Data Test - elderaffairs.state.fl.uselderaffairs.state.fl.us/doea/eCIRTS/CARES_CIRTS_REPORTS.pdf ·...

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

Report run on: 08/31/2018 09:51 AM of 163 3008_report.rdf

Report run by: RSHQALL Dispose of this report so that it cannot be read or reconstructed

Test D

ata

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


1271 B

1271 B

1271

0000 Provider Name

0001 Provider Name


1271 B

1271

0003 Provider Name


1271 B

1271

0072 Erovider Name


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


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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Test D

ata

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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Test D

ata

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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Test D

ata

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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Test D

ata

Client List for Diversion Report on Hospital-Based Clients Assessed by CARES


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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Test D

ata

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



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Test D

ata

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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Test D

ata

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

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 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


PRRE NONE PRRE


NHTP NONE NUHO

NUHO LTCN NUHO

NHTP LTCN NUHO


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


PRRE NONE PRRE


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



PRRE NONE PRRE

PRRE NONE PRRE

NHTP NONE NUHO 03/03/2018 IH

HOSP NONE HOSP

NHTP NONE NUHO


TEST, NAME

TEST, NAME

TEST, NAMETEST, NAME

TEST, NAME

TEST, NAME

TEST, NAME

4062442660 11/11/2017 NHTP NONE NUHO 11/11/2017 NN

Report run on: 08/31/2018 08:53 AM

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Test D

ata

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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Test D

ata

Count of All PAC Cases by Case Closed Reason


NO LONGER NEEDED Total

03A 44 44

03B 74 74

04A 273 273

04B 35 35

Total 426 426

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Test D

ata

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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Test D

ata

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


0 1 1

Annual

0


Terminated 0 0 0 0


Diversion Rate: 100 %

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Test D

ata

Diversion Report based on Care Level, PR and Living Arrangement at 30 Days Staffing


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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Test D

ata

Diversion Report on Hospital-based (Upstreaming) Clients Assessed by CARES


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


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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Test D

ata

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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Test D

ata

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



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



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

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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


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


Test D

ata

Incomplete Assessments Report

PSA: ALL

PSA: 02B

1001141485

Count: 24

TEST, NAME 02/05/2015 SUPERVISOR02B 03/12/2015

PSA: 05A


4061417625

Count: 1

TEST, NAME 08/04/2017 RSSRCARESCW05A 08/09/2017

PSA: 07A


4062430497

4062661377

Count: 2


07/08/2015

07/08/2015

RSSUPERVISOR07A

RSSUPERVISOR07A

08/03/2015

08/03/2015

PSA: 07B


4061425860

1001141726

Count: 2


04/01/2014

04/15/2016

RSSUPERVISOR07B

RSSUPERVISOR07B

04/19/2016

04/19/2016

PSA: 11A


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


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




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


1001141224 MENTAL ILLNESS NO EXEMPTION














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


Test D

ata

Incomplete PASRR PSA: ALL

Case Worker: ALL


Exemption Exemption

1001141409 MENTAL ILLNESS DELIRIUM/7 DAYS 11/19/2014



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



1001141414 INTELLECTUAL DISABILITY PROTECTIVE 07/10/2015 SERVICES/7 DAYS


1001141285 INTELLECTUAL DISABILITY EXEMPTED RESPITE/14 11/06/2014 DAYS





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


Test D

ata

Information Only Case Summary Report PSA: ALL


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


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


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


Test D

ata

Level II Due Date for 30 Day Hospital Exemption PSA: ALL

Case Worker: ALL


Exemption Exemption


1001141281 BOTH EXEMPTED HOSPITAL/30 09/26/2014 EXEMPTED RESPITE/14 DAYS DAYS








1001141455 INTELLECTUAL DISABILITY EXEMPTED 10/03/2014 11/11/2014 HOSPITAL/30 DAYS


1001141452 MENTAL ILLNESS EXEMPTED HOSPITAL/30 10/04/2016 09/09/2016 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


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


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


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


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


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


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

Report run on: 08/31/2018 08:56 AM Page 1 of 9 diversion_barrier.rdf


Test D

ata

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 4061819129 ARC or ADRC

4061408607 ARC or ADRC TEST, NAME








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


TELEPHONE APPROVED CALL/CASE MGR

TELEPHONE DENIED CALL/CARES


TELEPHONE DENIED CALL/CASE MGR

NO DATA NO DATA ENTERED ENTERED


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


NOT ELIGIBLE


NO DATA ENTERED

Report run on: 08/31/2018 09:37 AM Page 1 of 16 non_imm_risk.rdf


Test D

ata

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



NURSING FACILITY

STATE MENT HOSPITAL

TELEPHONE SCREEN


Sub-Total by PSA: 8

Report Total: 8

Total by Assessor

PSA Assessor

701B COMPREHENSIVE ASSESSMENT INSTRUMENT


NONE




SCREENING FORM

Count

VOCATIONAL REHABILITATION 1







02B VOCATIONAL REHABILITATION 8

Total by Instrument

PSA Instrument Count

02B 701B COMPREHENSIVE ASSESSMENT INSTRUMENT 6

SCREENING FORM 1

NONE 1

Report run on: 08/30/2018 04:51 PM Page 1 of 2 assm_by_cw.rdf

Report run by: RSHQALL Dispose of this report so that it can not be read or reconstructed

Test D

ata

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

Report run on: 08/30/2018 04:51 PM Page 2 of 2 assm_by_cw.rdf

Report run by: RSHQALL Dispose of this report so that it can not be read or reconstructed

Test D

ata

Number of Assessments Completed VS. Number of Assessments Entered in CIRTS By Caseworker Report

PSA: ALL


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

Report run on: 08/31/2018 09:54 AM Page 1 of 1 assm_comp_enter.rdf


Test D

ata

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

Report run on: 08/31/2018 09:37 AM Page 1 of 17 num_cases_by_ref.rdf


Test D

ata

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

Report run on: 08/31/2018 09:39 AM Page 1 of 2 nhd_ems_summ.rdf


Test D

ata

Nursing Home Diversion Enrollment Management System Report PSA: ALL Caseworker: ALL

EMS Release Date Between: 01/01/2017 and 12/31/2017

Report run on: 08/31/2018 09:57 AM Page 1 of 2 nhd_enroll_mgt.rdf


Test D

ata

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.

Report run on: 08/31/2018 09:57 AM Page 2 of 2 nhd_enroll_mgt.rdf


Test D

ata

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

Report run on: 08/31/2018 09:53 AM Page 1 of 1 open_cases_move.rdf Report run by: RSHQALL Dispose of this report so that it cannot be read or reconstructed

Test D

ata

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

Report run on: 08/31/2018 10:03 AM Page 1 of 1 pas_name_list.rdf


Test D

ata

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)


Both SMI & ID(BO)


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




*NotExcluded


*Severity ofIllness

*TerminalIllness

Total


Report run on: 08/31/2018 10:03 AM Page 1 of 3 pas_report.rdf


Test D

ata

PAS Report


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



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


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


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.



Test D

ata

PAS Report


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


Services

ALF with



Adult Geriatric


Facility

Group Home


Disability (MRDD)

Temporary Nursing

Home

*NursingHome

Transition

Nursing Home


Private Residence

Psych Facility

Rehab Hospital


State Mental

Hospital/ Nursing

Home Unit


Total


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


Need Specialized Services

Total

#Received from




Test D

ata

PAS Statewide



Mental Illness (MI)


Both SMI & ID(BO)


ID(NO)

Total

1 0 0 1 2

SMI=Serious Mental

Illness (MI)


Both SMI & ID(BO)


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:


CARES Total

1 0 2 3

Level I Resident Review

Total

1 0 1


*Conv.Care/30

Day

*ChronicMI

Delirium/7 Days




*NotExcluded


*Severity ofIllness

*TerminalIllness

Total

0 0 0 1 0 0 0 0 0 0 0 1



*Conv.Care/30

Day

Delirium/7 Days




*NotExcluded


*Severity ofIllness

*TerminalIllness

Total

0 0 0 0 0 0 0 0 0 0 0


Report run on: 08/31/2018 08:43 AM Page 1 of 3 statewide_pas.rdf


Test D

ata

PAS Statewide



Never Admitted



Review

Client Discharged

Prior to Level II

Total

0 0 0 0 0 0

Never Admitted



Review

Client Discharged

Prior to Level II

Total

0 0 0 0 0 0


Scheduled Completed

0 0

Need Specialized Services/Can't



Not Received

(NP-Old PAS)


Not Received

(NR-New PAS)

No Specialized

Services Needed

Excluded Level II


Need Specialized

Services

Total

0 0 0 0 0 0 0


SAMH Disposition:

#Referred to SAMH

#Received from SAMH


Nursing Facility

Inappropriate



Need Specialized

Services


*Out ofCompliance

Total

0 0 0 0 0 0 0 0 0




Test D

ata

PAS Statewide



Adult Family

Care Home

ALF with

Extended Congregate

Care

ALF with


Services

ALF with



Adult Geriatric


Facility

Group Home


Disability (MRDD)


*NursingHome

Transition

Nursing Home


Private Residence

Psych Facility

Rehab Hospital


State Mental



Total

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0



Adult Family

Care Home

ALF with

Extended Congregate

Care

ALF with


Services

ALF with



Adult Geriatric


Facility

Group Home


Disability (MRDD)

Temporary Nursing

Home

*NursingHome

Transition

Nursing Home


Private Residence

Psych Facility

Rehab Hospital


State Mental

Hospital/ Nursing

Home Unit


Total

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0



#Referred to APD

#Received from APD


Nursing Home





Total

0 #Received from0 0 0 0 0 0 0 0




Test D

ata

PAS Summary



Mental Illness (MI)


Both SMI & ID(BO)


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)


Both SMI & ID(BO)


ID(NO)

Total

Total

Report run on: 08/31/2018 08:32 AM Page 1 of 10 summary_pas.rdf


Test D

ata

PAS Summary


Number of Level I Evaluations(including Returned to Sender) Number of Level I Evaluations/Resident Review Evaluations Completed By: Returned to Screener:


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



Test D

ata

PAS Summary



*Conv.Care/30

Day

*ChronicMI

Delirium/7 Days




*NotExcluded


*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




Test D

ata

PAS Summary



*Conv.Care/30

Day

Delirium/7 Days




*NotExcluded


*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




Test D

ata

PAS Summary



Never Admitted



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



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



Test D

ata

PAS Summary



Scheduled Completed

02A 0 0

02B 0 0

Total 0 0

Need Specialized Services/Can't



Not Received

(NP-Old PAS)


Not Received

(NR-New PAS)

No Specialized

Services Needed

Excluded Level II


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




Test D

ata

PAS Summary


SAMH Disposition:

#Referred to SAMH

#Received from SAMH


Nursing Facility

Inappropriate



Need Specialized

Services


*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




Test D

ata

PAS Summary



Adult Family

Care Home

ALF with

Extended Congregate

Care

ALF with


Services

ALF with



Adult Geriatric


Facility

Group Home


Disability (MRDD)


*NursingHome

Transition

Nursing Home


Private Residence

Psych Facility

Rehab Hospital


State Mental



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




Test D

ata

PAS Summary



Adult Family

Care Home

ALF with

Extended Congregate

Care

ALF with


Services

ALF with



Adult Geriatric


Facility

Group Home


Disability (MRDD)

Temporary Nursing

Home

*NursingHome

Transition

Nursing Home


Private Residence

Psych Facility

Rehab Hospital


State Mental

Hospital/ Nursing

Home Unit


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




Test D

ata

PAS Summary



#Referred to APD

#Received from APD


Nursing Home





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




Test D

ata

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:


TEST NAME 4062555191 05/21/2014 Y Y ARC


Case Worker:


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


Case Worker:


TEST NAME 4062092657 05/12/2014 05/14/2014 Y Y NH


Report run on: 08/31/2018 09:39 AM

Report run by: RSHQALL Page 1 of 192 pend_assm_staff.rdf


Test D

ata

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

Report run on: 08/31/2018 09:39 AM Page 192 of 192 pend_assm_staff.rdf


Test D

ata

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.

Report run on: 08/31/2018 09:55 AM Page 1 of 1 cares_poss_dups.rdf


Test D

ata

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

Report run on: 08/31/2018 09:41 AM Page 1 of 1 proj_aids_care.rdf


Test D

ata

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 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

Report run on: 08/31/2018 10:11 AM Page 1 of 164 staffing_log.rdf


Test D

ata

Staffing Log


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


Assessment Site


Staffing Date LOC

Placement Rec

Diversion Barrier

Level I Indicator


PSA: 08A

4062618612

1

MEDI OFFC N 11/22/2017 12/14/2017 SKD NHTP NONE NO


Assessment Site


Staffing Date LOC

Placement Rec

Diversion Barrier

Level I Indicator


Client Count (by report):

4061653841

1

4,414

MEDI NH 701B 06/27/2017 12/04/2017 SKD NHTP NONE NO

Report run on: 08/31/2018 10:11 AM Page 164 of 164 staffing_log.rdf

Dispose of this report so that it cannot be read or reconstructedReport run by: RSHQALL

Test D

ata

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

Report run on: 08/31/2018 09:42 AM Page 1 of 4 summ_case_assign.rdf


Test D

ata


Caseworker: ALL


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



Test D

ata


Caseworker: ALL


11A 0 1 87 41 129

11A 0 0 102 0 102



Test D

ata


Caseworker: ALL


Total:

Incomplete Assessments Staffing Needed Follow-ups

Assessments Needed

Overdue Assignments

3 223 2306 923 3455



Test D

ata

Summary of Cases by Assessment Site


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

Report run on: 08/31/2018 08:31 AM Page 1 of 1 summ_cases_site.rdf


Test D

ata

Summary of Cases by Assessor and Program Recommendation PSA: ALL


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

Report run on: 08/30/2018 04:49 PM Page 1 of 2 case_sum_assor.rdf Dispose of this report so that it cannot be read or reconstructedReport run by: RSHQALL

Test D

ata

Summary of Cases by Assessor and Program Recommendation PSA: ALL


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 1001141503 T 01/01/2017 VOC

02B NONE 1001141370 NH 01/01/2017 VOC

Report run on: 08/30/2018 04:49 PM Page 2 of 2 case_sum_assor.rdf Dispose of this report so that it cannot be read or reconstructedReport run by: RSHQALL

Test D

ata

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:

Report run on: 08/30/2018 04:48 PM Page 1 of 1 case_sum_cnty.rdf


Test D

ata

Summary of Work Completed by Caseworker and Payment Type PSA: ALL


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 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

Report run on:

Report run by:

08/31/2018 09:52 AM

RSHQALL

Page 1 of 24 work_completed.rdf


Test D

ata

Summary of Work Completed by Caseworker and Payment Type PSA: ALL


PSA County Case Worker Payment Type Referrals Assessments Staffings Followups Completed Scheduled



Total for PSA: 0 1 1 1 0

07A LAKE MEDICAID 0 1 1 1 0




08A MARION MEDICAID 0 1 1 3 0




Information Requests

Report run on: 08/31/2018 09:52 AM Page 24 of 24 work_completed.rdf


Test D

ata

Temporary Nursing Home Diversion on Clients Assessed by CARES


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


Terminated 0 0 0 0


Summary By Living Arrangements


Community 0 2 0 0


Terminated 0 0 0 0


Diversion Rate: 6.67 %

Report run on: 08/31/2018 09:43 AM Page 1 of 4 temp_nhd_clnts.rdf


Test D

ata



PSA: 03B






Terminated 0 0 0 0

Not Done or Due 137 -23 12 72



Community 0 13 7 0


Terminated 0 0 0 0





Test D

ata



PSA: 04A






Terminated 0 0 0 0




Community 0 1 1 0


Terminated 0 0 0 0





Test D

ata



PSA: 04B






Terminated 0 0 0 0

Not Done or Due 73 -19 23 54



Community 0 0 0 0


Terminated 0 0 0 0


Diversion Rate: 0 %



Test D

ata

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 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


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 Date


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


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


Test D

ata

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 Date


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:


Assessment Date


Staffing Date


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:


Assessment Date


Staffing Date


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


Test D

ata

Time Parameters Report PSA: ALL


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


Test D

ata

Time Parameters Report PSA: ALL


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


Test D

ata

Unduplicated Count of All PAC Clients PSA: ALL


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

ata

Unduplicated Count of Clients by Level of Care


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

ata

Data Test - elderaffairs.state.fl.uselderaffairs.state.fl.us/doea/eCIRTS/CARES_CIRTS_REPORTS.pdf ·...

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