: Returned to Screener:
Hospital Nursing Home
CARES Total
1 0 2 3
Level I Resident Review
Total
1 0 1
Level II MI Exclusions/Exemptions:
*Conv.Care/30
Day
*ChronicMI
Delirium/7 Days
Exempted Hospital/ 30 Days
Exempted Respite/ 14 Days
*ExcludedRespite/14 Days
*NotExcluded
No Exemption Protective Services/7Days
*Severity ofIllness
*TerminalIllness
Total
0 0 0 1 0 0 0 0 0 0 0 1
*This denotes a PAS exclusion used prior to August 1, 2007. This exclusion is not valid for a PASRR screening effective August 1, 2007.
Level II ID Exclusions/Exemptions:
*Conv.Care/30
Day
Delirium/7 Days
Exempted Hospital/ 30 Days
Exempted Respite/ 14 Days
*ExcludedRespite/14 Days
*NotExcluded
No Exemption Protective Services/7Days
*Severity ofIllness
*TerminalIllness
Total
0 0 0 0 0 0 0 0 0 0 0
*This denotes a PAS exclusion used prior to August 1, 2007. This exclusion is not valid for a PASRR screening effective August 1, 2007.
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PAS Statewide
Start Date: 01/01/2017 End Date: 12/31/2017
Number of Level II MI Evaluations Not Needed: Number of Level II ID Evaluations Not Needed:
Never Admitted
Deceased Stay Not Extended
Medical Documentation
Review
Client Discharged
Prior to Level II
Total
0 0 0 0 0 0
Never Admitted
Deceased Stay Not Extended
Medical Documentation
Review
Client Discharged
Prior to Level II
Total
0 0 0 0 0 0
Psychiatric Evaluations: MI Dispositions:
Scheduled Completed
0 0
Need Specialized Services/Can't
Provide in Nursing Home
*PsychiatricEvaluation
Not Received
(NP-Old PAS)
Psychiatric Evaluation
Not Received
(NR-New PAS)
No Specialized
Services Needed
Excluded Level II
Psychiatric Evaluation
Need Specialized
Services
Total
0 0 0 0 0 0 0
*This denotes a PAS disposition used prior to August 1, 2007. This disposition is not valid for a PASRR screeningeffective August 1, 2007.
SAMH Disposition:
#Referred to SAMH
#Received from SAMH
Excluded by Psychiatrist
Nursing Facility
Inappropriate
Need Specialized Services/Cannot
Provide in Nursing Home
Need Specialized
Services
No Specialized Services Needed
*Out ofCompliance
Total
0 0 0 0 0 0 0 0 0
*This denotes a PAS disposition used prior to August 1, 2007. This disposition is not valid for a PASRR screening effective August 1, 2007.
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PAS Statewide
Start Date: 01/01/2017 End Date: 12/31/2017
SAMH Placement Recommendation for Specialized Services:
Adult Family
Care Home
ALF with
Extended Congregate
Care
ALF with
Limited Mental Health
Services
ALF with
Limited Nursing Services
Assisted Living Facility
Adult Geriatric
Residential Treatment
Facility
Group Home
Hospital Facility For Intellectual
Disability (MRDD)
Temporary Nursing Home
*NursingHome
Transition
Nursing Home
Other Prison Nursing Home
Private Residence
Psych Facility
Rehab Hospital
Supervised Apartment
State Mental
Hospital/ Nursing Home Unit
State Mental Hospital
Total
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
*Placement recommendation obsolete effective March 1, 2014.
SAMH Actual Placement:
Adult Family
Care Home
ALF with
Extended Congregate
Care
ALF with
Limited Mental Health
Services
ALF with
Limited Nursing Services
Assisted Living Facility
Adult Geriatric
Residential Treatment
Facility
Group Home
Hospital Facility For Intellectual
Disability (MRDD)
Temporary Nursing
Home
*NursingHome
Transition
Nursing Home
Other Prison Nursing Home
Private Residence
Psych Facility
Rehab Hospital
Supervised Apartment
State Mental
Hospital/ Nursing
Home Unit
State Mental Hospital
Total
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
*Placement recommendation obsolete effective March 1, 2014.
Level II ID Disposition:
#Referred to APD
#Received from APD
Needs Specialized Services/Cannot Provide in
Nursing Home
Excluded Level II APD Evaluation
*EvaluationNot Received
No Specialized Services Needed
Need Specialized Services
Total
0 #Received from0 0 0 0 0 0 0 0
*This denotes a PAS disposition used prior to August 1, 2007. This disposition is not valid for a PASRR screening effective August 1, 2007.
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PAS Summary
PSA: ALL Start Date: 01/01/2017 End Date: 12/31/2017
Level 1 Evaluation Indicator: Resident Review Evaluation Indicator: SMI=Serious
Mental Illness (MI)
ID=Intellectual Disability (MR & ID)
Both SMI & ID(BO)
No Indication of SMI or
ID(NO)
Total
02A 1 0 0 0 1
02B 0 0 0 1 1
Total 1 0 0 1 2
SMI=Serious Mental
Illness (MI)
ID=Intellectual Disability (MR & ID)
Both SMI & ID(BO)
No Indication of SMI or
ID(NO)
Total
Total
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PAS Summary
PSA: ALL Start Date: 01/01/2017 End Date: 12/31/2017
Number of Level I Evaluations(including Returned to Sender) Number of Level I Evaluations/Resident Review Evaluations Completed By: Returned to Screener:
Hospital Nursing Home
CARES Total
02A 1 0 1 2
02B 0 0 1 1
Total 1 0 2 3
Level I Resident Review
Total
02A 1 0 1
Total 1 0 1
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PAS Summary
PSA: ALL Start Date: 01/01/2017 End Date: 12/31/2017
Level II MI Exclusions/Exemptions:
*Conv.Care/30
Day
*ChronicMI
Delirium/7 Days
Exempted Hospital/ 30 Days
Exempted Respite/ 14 Days
*ExcludedRespite/14 Days
*NotExcluded
No Exemption Protective Services/7Days
*Severity ofIllness
*TerminalIllness
Total
02A 0 0 0 1 0 0 0 0 0 0 0 1
02B 0 0 0 0 0 0 0 0 0 0 0 0
Total 0 0 0 1 0 0 0 0 0 0 0 1
*This denotes a PAS exclusion used prior to August 1, 2007. This exclusion is not valid for a PASRR screening effective August 1, 2007.
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PAS Summary
PSA: ALL Start Date: 01/01/2017 End Date: 12/31/2017
Level II ID Exclusions/Exemptions:
*Conv.Care/30
Day
Delirium/7 Days
Exempted Hospital/ 30 Days
Exempted Respite/ 14 Days
*ExcludedRespite/14 Days
*NotExcluded
No Exemption Protective Services/7Days
*Severity ofIllness
*TerminalIllness
Total
02A 0 0 0 0 0 0 0 0 0 0 0
02B 0 0 0 0 0 0 0 0 0 0 0
Total 0 0 0 0 0 0 0 0 0 0 0
*This denotes a PAS exclusion used prior to August 1, 2007. This exclusion is not valid for a PASRR screening effective August 1, 2007.
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PAS Summary
PSA: ALL Start Date: 01/01/2017 End Date: 12/31/2017
Number of Level II MI Evaluations Not Needed: Number of Level II ID Evaluations Not Needed:
Never Admitted
Deceased Stay Not Extended
Medical Documentation
Review
Client Discharged
Prior to Level II
Total
02A 0 0 0 0 0 0
02B 0 0 0 0 0 0
Total 0 0 0 0 0 0
Never Admitted
Deceased Stay Not Extended
Medical Documentation
Review
Client Discharged
Prior to Level II
Total
02A 0 0 0 0 0 0
02B 0 0 0 0 0 0
Total 0 0 0 0 0 0
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PAS Summary
PSA: ALL Start Date: 01/01/2017 End Date: 12/31/2017
Psychiatric Evaluations: MI Dispositions:
Scheduled Completed
02A 0 0
02B 0 0
Total 0 0
Need Specialized Services/Can't
Provide in Nursing Home
*PsychiatricEvaluation
Not Received
(NP-Old PAS)
Psychiatric Evaluation
Not Received
(NR-New PAS)
No Specialized
Services Needed
Excluded Level II
Psychiatric Evaluation
Need Specialized
Services
Total
02A 0 0 0 0 0 0 0
02B 0 0 0 0 0 0 0
Total 0 0 0 0 0 0 0
*This denotes a PAS disposition used prior to August 1, 2007. This disposition is not valid for a PASRR screeningeffective August 1, 2007.
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PAS Summary
PSA: ALL Start Date: 01/01/2017 End Date: 12/31/2017
SAMH Disposition:
#Referred to SAMH
#Received from SAMH
Excluded by Psychiatrist
Nursing Facility
Inappropriate
Need Specialized Services/Cannot
Provide in Nursing Home
Need Specialized
Services
No Specialized Services Needed
*Out ofCompliance
Total
02A 0 0 0 0 0 0 0 0 0
02B 0 0 0 0 0 0 0 0 0
Total 0 0 0 0 0 0 0 0 0
*This denotes a PAS disposition used prior to August 1, 2007. This disposition is not valid for a PASRR screening effective August 1, 2007.
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PAS Summary
PSA: ALL Start Date: 01/01/2017 End Date: 12/31/2017
SAMH Placement Recommendation for Specialized Services:
Adult Family
Care Home
ALF with
Extended Congregate
Care
ALF with
Limited Mental Health
Services
ALF with
Limited Nursing Services
Assisted Living Facility
Adult Geriatric
Residential Treatment
Facility
Group Home
Hospital Facility For Intellectual
Disability (MRDD)
Temporary Nursing Home
*NursingHome
Transition
Nursing Home
Other Prison Nursing Home
Private Residence
Psych Facility
Rehab Hospital
Supervised Apartment
State Mental
Hospital/ Nursing Home Unit
State Mental Hospital
Total
02A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
02B 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
*Placement recommendation obsolete effective March 1, 2014.
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PAS Summary
PSA: ALL Start Date: 01/01/2017 End Date: 12/31/2017
SAMH Actual Placement:
Adult Family
Care Home
ALF with
Extended Congregate
Care
ALF with
Limited Mental Health
Services
ALF with
Limited Nursing Services
Assisted Living Facility
Adult Geriatric
Residential Treatment
Facility
Group Home
Hospital Facility For Intellectual
Disability (MRDD)
Temporary Nursing
Home
*NursingHome
Transition
Nursing Home
Other Prison Nursing Home
Private Residence
Psych Facility
Rehab Hospital
Supervised Apartment
State Mental
Hospital/ Nursing
Home Unit
State Mental Hospital
Total
02A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
02B 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
*Placement recommendation obsolete effective March 1, 2014.
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PAS Summary
PSA: ALL Start Date: 01/01/2017 End Date: 12/31/2017
Level II ID Disposition:
#Referred to APD
#Received from APD
Needs Specialized Services/Cannot Provide in
Nursing Home
Excluded Level II APD Evaluation
*EvaluationNot Received
No Specialized Services Needed
Need Specialized Services
Total
02A 0 #Received from00 0 0 0 0 0 0 0
02B 0 00 0 0 0 0 0 0 0
Total 0 0 0 0 0 0 0 0
*This denotes a PAS disposition used prior to August 1, 2007. This disposition is not valid for a PASRR screening effective August 1, 2007.
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Pending Assessment/Staffing Report PSA: ALL
Case Worker: ALL
PSA: 01A
Case Worker: BUONO, LILI
Client Name (Last-First-MI) Client ID Case Open Date or Received Completed Referral Reassessment Request Date Assessment Date 3008? 3008? Source
TEST NAME Z
TEST NAME
TEST NAME
TEST NAME K
TEST NAME C
TEST NAME
4061726304
4061916787
4061976826
4061567074
4061556761
4061740998
05/12/2014 05/22/2014 Y Y ARC
05/19/2014 05/19/2014 Y Y DCF
05/20/2014 Y Y ARC
05/21/2014 Y Y ARC
05/27/2014 05/27/2014 Y Y DCF
05/27/2014 Y Y NH
Count by Caseworker: 6
Case Worker:
Client Name (Last-First-MI) Client ID Case Open Date or Received Completed Referral Reassessment Request Date Assessment Date 3008? 3008? Source
TEST NAME 4062555191 05/21/2014 Y Y ARC
Count by Caseworker: 1
Case Worker:
Client Name (Last-First-MI) Client ID Case Open Date or Received Completed Referral Reassessment Request Date Assessment Date 3008? 3008? Source
TEST NAME
TEST NAME Z
TEST NAME
4062351748
4062472669
4062076633
05/06/2014 Y Y MCO
05/07/2014 Y Y MCO
05/09/2014 Y Y MCO
Count by Caseworker: 3
Case Worker:
Client Name (Last-First-MI) Client ID Case Open Date or Received Completed Referral Reassessment Request Date Assessment Date 3008? 3008? Source
TEST NAME 4062092657 05/12/2014 05/14/2014 Y Y NH
Count by Caseworker: 1
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Pending Assessment/Staffing Report PSA: ALL
Case Worker: ALL
Referral Source Counts by PSA
PSA: 11A
Referral Source Record Count
ARC 205
C 58
DCF 7
DOH 3
FAM 4
H 2
MCO 593
MHC 2
NH 140
OMW 1
PAC 98
PACE 25
SEFA 7
UHC 1
VOC 3
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Possible Duplicate Clients with Open Cases Report
PSA: ALL
SSN PSA SSN PSA Date of Birth First Name Last Name
000000000 11A 000000000 07A 01/02/1942 TEST NAME
11A 11A TEST NAME
02B 02B TEST NAME
11A 11A TEST NAME
11A 11A TEST NAME
07B 07B TEST NAME
09A 09A TEST NAME
06A 06A TEST NAME
11A 11A TEST NAME
11A 11A TEST NAME
11A 11A TEST NAME
02B 11A TEST NAME
Total: 12
This report lists clients with more than one SSN whose names and dates of birth are the same and have open cases. Please confirm that the clients are the same person before moving the client data from the incorrect SSN to the correct SSN. Once this is done, delete the incorrect SSN.
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443
Project Aids Care Summary Report PSA: ALL Start Date: 01/01/2017 End Date: 12/31/2017
PSA County PAC TERM Reason Client Name Client ID Accepted Date Termination Date # of Days in PAC
04A DUVAL LOST CONTACT 4062257968 08/01/2000 10/18/2001
NOT 4061841159 09/30/2003 ELIGIBLE/FINANCIAL NOT 4061748715 03/30/2006 ELIGIBLE/FINANCIAL NOT
TEST, NAME
TEST, NAME
TEST, NAME
TEST, NAME 4062515045 07/24/2007 ELIGIBLE/FINANCIAL NOT ELIGIBLE/MEDICAL TEST, NAME 4062715365 04/04/2006
Client count per PSA : 5 443
Client count per County : 5 443
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Staffing Log
PSA: ALL Staffing Date: 01/01/2017 To 12/31/2017
PSA: 02B
Payment Assessment Assessment Staffing Placement Diversion Level I Client Name Client ID Type Site Instrument Employee Name LOC Date Date LOC Rec Barrier Indicator
1001141852 PRPA SMHO 701B 07/01/2017 07/01/2017 SKD SHNH
1001141852 PRPA SMHO 701B 03/01/2017 03/01/2017 SKD SHNH
1001141852 PRPA SMHO 701B 06/01/2017 06/01/2017 SKD SHNH
1001141852 PRPA SMHO 701B 07/03/2017 07/03/2017 SKD SHNH
1001141852 PRPA T 701S 03/02/2017 03/02/2017 SKD SHNH
TEST, NAMETEST, NAMETEST, NAMETEST, NAMETEST, NAMETEST, NAME 1001141852 PRPA T 701S 03/09/2017 WHL SMHO
1001141330 MEDI OFFC 701B 01/01/2017 01/01/2017 WHL OTHR WLAC BO
4061818230 MEDP NH 701B 08/05/2017 11/18/2017 SKD NHTR NONE NO
1001141425 PRPA SMHO 701B 01/01/2017 01/01/2017 WHL OTHR WLAC NO
1001141370 PRPA NH 701B 01/01/2017 01/01/2017 SKD ALFN WLAC NO
1001141127 PRPA SMHO 701B 02/10/2017 02/10/2017 SKD NHTP NO
1001141127 PRPA T 701S 01/01/2017 02/10/2017 SKD NHTP NO
6
TEST, NAMETEST, NAMETEST, NAMETEST, NAMETEST, NAMETEST, NAMEClient Count (by PSA):
PSA: 03A
Payment Assessment Assessment Staffing Placement Diversion Level I Client Name Client ID Type Site Instrument Employee Name LOC Date Date LOC Rec Barrier Indicator
4062083024 MEDP OFFC N 10/01/2017 11/04/2017 SKD NUHO NONE NO
4061958559 MEDP OFFC O 10/23/2016 11/25/2017 ROH PRRE
4062616126 MEDP NH 701T 12/21/2017 12/30/2017 SKD NUHO REFH NO
4062088038 MEDP NH 701T 12/16/2017 12/30/2017 SKD NUHO REFH NO
4062756188 MEDP OFFC O 02/08/2005 12/23/2017 ROH PRRE
4062697501 MEDP OFFC N 09/28/2017 11/25/2017 INO NUHO NO
4062697501 MEDP ALF 701T 10/14/2017 WHL OTHR NO
4062213150 MEDP CH 701B 10/06/2017 10/28/2017 INO PRRE NO
4061819129 MEDP NH 701B 09/09/2017 11/25/2017 INO NHTR NONE NO
4061819129 MEDP OFFC N 09/09/2017 10/28/2017 INO NUHO NONE NO
4062471871 MEDP OFFC O 01/17/2014 09/30/2017 INO PRRE NO
4061478850 MEDP NH 701B 12/10/2017 12/30/2017 SKD NHTP NONE NO
4061819102 MEDP OFFC N 09/03/2017 10/28/2017 INO NUHO NONE NO
TEST, NAMETEST, NAMETEST, NAMETEST, NAMETEST, NAMETEST, NAMETEST, NAMETEST, NAMETEST, NAMETEST, NAMETEST, NAMETEST, NAMETEST, NAMETEST, NAME 4062171383 MEDP OFFC N 08/24/2017 11/04/2017 INO NUHO NONE NO
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Staffing Log
PSA: ALL Staffing Date: 01/01/2017 To 12/31/2017
PSA: 06B
Client Name Client ID Payment Type
Assessment Site
Assessment Instrument Employee Name LOC Date
Staffing Date LOC
Placement Rec
Diversion Barrier
Level I Indicator
TEST, NAMEClient Count (by PSA):
PSA: 07A
4061501687
1
MEDP H 701B 12/02/2017 12/14/2017 SKD NUHO NO
Client Name Client ID Payment Type
Assessment Site
Assessment Instrument Employee Name LOC Date
Staffing Date LOC
Placement Rec
Diversion Barrier
Level I Indicator
TEST, NAMEClient Count (by PSA):
PSA: 08A
4062618612
1
MEDI OFFC N 11/22/2017 12/14/2017 SKD NHTP NONE NO
Client Name Client ID Payment Type
Assessment Site
Assessment Instrument Employee Name LOC Date
Staffing Date LOC
Placement Rec
Diversion Barrier
Level I Indicator
TEST, NAMEClient Count (by PSA):
Client Count (by report):
4061653841
1
4,414
MEDI NH 701B 06/27/2017 12/04/2017 SKD NHTP NONE NO
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Summary of CARES Assignments PSA: 11A
Caseworker: ALL
Incomplete PSA Caseworker Assessments Staffing Needed Followups Assessments Needed Overdue Assignments
11A 0 0 37 0 37
11A 0 0 1 0 1
11A 0 0 43 0 43
11A 0 20 190 18 228
11A 0 0 36 0 36
11A 0 1 71 0 72
11A 0 27 93 64 184
11A 1 2 2 4 9
11A 1 4 8 0 13
11A 0 0 1 0 1
11A 0 23 199 73 295
11A 0 0 26 0 26
11A 0 0 2 14 16
11A 0 0 2 1 3
11A 0 9 6 59 74
11A 0 0 0 9 9
11A 0 0 21 0 21
11A 0 0 2 0 2
11A 0 0 89 0 89
11A 0 0 17 0 17
11A 0 0 1 0 1
11A 0 0 21 0 21
11A 0 0 1 0 1
11A 0 0 103 23 126
11A 0 0 11 59 70
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Summary of CARES Assignments PSA: 11A
Caseworker: ALL
Incomplete PSA Caseworker Assessments Staffing Needed Followups Assessments Needed Overdue Assignments
11A 1 21 146 77 245
11A 0 0 7 0 7
11A 0 0 1 0 1
11A 0 1 16 2 19
11A 0 12 57 73 142
11A 0 0 31 0 31
11A 0 0 28 0 28
11A 0 1 14 65 80
11A 0 0 16 0 16
11A 0 11 5 73 89
11A 0 0 1 0 1
11A 0 0 1 0 1
11A 0 0 1 0 1
11A 0 0 215 0 215
11A 0 22 62 57 141
11A 0 14 13 93 120
11A 0 1 0 1 2
11A 0 0 1 0 1
11A 0 0 10 0 10
11A 0 5 32 1 38
11A 0 15 184 17 216
11A 0 17 3 80 100
11A 0 0 10 0 10
11A 0 0 19 0 19
11A 0 16 261 19 296
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Summary of CARES Assignments PSA: 11A
Caseworker: ALL
Incomplete PSA Caseworker Assessments Staffing Needed Followups Assessments Needed Overdue Assignments
11A 0 1 87 41 129
11A 0 0 102 0 102
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Summary of CARES Assignments PSA: 11A
Caseworker: ALL
Incomplete PSA Caseworker Assessments Staffing Needed Followups Assessments Needed Overdue Assignments
Total:
Incomplete Assessments Staffing Needed Follow-ups
Assessments Needed
Overdue Assignments
3 223 2306 923 3455
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Summary of Cases by Assessment Site
Start Date: 01/01/2017 End Date: 12/31/2017
PSA ALF
Asmt % of
Total
Desk Review
Asmt % of Total
NH Asmt
% of Total
Client Home
Asmt % of
Total Hospital
Asmt % of
Total
Psych Facil Asmt
% of Total
Other Sites
% of Total
Other (Jail)
% of Total
Other Phone
% of Total
MR/DD Asmt
% of Total Total
02B 03A 03B 04A 04B 05A 06B 07A 08A 11A
0 14 94
107 110
0 0 0 0 0
0% 1.87% 6.72% 6.27%
11.23% 0% 0% 0% 0% 0%
0 439 529 645 227
0 0 1 0 0
0% 58.68% 37.83% 37.82% 23.18%
0% 0%
100% 0% 0%
4 210 505 664 408
0 0 0 1 0
17.39% 28.07% 36.12% 38.94% 41.67%
0% 0% 0%
100% 0%
1 62
210 215 163
0 0 0 0 1
4.34% 8.28%
15.02% 12.6%
16.64% 0% 0% 0% 0%
100%
0 7 5
34 8 1 1 0 0 0
0% 0.93% 0.35% 1.99% 0.81% 100% 100%
0% 0% 0%
0 0 2 2 1 0 0 0 0 0
0% 0%
0.14% 0.11% 0.1%
0% 0% 0% 0% 0%
13 4
12 22 15
0 0 0 0 0
56.52% 0.53% 0.85% 1.29% 1.53%
0% 0% 0% 0% 0%
0 0 0 0 0 0 0 0 0 0
0% 0% 0% 0% 0% 0% 0% 0% 0% 0%
5 12 41 16 47 0 0 0 0 0
21.73% 1.6%
2.93% 0.93%
4.8% 0% 0% 0% 0% 0%
0 0 0 0 0 0 0 0 0 0
0% 0% 0% 0% 0% 0% 0% 0% 0% 0%
23 748
1,398 1,705
979 1 1 1 1 1
SW 325 2.61% 1,841 25.75% 1,792 26.22% 652 15.69% 56 20.41% 5 0.04% 66 6.07% 0 0% 121 3.20% 0 0% 4,858
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Summary of Cases by Assessor and Program Recommendation PSA: ALL
Start Date: 01/01/2017 End Date: 01/01/2017
PSA Case Worker Program Recommendation Count
02B OTHER PROGRAM 1
CASE NOT STAFFED 2
CASE NOT STAFFED 1
CASE NOT STAFFED 3
NONE 1
Count Total: 8
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Summary of Cases by Assessor and Program Recommendation PSA: ALL
Start Date: 01/01/2017 End Date: 01/01/2017
PSA Case Worker Program Recommendation Client ID Asmt Site Case Opened Date Assessor
02B OTHER PROGRAM 1001141425 SMHO 01/01/2015 VOC
02B CASE NOT STAFFED 1001141273 SMHO 04/04/2014 VOC
02B CASE NOT STAFFED 1001141496 SMHO 03/01/2014 VOC
02B CASE NOT STAFFED 1001141170 SMHO 01/01/2014 VOC
02B CASE NOT STAFFED 1001141608 SMHO 09/09/2016 VOC
02B CASE NOT STAFFED 1001141718 SMHO 09/09/2016 VOC
02B CASE NOT STAFFED 1001141503 T 01/01/2017 VOC
02B NONE 1001141370 NH 01/01/2017 VOC
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Summary of Cases by Worker, County and Assessment Site PSA: ALL Start Date: 01/01/2017 End Date: 01/01/2017
PSA
02B
Grand Total: 8
Case Worker
FRANKLIN
LEON
LEON
WAKULLA
GADSDEN
LEON
County
STATE MENT HOSPITAL
STATE MENT HOSPITAL
STATE MENT HOSPITAL
STATE MENT HOSPITAL
STATE MENT HOSPITAL
NURSING FACILITY
STATE MENT HOSPITAL
TELEPHONE SCREEN
Assessment Site
1
0
0
0
0
0
0
0
Medicaid
0
1
0
0
0
0
0
0
Pending
0
0
0
0
0
0
0
Entered
0
1
1
1
1
1
Pay
1
0
0
0
0
0
0
0
0
0 0
0
0
0 0 1
1
Total Medicaid
0
No Data
0
1
Private
1 1 0 6
1
0
0
0
0
0
0
0
0
1
1
1
3
1
0
1
0
0
0
0
0
0
1
4
1
1
1
1
1
1
1
1
1
1
1
1
3
2
1
1
4
Total: 1 1 0 6 8
Total:
Total:
Total:
Total:
Total:
Total:
Total:
Total:
Total:
Total:
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Summary of Work Completed by Caseworker and Payment Type PSA: ALL
Case Worker: ALL Start Date: 01/01/2017 End Date: 12/31/2017
PSA
02A
County
BAY
Case Worker Payment Type
PRIVATE PAY
Referrals
0
Assessments
0
Staffings
0
Followups Completed
0
Scheduled
0
Total for Case Worker: PRIVATE PAY
0
0
0
0
0
0
0
0
0
0
Total for Case Worker: MEDICAID PENDING
0
0
0
0
0
0
0
0
0
0
Total for Case Worker: MEDICAID PENDING
0
0
0
0
0
0
0
0
0
0
Total for Case Worker: 0 0 0 0 0
WASHINGTON
Total for County:
MEDICAID PENDING
0
0
0
0
0
0
0
0
0
0
Total for Case Worker: 0 0 0 0 0
Total for County: 0 0 0 0 0
02B ALACHUA
Total for PSA:
MEDICAID PENDING
0
1
0
1
0
1
0
3
0
1
FRANKLIN
Total for Case Worker:
Total for County:
NO DATA ENTERED
1
1
0
1
1
0
1
1
0
3
3
0
1
1
0
LEON
Total for Case Worker:
Total for County:
NO DATA ENTERED
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Total for Case Worker: MEDICAID
MEDICAID PENDING
NO DATA ENTERED
PRIVATE PAY
0
0
0
0
0
0
0
0
1
3
0
0
0
1
1
0
0
0
0
0
0
0
0
0
0
0 4 2 0 0
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Summary of Work Completed by Caseworker and Payment Type PSA: ALL
Case Worker: ALL Start Date: 01/01/2017 End Date: 12/31/2017
PSA County Case Worker Payment Type Referrals Assessments Staffings Followups Completed Scheduled
Total for Case Worker: 0 1 1 1 0
Total for County: 0 1 1 1 0
Total for PSA: 0 1 1 1 0
07A LAKE MEDICAID 0 1 1 1 0
Total for Case Worker: 0 1 1 1 0
Total for County: 0 1 1 1 0
Total for PSA: 0 1 1 1 0
08A MARION MEDICAID 0 1 1 3 0
Total for Case Worker: 0 1 1 3 0
Total for County: 0 1 1 3 0
Total for PSA: 0 1 1 3 0
Information Requests
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Temporary Nursing Home Diversion on Clients Assessed by CARES
PSA: ALL Start Date: 01/01/2017 End Date: 12/31/2017
PSA: 03A
Total Clients: 30 Summary By Placement Recommendations
Initial 30-day 90-day Annual
Community 0 11 11 11
Temporary NH 0 12 9 0
Nursing Home 0 2 1 0
Terminated 0 0 0 0
Not Done or Due 30 5 9 19
Summary By Living Arrangements
Initial 30-day 90-day Annual
Community 0 2 0 0
Nursing Home 0 10 9 9
Terminated 0 0 0 0
Not Done or Due 30 18 21 21
Diversion Rate: 6.67 %
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Temporary Nursing Home Diversion on Clients Assessed by CARES
PSA: ALL Start Date: 01/01/2017 End Date: 12/31/2017
PSA: 03B
Total Clients: 137 Summary By Placement Recommendations
Initial 30-day 90-day Annual
Community 0 65 65 65
Temporary NH 0 89 50 0
Nursing Home 0 6 10 0
Terminated 0 0 0 0
Not Done or Due 137 -23 12 72
Summary By Living Arrangements
Initial 30-day 90-day Annual
Community 0 13 7 0
Nursing Home 0 76 43 43
Terminated 0 0 0 0
Not Done or Due 137 48 87 94
Diversion Rate: 9.49 %
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Temporary Nursing Home Diversion on Clients Assessed by CARES
PSA: ALL Start Date: 01/01/2017 End Date: 12/31/2017
PSA: 04A
Total Clients: 149 Summary By Placement Recommendations
Initial 30-day 90-day Annual
Community 0 48 47 47
Temporary NH 0 84 30 0
Nursing Home 0 10 20 0
Terminated 0 0 0 0
Not Done or Due 149 7 52 102
Summary By Living Arrangements
Initial 30-day 90-day Annual
Community 0 1 1 0
Nursing Home 0 83 29 29
Terminated 0 0 0 0
Not Done or Due 149 65 119 120
Diversion Rate: 0.67 %
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Temporary Nursing Home Diversion on Clients Assessed by CARES
PSA: ALL Start Date: 01/01/2017 End Date: 12/31/2017
PSA: 04B
Total Clients: 73 Summary By Placement Recommendations
Initial 30-day 90-day Annual
Community 0 21 19 19
Temporary NH 0 61 11 0
Nursing Home 0 10 20 0
Terminated 0 0 0 0
Not Done or Due 73 -19 23 54
Summary By Living Arrangements
Initial 30-day 90-day Annual
Community 0 0 0 0
Nursing Home 0 61 11 11
Terminated 0 0 0 0
Not Done or Due 73 12 62 62
Diversion Rate: 0 %
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Time Lag Report by Caseworker PSA: ALL Start Date: 01/01/2017 End Date: 12/31/2017 Caseworker: ALL
PSA: 02B
Client ID
Caseworker:
Client Name
Casework TestCase Open Date or Reassessment Request Date
Assessment Date
Staffing Info Received Date
Staffing Date
Days Case Open To Assess or Request to
Reassess
Days Assess To
Staffing
1001141852 LIN TESTTTT 07/01/2017 07/01/2017 07/01/2017 07/01/2017 0 0
PSA: 02B
Client ID
Caseworker:
Client Name
LESTER, TESTING Case Open Date or Reassessment Request Date
Assessment Date
Staffing Info Received Date
DaStaffing To AssessDate
ys Case Open or Request to Ass
Reassess
Days ess To
Staffing
1001141370 TEST NAME 01/01/2017 01/01/2017 01/01/2017 01/01/2017 0 0 1001141127 TEST NAME 01/01/2017 01/10/2017 02/10/2017 02/10/2017 9 1 1001141127 TEST NAME 02/02/2017 02/02/2017 02/10/2017 02/10/2017 0 1 1001141852 TEST NAME 03/01/2017 03/01/2017 03/01/2017 03/01/2017 0 1 1001141852 TEST NAME 03/01/2017 03/02/2017 03/02/2017 03/02/2017 1 1 1001141852 TEST NAME 03/09/2017 03/09/2017 03/09/2017 03/09/2017 0 1 1001141852 TEST NAME 05/09/2017 05/09/2017 06/01/2017 06/01/2017 0 1 1001141852 TEST NAME 07/01/2017 07/02/2017 07/03/2017 07/03/2017 1 1 1001141823 TEST NAME 05/31/2017 05/31/2017 04/11/2018 04/12/2018 0 2
PSA: 03A
Client ID
Caseworker:
Client Name
Caseworker, TestCase Open Date or Reassessment Request Date
Assessment Date
Staffing Info Received Date
Staffing Date
Days Case Open To Assess or Request to
Reassess
Days Assess To
Staffing
4061803692 4062467083
TEST TEST
NAME NAME
11/15/2012 03/04/2017
11/16/2012 01/04/2013
01/16/2017 03/04/2017
01/21/2017 03/09/2017
1 -1520
5 4
PSA: 03A
Client ID
Caseworker:
Client Name
Caseworker, TestCase Open Date or Reassessment Request Date
Assessment Date
Staffing Info Received Date
DStaffing To AssessDate
ays Case Open or Request to Ass
Reassess
Days ess To
Staffing
4061938562 TEST NAME 10/01/2017 10/09/2017 10/09/2017 10/14/2017 8 5 4062556074 TEST NAME 12/01/2017 12/08/2017 12/08/2017 12/09/2017 7 1 4061822799 TEST NAME 12/31/2017 01/07/2018 01/07/2018 01/13/2018 7 5 4062703930 TEST NAME 11/09/2017 11/10/2017 11/10/2017 11/11/2017 1 1 4061726949 TEST NAME 10/12/2017 10/22/2017 10/22/2017 10/28/2017 10 5 4062782324 TEST NAME 10/06/2017 10/08/2017 10/08/2017 10/14/2017 2 5 4061813883 TEST NAME 11/30/2017 12/10/2017 12/10/2017 12/16/2017 10 5 4062301932 TEST NAME 10/05/2017 10/08/2017 11/05/2017 11/11/2017 3 5
Report run on: 08/31/2018 09:46 AM Page 1 of 152 time_lag.rdf
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Test D
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Time Lag Report by Caseworker PSA: ALL Start Date: 01/01/2017 End Date: 12/31/2017 Caseworker: ALL
PSA: 10A
Client ID
Caseworker:
Client Name Case Open Date or Reassessment Request Date
Assessment Date
Staffing Info Received Date
Staffing Date
Days Case Open To Assess or Request to
Reassess
Days Assess To
Staffing
4062440052 TEST NAME 06/09/2017 04/09/2013 06/09/2017 06/09/2017 -1522 1
PSA: 11A
Client ID
Caseworker:
Client Name Case Open Date or Reassessment Request Date
Assessment Date
Staffing Info Received Date
Staffing Date
Days Case Open To Assess or Request to
Reassess
Days Assess To
Staffing
4062669313 TEST NAME 04/01/2017 02/15/2013 04/15/2017 04/15/2017 -1506 0
PSA: 11A
Client ID
Caseworker:
Client Name Case Open Date or Reassessment Request Date
Assessment Date
Staffing Info Received Date
Staffing Date
Days Case Open To Assess or Request to
Reassess
Days Assess To
Staffing
4062669313 TEST NAME 02/25/2013 02/25/2013 04/27/2017 04/27/2017 0 1
Report run on: 08/31/2018 09:46 AM Page 152 of 152 time_lag.rdf
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Test D
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Time Parameters Report PSA: ALL
Start Date: 01/01/2017 End Date: 12/31/2017
Caseworker: ALL
Total Avg Time From Open Date Avg Time From Avg Time From Staff %of Clients Staffed Assessment to Assessment or Date Assessment To Info Received To Within 12 Days of
PSA Caseworker County Count Requested to Re-Assessment Staffing Staffing Staff Info Received
02B WAKULLA 1 88.00 0.00 0.00 100.00
1 88.00 0.00 0.00 100.00
LEON 2 0.50 113.50 1.00 100.00
WAKULLA 7 25.57 7.57 1.00 100.00
9 20.00 31.11 1.00 100.00
ALACHUA 2 0.50 1090.50 4.50 100.00
2 0.50 1090.50 4.50 100.00
ALACHUA 67 9.58 21.60 3.97 98.51
BRADFORD 37 10.05 121.27 3.73 100.00
COLUMBIA 5 12.20 6.40 7.60 80.00
LEVY 1 7.00 5.00 5.00 100.00
PUTNAM 70 12.46 5.51 3.76 97.14
SUWANNEE 1 16.00 5.00 5.00 100.00
UNION 1 5.00 35.00 0.00 100.00
182 10.85 35.15 3.93 97.80
PUTNAM 1 40.00 1.00 1.00 100.00
1 40.00 1.00 1.00 100.00
ALACHUA 1 1.00 1.00 1.00 100.00
PUTNAM 1 2.00 4.00 0.00 100.00
SUWANNEE 1 6.00 1.00 6.00 100.00
3 3.00 2.00 2.33 100.00
ALACHUA 97 19.68 50.03 6.47 82.47
BRADFORD 2 22.50 545.50 2.50 100.00
Report run on: 08/31/2018 09:59 AM Page 1 of 57 time_parameter.rdf
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Test D
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Time Parameters Report PSA: ALL
Start Date: 01/01/2017 End Date: 12/31/2017
Caseworker: ALL
PSA Caseworker County
Total Assessment
Count
Avg Time From Open Date to Assessment or Date
Requested to Re-Assessment
Avg Time From Assessment To
Staffing
Avg Time From Staff Info Received To
Staffing
%of Clients Staffed Within 12 Days of
Staff Info Received
04B Average 1103 15.58 167.66 2.48 99.82
State Average 5428 13.27 90.70 4.73 96.61
Report run on: 08/31/2018 09:59 AM Page 57 of 57 time_parameter.rdf
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Test D
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Unduplicated Count of All PAC Clients PSA: ALL
Start Date: 01/01/2017 End Date: 12/31/2017
442
03A
03B
04A
04B
ALACHUA
COLUMBIA
DIXIE
HAMILTON
LEVY
PUTNAM
SUWANNEE
UNION
CITRUS
HERNANDO
LAKE
MARION
SUMTER
BAKER
CLAY
DUVAL
NASSAU
SAINT JOHNS
FLAGLER
VOLUSIA
MEDICAID MEDICAID PENDING
25
5
3
1
3
8
12
2
3
12
42
9
8
1
3
246
1
22
8
28
244 198
0 25
0 5
0 3
0 1
0 3
0 8
0 12
0 2
0 3
0 12
0 42
0 9
0 8
1 0
2 1
195 51
1 0
9 13
8 0
28 0
442
244 198
Total:
Total:
Total
Report run on: 08/31/2018 09:50 AM Page 1 of 1 undup_pac_clnts.rdf Report run by: RSHQALL Dispose of this report so that it cannot be read or reconstructed
Test D
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Unduplicated Count of Clients by Level of Care
PSA: ALL Staffing Date: 01/01/2017 To 12/31/2017
Legend of Levels of Care:
DNM DOES NOT MEET LOC
DWC DOES NOT MEET WAIVER CRITERIA
INO INTERMEDIATE ONE
DNM INO INT ROH RON SKD WHL Total
02B 0 0 0 0 0 9 3 12
03A 1 351 1 59 0 249 89 750
03B 0 650 1 77 1 529 203 1461
04A 0 639 0 277 0 577 210 1703
04B 0 537 7 41 0 328 178 1091
05A 0 0 0 0 0 1 0 1
06B 0 0 0 0 0 1 0 1
07A 0 0 0 0 0 1 0 1
08A 0 0 0 0 0 1 0 1
Total 1 2177 9 454 1 1696 683 5,021
Report run on: 08/31/2018 10:15 AM Page 1 of 1 undup_cnts_loc.rdf Dispose of this report so that it cannot be read or reconstructedReport run by: RSHQALL
Test D
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