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Older Adult Baseline Administrative Information

Page history last edited by Leanor Johansen 4 years, 10 months ago

Administrative Information Section





Client ID: Client's IS number

Client DOB: Client's date of birth

Episode ID: 8 digit alphanumeric ID for FSP episode. Found on print out of confirmation of an open episode

Client L. Name: Client's Last Name

Client's F. Name: Client's First Name


Partnership Date is the first day that you provide FSP services (not outreach and engagement) after you receive countywide authorization to provide FSP services. This usually coincides with the opening of FSP episode. This date can never precede the countywide authorization date.


Partnership Services Coordinator ID is the last name of the person who is responsible for the outcomes. This person is someone people will contact if there is a problem with the data. This might be the person completing the assessment, the team leader, the clinician, or the program manager, it's up to the individual agency.


Assessment Date: Date you are initiating this assessment.


Assessment Completed byThis is the National Provider Identifier number (NPI #) of the person actually completing the outcomes. In the past this was formally the staff code. Now the NPI# is used for billing services as a rendering provider due to changes with IBHIS.  This field will only accept the NPI# of the rendering provider associated with your site and no longer accepts the prior staff code.


FSP Program NameCheck the appropriate box for the program you have been approved to provide for this client.  Please Note: We have added a couple of new FSP programs to the OMA online application that you will see in Online the drop down menu. However, the paper forms (as shown above) are in the process of being updated to reflect these new FSP programs.  In the meanwhile please have your staff write in the correct program name if not shown above on the paper forms.




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