- Multi-Step Intake Record Options Map

When entering or updating the content of referral records, it is necessary to configure the fields and options in the various sections of the Referral Information Form page:

Application Evaluation	Referral Source	Demographic Data	Legal Data
Substance Abuse Data

Click any of the above sections to view more information on the fields and options that may be configured during data entry in that section.

TIP: Required fields and options are marked in the application with a red asterisk (*). If those fields and options are not configured, the referral record section cannot be saved.

Updating Application Evaluation Information

The Application Evaluation section of the referral record contains key information on the applicant and his or her application process. To update this information, complete the following steps from the Referral Information Form page:

Click Update Application Evaluation. The Update Application Evaluation page is displayed.

TIP: When entering a new referral, the application evaluation information is entered directly into the Referral Information Form page, and this step does not need to be completed.

Make changes or additions to the information on this page as necessary. This information includes:

First Name *

In this field, type or make changes to the applicant's first name.

Last Name *

In this field, type or make changes to the applicant's last name.

Alias

Birth Date

Social Security #

In this field, type or make changes to the applicant's social security number (using nnn-nn-nnnn format).

Click this drop-down arrow and select the program or program type to which the applicant is applying.

TIP: Once intake or admission has been processed for this referral, the value in this field is read-only and cannot be updated.

Eligibilities

Click one or more of the available Eligibilities check boxes to specify the clinical and/or financial eligibilities of the applicant. Available selections are:

SPMI	DSS	Medicare	ETOH
Community Bed	SSI	AIDS	Low Income
SSDI	NY/NY	DAS	PA
MICA	Medicaid	VA

TIP: When "DAS" is selected as an eligibility, and CREATE REFERRAL is clicked on the Referral Information Form page, or UPDATE is clicked on the Update Application Evaluation page, DAS case manager, phone, and approval date fields are added to the referral record. Click Update Application Evaluation to go to the Update Application Evaluation page to enter values in these fields. Intake cannot be processed for a DAS-eligible referral until the approval date has been entered.

DAS Information

When a referral is DAS-eligible, the following fields and options are added to the Update Application Evaluation page:

DAS Case Manager

In this field, type the name of the applicant's DAS case manager.

Phone

Click the Work/Home drop-down arrow and select the type of phone number being entered. In the Phone field, type the DAS case manager's phone number (using (nnn) nnn-nnnn format followed by the case manager's extension, if applicable).

DAS Approval Date

In this field, type the date on which the applicant's DAS eligibility was approved (using mm/dd/yy format).

TIP: Intake cannot be processed for a DAS-eligible referral until a date is entered in this field.

TIP: These fields are only available for DAS-eligible referrals.

Interviewers

To schedule or update an interview for the applicant, configure the following interview fields and options as necessary:

Interviewers	Click one or both drop-down arrows and select the worker(s) who are to conduct the interview with the applicant. The following users are available for selection from the interviewers list: the user doing the referral record data entry anyone in the "Intake Staff" user group anyone with the "Referrals Data Entry" permission and chart access to the selected program (or at least one of the programs if a program group has been selected) anyone who has been selected as a screener or interviewer for the selected program, or anyone who has entered a referral tracking note for a referral with a screening date in the past 90 days for the selected program (or any of the programs in the program group) anyone who has the "Include in Direct Care Staff Lists" permission and chart access to the program for which the referral was created
Date	Click the drop-down arrow and select the date on which the interview took place, or on which it is to take place.
Time	Click the drop-down arrows and select the interview time.
Location	Click this drop-down arrow and select the location at which the interview is to be held. If the appropriate location is not listed, select "Other Place" and type the location name in the Other field. TIP: The locations available for selection here are those that have been configured using the System Setup module, Agency Program Information, Configure Locations feature. For more information, see Configure Locations.
Delete	Click this check box to remove a canceled interview. TIP: The delete option is only available on referral records that have been saved at least once, and it can only be used to remove interviews with today's date or a date in the future. It cannot be used to delete past interviews.

For each additional interview being entered or updated, configure another set of the above fields and options. Up to four interviews can be scheduled for each applicant.

TIP: When an interview is scheduled, the AWARDS system generates and sends a notification message to all agency participants.

Referral Tracking Notes

To enter or update a referral tracking note for this applicant, configure the following fields and options as necessary:

Date	Click the drop-down arrow and select the date for which the note is being written. The default value is today's date. TIP: Only one referral note can be added per status and date combination.
Disposition Status for Note	Click the drop-down arrow and select the application/referral record status on which this note is remarking. Available selections are: "Screening," "Hold (Info Req.)," "Hold (Other)," "1st Interview," "2nd Interview," "Accepted," "Withdrawn," and "Rejected."
Text	In the text box, type or make changes to the referral tracking note text. TIP: To spell check the referral tracking note text, click Spell Check and follow the instructions on the spell check window that is opened.
Fair Housing Evaluative Disqualifiers	Click Fair Housing Evaluative Disqualifiers to view a list of pre-defined disqualifiers. Text from this list can be copied and pasted into the referral tracking note as necessary. To do so, highlight the appropriate text and press Ctrl and C, the click the mouse cursor in the text box in the referral record. Press Ctrl and V. The text is pasted. TIP: This option is only available when an SRO/Supported Housing program was selected on the Intake Information Settings page.

TIP: The following rules must be observed when entering or updating referral tracking notes:
Notes can only be updated by the original writer.
Notes can only be edited within 90 days after they were written.
Note writers cannot create new notes using the same status and date as an existing note they wrote.
Note dates must be dated with the screen date or later, and cannot be post-dated later than next year.

Anticipated Admission Date

If applicable, in the Anticipated Admission Date field, type or make changes to the date on which it is expected the applicant will be admitted to the selected program (using mm/dd/yy format).

When all changes have been made, click UPDATE if this is an existing referral or CREATE NEW REFERRAL if this is a new referral. The application evaluation information is saved, and the Referral Information Form page is re-displayed.

The process of updating application evaluation information is now complete.

Updating Referral Source Information

The Referral Source section of the referral record contains information on the person or agency by which this applicant was referred. To update this information, complete the following steps from the Referral Information Form page:

TIP: This information must be updated before intake or admissions can be processed for the applicant.

When entering referral source information for the first time, click Update Referral Source. When updating existing referral source information, click Update Application Evaluation, and from the Update Application Evaluation page, click Update Referral Source.

The Referral Source Selection Settings page is displayed.

Click one of the "Referred By" radio buttons on this page to indicate who referred the applicant.

Available options:

Self	If this option is selected, continue with step 3.
Agency	If this option is selected, continue with step 4.

Click CONTINUE. The referral source information is saved and the Referral Information Form page is re-displayed. The process of updating referral source information is now complete.
To limit agency selection by name, type one or more of the letters that begin the referring agency's name in the Agency/Initial field. If this field is left blank, all agencies will be included in the referral source selection process.
Click CONTINUE. The Referral Source Agency Selection page is displayed.

Click the agency drop-down arrow and select the referring agency. If the referring agency is not listed, select "Add New Agency."

TIP: The agency selection list is limited to those agencies whose names begin with those letters entered in the "Agency/Initial" field on the previous page.

Click CONTINUE. The Referral Source Agency & Contact Update page is displayed.

Make changes or additions to the referring agency information as necessary, including: Agency (name), Program Type, Street Address, City, State, and Zip (code).
Make changes or additions to the contact person at the referring agency as necessary, including: Name, Phone, Title, and Phone/Fax Number.

If the appropriate individual is not listed in the Contact Person selection list, select "Add New Contact Person" and enter his or her information in the fields below.

Click APPLY CONTACT UPDATE & CONTINUE REFERRAL UPDATE. The Referral Information Form page is re-displayed.

The process of updating referral source information is now complete.

Updating Demographic Data

The Demographic Data section of the referral record contains demographic information on the applicant or consumer. To update this information, complete the following steps from the Referral Information Form page:

Click Update Demographic Data. The Update Demographic Data page is displayed.
Make changes or additions to the information on this page as necessary. This information includes:

Status Date *

The status date is the date on which the application status was last changed and on which the current status began. In the Status Date field, type the disposition date (using mm/dd/yy format). The default value is today's date.

Intake Status

Click this drop-down arrow and select the disposition status (current status) for the applicant. Available selections are:

Psychosocial Screening	Hold-Incomplete Info	Hold-No Openings	Hold-LowIncome NoVacancy
Hold-DAS No Vacancy	Hold-Other Reason	1st Intake Interview	2nd Intake Interview
3rd Intake Interview	Accepted-Admission	Accepted-Wait Priority	Accepted-Wait Non-Priority
Accepted-Withdrawn	Withdrawn-No Show	Withdrawn-Discharged	Withdrawn-Other
Withdrawn-Forms Returned	Rejected

Street Address

In this field, type or make changes to the applicant's current street address.

TIP: Once an applicant has been admitted, address information cannot be updated from his or her referral record. This information must be updated using the Housing module. For more information, see Working with External Residence Housing Records.

City, State, Zip

In these fields, type or make changes to the applicant's current city, state, and zip code.

Residence County

In this field, type or make changes to the county of the applicant's current residence.

Phone

In this field, type or make changes to the applicant's phone number (using (nnn) nnn-nnnn format).

TIP: Once an applicant has been admitted, phone number information cannot be updated from his or her referral record. This information must be updated using the Housing module. For more information, see Working with External Residence Housing Records.

Move In Date

In this field, type or make changes to the date on which the applicant moved into his or her current residence (using mm/dd/yy format).

Living Arrangements

Click this drop-down arrow and select the applicant's current living status. Available selections are:

Living with spouse/relative

Living w non-related person

Living alone

Race

Click this drop-down arrow and select the race of the applicant. Available selections may include:

Native American	Asian American	African American	Euro American
Latin American	Arab American	Multi-Ethnic	Black-Unspecified
Black-Jamaican	Black-Other	Chinese	Indo-Chinese
Indian/Pakistani	Asian-Other	Unknown	Other Ancestry

Ethnicity

Click this drop-down arrow and select the consumer's ethnicity. Available selections may include:

Puerto Rican	Cuban	Latin-Other	Mexican
Not Latin	Central American	South American

TIP: If "Latin American" was not selected as the consumer's race, "Not Latin" should be selected as his or her ethnicity.

Mother's Maiden Name

In this field, type or make changes to the maiden name of the applicant's mother.

Birth Place

In this field, type or make changes to the applicant's birth place.

Citizen

Click this drop-down arrow and select the applicant's citizenship status. Available selections are:

US Citizen

Registered Alien

Undocumented Alien

Alien Registration

If "Registered Alien" was selected under the Citizen option, type or make changes to the applicant's alien registration number in the Alien Registration field.

Primary Language

Click this drop-down arrow and select the language primarily spoken by the applicant. Available selections are:

English	Spanish	French	Chinese
Arabic	Hebrew	Hindi	Russian
Sign Language	Other	Creole	Greek
Italian	Japanese	Vietnamese	Braille

Veteran/Discharge Type

Click this drop-down arrow and select the applicant's status as a veteran. Available selections are:

Not a Veteran

Honorable Discharge

Not Honorable Discharge

Unknown Discharge Type

Marital Status

Click this drop-down arrow and select the applicant's current marital status. Available selections are:

Single	Married	Common Law	Divorced
Separated	Remarried	Widow(er)

Significant Other

Click this drop-down arrow and select "Yes" or "No" to indicate whether the applicant has a significant other.

Number of Children

In this field, type or make changes to the number of children the applicant has.

Children Living with Client

In this field, type or make changes to the number of children living with the applicant.

Currently Pregnant

Click this drop-down arrow and select "Yes" or "No" to indicate whether the applicant is currently pregnant.

TIP: This option is marked "N/A" if the applicant is a male.

Current Living Situation

Click this drop-down arrow and select the type of housing the applicant is currently in. Available selections are:

Independent Housing	Assisted / Supp. Housing	Supervised Non-Facility	Supervised Facility
Hospital	Other Treatment Facility	Homeless	Correctional Facility
Unknown	WIth Family or Friends	Emergency Shelter	Transitional Housing
Psychiatric Facility	Other

Previous Living Situation

Click this drop-down arrow and select the type of housing the applicant was previously in. Available selections are:

Independent Housing	Assisted / Supp. Housing	Supervised Non-Facility	Supervised Facility
Hospital	Other Treatment Facility	Homeless	Correctional Facility
Unknown	WIth Family or Friends	Emergency Shelter	Transitional Housing
Psychiatric Facility	Other

Monthly Income

Click this drop-down arrow and select the applicant's currently monthly income. Available options are:

$1 to $150	$151 to $250	$251 to $500	$501 to $1000
$1001 to 1500	$1501 to $2000	More than $2000

Primary Income

Click this drop-down arrow and select the source of the applicant's monthly income. Available selections are:

Employment Earnings	Unemployment Benefits	Private Disability Benefits	General Assistance
Alimony/Child Support	SSI/SSD/SSA	VA Benefits	TANF
Self-pay	Home Relief	Medicaid	Medicaid Managed Care
Private Insurance	Medicare	DSS Congregate Care	Other
None	Unknown

Education Level

Click this drop-down arrow and select the last grade level completed by the applicant. "01" represents first grade, "02" represents second grade, and so on. Available selections are "01" through "20."

Employment Status

Click this drop-down arrow and select "Employed" or "Unemployed" to indicate whether the applicant is currently employed.

Mental Health Conditions

Click each of these drop-down arrows and select "Yes" or "No" to indicate whether the applicant has any of the listed mental health conditions.

Axis I Diagnosis

In these fields, type or make changes to the applicant's Axis I diagnoses.

When all changes have been made, click UPDATE. The demographic data is saved, and the Referral Information Form page is re-displayed.

The process of updating demographic data is now complete.

Updating Legal Data

The Legal Data section of the referral record contains legal, domestic violence, and trauma information for the applicant. To update this information, complete the following steps from the Referral Information Form page:

Click Legal Data. The Court Cases Information page is displayed.
Make changes or additions to the information on this page as necessary. This information may include:

Arrests

Open Court Cases

Domestic Violence History

Trauma History

When all changes have been made, click SAVE. The legal data is saved, and the Referral Information Form page is re-displayed.

The process of updating legal information is now complete.

Updating Substance Abuse Data

The Substance Abuse section of the face sheet contains information on the applicant's history of drug and alcohol use. To update this information, complete the following steps from the Referral Information Form page:

Click Substance Abuse. The Substance Abuse Information (Recorded at the Time of Intake) page is displayed.
Make changes or additions to the information on this page as necessary. This information may include:

Problem Substances

Dependence / Abuse Continuum

Placement Factors

When all changes have been made, click UPDATE. The substance abuse information is saved and the Referral Information Form page is re-displayed.

The process of updating substance abuse information is now complete.