City and County of San Francisco

Transcription

1 City and County of San Francisco Avatar CalPM User Guide ***see page 70*** May 2010 CBHS 1

2 Table of Contents Avatar Glossary...2 Avatar Desktop...3 Logging On To Avatar...14 Navigating in Avatar...19 Creating My Favorites...21 Selecting a Client in Avatar...23 CalPM Admission - Outpatient...25 CSI Admission...34 Cal-OMS Admission...40 Financial Eligibility...57 Admission Referral Information...75 Contact Information...80 Avatar PM Consent Forms...84 UMDAP...84 Avatar Glossary Intro to Avatar-General Terminology: CBHS Community Behavioral Health Services May 2010 CBHS 2

3 DPH San Francisco Department of Public Health Avatar - The software being used to conduct business. Avatar CalPM - Practice Management application, where clients are registered, schedules maintained, billing and claims processing occur. CalPM is specific to California and differs from the national PM product. Avatar CWS Clinician s Work Station clinical documentation (I.E.-Assessments, Treatment Plans and Progress Notes etc.) will occur in Clinician Workstation. Avatar MSO Managed Services Organization, outside providers. Client - Person receiving services. User - Person who accesses Avatar with an ID and Password. Practitioner - Person who provides services to clients. (Psychiatrists, Social Workers, Psychologists, Nurses, Direct Care Staff). Admitting Practitioner Is the Case Manager Options - Data is entered into the system through the options. Options are launched from menus, and appear as windows separate from the main screen. Open options can be accessed via the Windows Taskbar at the bottom of the desktop. Examples of Options are: Client Demographic option, Treatment Plan option, and Client Charge Input option. Episode - An episode begins with an admission to a program or agency and ends with a discharge from that program or agency (typically equivalent to the length of stay in a program or an episode of care). It is important to choose the correct episode when entering data into a client s chart in Avatar. The episode (program or agency) will be the one where the attending practitioner (primary staff) is coordinating treatment for MH. For SA, the episode will be the one open to the specific program of care. Services from other programs can be obtained as usual while the client is registered in one episode. When a client is transferred to another episode (program or agency) he/she will be discharged from the episode and admitted to the next episode or can be transferred to another like program or agency. If the current episode is the last one the client will have before being closed to the entire MHS the client will be closed via the Discharge option. CSI (MH) or CalOMS (SA) discharge must be completed at the time of discharge from the program or agency. A program discharge assessment mudy br completed at the time of discharge from each specific program course of treatment. Legal Entity Program parent agency, contracting agency, higest operational business unit registered with the State to do business in California. May 2010 CBHS 3

4 Program Equivalent to a specific Reporting Unit. The program managing and direct client care with specific services, payors or treatment protocols authorized by CBHS. Provider Facility authorized by the State, DMH or ADP, and approved by CBHS, to provide billable client services. Netsmart Technologies - Vendor which provides Avatar software Avatar Desktop Description of Icons on Avatar Desktop Select Appointment To Do Click on Icon to choose a client. Click on Icon to view upcoming appointments. Click on Icon to view To do items. These items are generated by workflow, and can originate from the system or from other users. (NOTE: If the TO DO list is open for an extended period of time, refresh it by clicking on the REFRESH button at bottom of the list. Never use the Internet Explorer refresh icon, as this will cause the user to be logged out of Avatar.) My Applications This shows executables and batch files placed there by the user. Work done in these applications is NOT connected to the Avatar database. Applications can be organized into folders. Create new folders by right clicking. Favorites The user can add favorite options here much like Internet Explorer s favorites. Add these options by clicking and dragging it onto the open favorites screen. They can also be added May 2010 CBHS 4

5 through Search for Options under help. Favorites can be organized into folders. Create new folders by right-clicking. My Preferences My Courses Lock Application Log off Help Tasks My Session Adjust spell checker, printer, and opening display here. It s recommended that spelling be checked from beginning of text. Spelling can only be checked field by field and not for the entire document at once. This links to Netsmart University. Ignore this Icon for now. This will lock the application to prevent unauthorized entry of data. It is important to lock the application whenever the user steps away from the terminal. The application will log the user off after X minutes of inactivity. This icon will log the user off the application. Be sure to save all work. The user will lose any unsaved work. The application will automatically log the user off after X minutes. Click on the Help Icon to access training materials. This is an alternative access point to the picture icons tasks. This shows clients for which the user is actively charting. The options that the user has open for that client will appear underneath the client s name. Access client specific options by right clicking on the client s name. May 2010 CBHS 5

6 Tool bar Consists of Tasks, Favorites, and any Avatar applications the user has security rights to access. General access to options is obtained here. Help is also on the toolbar, always displaying to the far right. Search for Option Located on the HELP menu. This option enables the user to quickly find options based on key search words. The options can be opened from the resulting grid, or added to the user s favorites. Status Bar Fly-Out Menus Sub Menu Items Displays the namespace with current system code in parentheses. Service time appears next to it. It appears along the bottom of the main window. Menu options with a black arrow to the right will reveal a sub menu if the user hovers over it. Click on the sub menu items to access options (assessment, treatment plans etc.) Terminology within an Option Option Toolbar The menu at the top of the client specific options lets you only access other client specific options. The long white bar below the icons lists client specific information. Exact information varies by implementation. May 2010 CBHS 6

7 Pages It is not uncommon for some tabs to consist of multiple pages. Always look in the upper left hand corner of the option when accessing EACH tab and note the number of pages present for that tab. Use the page forward and back arrows to access the various pages. Cut Copy Close Display Home Page Submit Lock Application This button will close most options. Use this X to close an option. It is NOT recommended that the user click on the X in the upper right corner of the window as this could result in loss of data and application integrity. This will bring the user back to the main screen without closing the option. This allows the user to have multiple options open. This will save the data entered in the option into the database. Typically, the option closes after submission. In some options, the user saves information by clicking on a FILE button. This will lock an application to prevent unauthorized entry of data. It is important to lock the application whenever the user steps away from the terminal. The application will log the user off after X minutes of inactivity. Copy, Cut, Paste text between fields in Avatar or between Avatar and other applications. Note: Spell Check will only check the text of the field where the cursor is currently located. Paste Spell Check Tabs Some options organize their contents via tabs. Click on various tabs to access different data fields. May 2010 CBHS 7

8 Bundles Multiple Select Boxes Radio Buttons F5 Options can be joined together and launched either simultaneously or sequentially. If launched simultaneously, the series of two or more bundled options can be accessed via buttons which line the bottom of the option. If launched sequentially, the user will save the first option and then the next option will appear. When a screen has multiple selection boxes in a field, select a box then CNTL + A to select ALL boxes. There isn t a way to multiple unselect Radio buttons and check boxes can be selected by clicking the mouse or by using the spacebar To clear any BLUE dropdown fields that may have been selected, press F5 and the field will be cleared May 2010 CBHS 8

9 CWS Chart Review Click on the keys to open the sub forms. Double click on titles and they will open to a report if there is one. May 2010 CBHS 9

10 Standard Formats Name Date No spaces before or after the comma s. Allowable punctuation: ( and -) LAST, FIRST or LAST, FIRST JR or LAST, FIRST MI MM/DD/YYYY-This format will default based on the date that is entered. The date can be entered as M/D/YY or MM/DD/YYYY or MMDDYY. Slashes can be replaced during entry with a -. For any date in the current year, it can be entered without the year such as MM/DD or MMDD. The user can also enter a date by clicking on the T or Y, or by double clicking in the date field to get a calendar from which to select the appropriate date. Another way to enter the date is T+#, where the # represents the number of days the user wants to add to today s date or T-# to subtract from today s date. Time Dollar Amounts Type 8A or 8P to get 8:00 AM or 8:00 PM Type 8:30 A or 8:30 P to enter 8:30 AM or 8:30 PM To enter the current time simply click on current time. An entered time can be changed by using the H and M up and down arrows next to the time. Enter whole dollar amounts without the decimal. Enter incremental dollar amounts with decimal and cent amounts. Dollar signs, spaces & commas are not required. Examples: Enter 10 for $10.00 or for $10.03 May 2010 CBHS 10

11 Misc. Avatar Items Action/Symbol What it does/what it means F1 Displays data element help message F5 Removes the selected dictionary value > A black arrow following a menu option means that there is a submenu attached. Tab Shift+Tab Enables user to move forward one field Enables user to move back one field F6 Enables user to move from TAB to TAB within a form Mouse Buttons Single click Left mouse button Single click Right mouse button on a menu option to go back to the previous menu Allows user to access menu options, move from one field to another, enter other table, and pull down dictionary lists as well as other important Avatar functions. Note: It is rare that you will have to double click the left mouse button. Field Colors Field Label Color Black Red Grayed out not accessible What it means Information is not required Information is required. The system will not allow the user to file forms without this information. Information will be defaulted in from another area in Avatar. Although in some instances these may not fill in until a selection is made in an associated field. May 2010 CBHS 11

12 Report Navigation Avatar uses two types of reports: Avatar System reports and Crystal reports. Displays are dependent on which type of report is chosen. Avatar System Report Navigation Navigation and print tool bar which appears at bottom of report display. -Use the next and previous buttons to move through the pages. -Use the % dropdown box to zoom in and out. This will print the currently displayed page of the report. Save the current report as a text file onto the hard drive. Print all or a range of pages of the report. Closes the report interface and returns the user to the option. May 2010 CBHS 12

13 Crystal Report Navigation When a Crystal Report is launched from Avatar, the report opens up in a Crystal Interface. This will appear as a separate button on your Windows Taskbar. The first time the user runs a Crystal Report in Avatar he/she will be prompted to download the report. Choose YES to this download. This is a typical Crystal Report toolbar, which appears at top of the report. The title of the report is at top. The x in the left of the toolbar is usually inactive. To close the Crystal report, use the Windows top right x. (NOTE: This x should not be used to close Avatar options.) Use the arrows to advance through the report moving one page at a time or immediately to the beginning or the end. Export Export the report in various formats (PDF, CSV, etc.) Zoom Zoom in and out. Find Search the report for a word or phrase. Workflow Terminology Workflow is used in CWS, and generates a TO DO list for users. Some options have workflow and May 2010 CBHS 13

14 Workflow Draft Pending Approval Final Pre-Display enable a user to send their work for review to another user. In workflow, this allows for a user to save data to the database as a draft, to be completed at a later date. In workflow, this allows a user to complete the option and forward the information to another user s to do list for review. The reviewing user will have the ability to accept or reject the submission, noting the reason. In workflow, this allows for the user to complete the data and make it a permanent and unchangeable part of the database. Some options have pre-displays, which enable the user to pick previous instances of administrations of that option. Finalized instances of the option can be opened in edit mode, but changes will not be saved. To start a new instance, click ADD. Logging On To Avatar The address for accessing your Avatar login is There will be an Avatar icon on your desktop. Click the Icon or use the link to access the Avatar Main Screens Use this screen to start the user authentication (Logon) process and this is the first screen that is displayed when the RADplus application is started. There are two frames in this screen, Task Bar and Task Frame. May 2010 CBHS 14

15 To begin access, Click either User Authentication Task Bar Task Frame User Authentication Icon button in the task bar is the same as the User Authentication task in the Task Frame. Once logged into Avatar, Icons will display in the Task Bar, which are the same as the wording in the Task Frame. Either can be selected to access Avatar and its menus and users can choose either based upon personal preference. During Training, choose AVCALPMTEST. May 2010 CBHS 15

16 After the July 1 go live, AVCALPMLIVE will be chosen to begin the Logon process. May 2010 CBHS 16

17 To Login: Enter the System Code of LIVE Enter your USER ID that s been assigned to you Enter your temporary password and you ll be prompted to change to a permanent password. Permanent password doesn t need to be in all caps When these have been populated, click Login May 2010 CBHS 17

18 Congratulations, you ve successfully logged into Avatar. This displays the user s personal homepage which could have appointments and caseloads. Should you receive this error, Click OK and try logging in again. Check Cap Locks or Num Locks as well. NOTE: You re allowed three attempts to successfully log in. After three, your account will be locked out and will need to be reset. May 2010 CBHS 18

19 Navigating in Avatar Which buttons do I use? Avatar is in your web browser but is an intranet system. Do not use the internet buttons such as search, favorites, home or the X in the upper right corner or you will be knocked out of the system and could create a hung session. It s best to ignore the items in this box below when working in Avatar. Avatar allows you to access the same menu options through the Menu Options dropdown, the Task Bar or the Task Frame This Icon will lock your session It s recommended to Lock your session or Logoff if leaving your workstation. Every action is logged in Avatar and sharing of logins is prohibited. The system has timeout features and work should be saved prior to leaving your workstation to prevent loss of data. May 2010 CBHS 19

20 Hovering over the Icons will display the option. Clicking on Tasks will give access to the same menu items as the Task Bar/Task Frame Refresh Menus can only be accessed thru the Tasks dropdown. If you re looking for an option, click Help, then click Search for Option. You re able to search by a partial word and the available options will display as well as the option path within the system. You can open the option from here by double clicking the highlighted option or clicking the Open button or search again. May 2010 CBHS 20

21 Creating My Favorites Avatar has the ability to create My Favorites for screens which are commonly used. My Favorites are specific to the user logging in no matter where the user logs in. Click on the Help button in the upper right corner above the Task Bar. Enter a few letters of the option you re searching for (correct spelling is required). Click Search to display all options found with the search criteria selected. Click Add to Favorites. The Favorites menu must be closed to create Favorites this way. May 2010 CBHS 21

22 Click OK to add or a New Folder can be created and the option added to the folder. Favorites can be moved between folders or deleted at any time. My Favorites can be accessed different ways but all open the same options. May 2010 CBHS 22

23 Selecting a Client in Avatar Click on the icon or text for Select Client. Select client can be used to verify the client is in the system or to access client driven screens such as updating demographic information, eligibility management, CSI or CalOMS information. Last Name,First Name Click Select Names meeting the criteria will appear under Select Client. Choose the client needed. May 2010 CBHS 23

24 After selecting a client, the client will appear in the Task Frame under My Session and the active client will be listed in RED. Clients can be toggled between by clicking on the client name. That client will appear in RED. To remove a client from My Session, right click on the client name and click Remove From Session. Logging off will also remove clients from My Session. May 2010 CBHS 24

25 CalPM Admission - Outpatient Purpose: The first step in the admission process is a brief registration and eligibility check with temporary registration at presentation. Use the Cal-PM Admission-Outpatient option to initiate a new client admission or update a returning client record in an Outpatient program. SF Avatar users use this option to enter or review client demographic information and open an episode of care at the agency level if Mental Health or at the program level if Substance Abuse. Description: The Admission and Demographic Tabs record patient demographic information and information required to admit the client to a program for services. Admission includes completion of Financial Eligibility information and other options applicable to the client situation. Information entered in this option is client and episode specific. Menu Path: Avatar PM>Client Management>Episode Management>Admission Outpatient Example: Client presents at clinic and the clinician decides to admit the client as an outpatient. May 2010 CBHS 25

26 Thoroughly Search for the client to reduce the possibility of creating a duplicate client by entering as much information as possible. There must be three fields populated for the Search button to activate. It s recommended to enter as much information as possible to reduce the chances of creating duplicate clients. Each field is given a score and scores are combined to help determine if the client is in the system. Enter at least three fields, Click Search. Choose the correct client if in the system or if the client isn t found, Click New to create a new client, auto assign the next ID and start an admission. If the client is already in the system, click OK to create another episode. Or, if the client is already open in your agency, click on the appropriate episode to review and/or edit admission information. May 2010 CBHS 26

27 Admissions Tab - Page 1 Label Field Required Comments Type Client Name Text Yes Defaults from the search but can be changed. See Names below Sex Radio Yes Select button appropriate to the sex of the client Date of Birth Numeric No Enter client birth date (MM/DD/YYYY) Age Numeric No Age auto-calculated in field Pre-Admit/ Admission date Date Yes Enter date (MM/DD/YYYY) T=today s date Y=yesterday s date, double click for a calendar, T-3 will count back 3 days Pre-Admit/ Time Yes Time can be entered or Current Admission Time Program Dropdown Yes Select from list. Can have multiple open Outpatient episodes but can only have one open Inpatient episode. Type of Dropdown Yes Select from list as appropriate Admission menu Source of Admission Dropdown No Select from list as appropriate May 2010 CBHS 27

28 Admitting Practitioner Attending Practitioner Text Yes Admitting Practitioner is the Case Manager. Enter the number or last name,first name of the practitioner. Click on Process Search a list of practitioners will appear in the field immediately below the Admitting Practitioner field. Choose a Practitioner from the dropdown Text No Enter the number or last name,first name of the practitioner. Click on Process Search a list of practitioners will appear in the field immediately below the Attending Practitioner field. Choose a Practitioner from the dropdown Practitioner Type Dropdown No Select from list as appropriate Facility Chart Number Social Security Number Perform Discharge Alert Type of Alert Numeric No Facility Chart Number = CHN MRN, will be filed automatically Numeric No Enter the Social Security Number (format is ) Radio No Discharge Alert can be set up to notify based on the type when a client is discharged. Select Y or N as appropriate Dropdown No If Yes is selected, then select Type of Alert from dropdown menu list Names 1. Use correct case. 2. Use no punctuation except hyphenated last names. 3. Avoid nicknames and abbreviated names. 4. Use the name as it appears in MEDS file or other official ID. 5. Enter middle initial in Client s Middle Initial field. 6. Select generation in Suffix field 7. Enter names with two first names in first name field with space 8. Enter names with two last names in last name field with space Examples: Mark Jones the third: Last Name: Jones First Name: Suffix: III Mark Jones, Jr: Last Name: Jones First Name: Mark Suffix: Jr Mark J Jones: Last Name: Jones First Name: Mark Middle Initial: J Margaret Jones Smith: Last Name: Jones Smith First Name: Margaret Jose Gonzalez Mendoza: Last Name: Gonzalez Mendoza First Name: Jose Mei Ling Chow: Last Name: Chow First Name: Mei Ling May 2010 CBHS 28

29 Admission Tab - Page 2 Label Field Required Comments Type Disposition Dropdown No Select from list as appropriate Presenting Problems Primary Presenting problems Secondary Presenting problems- Tertiary Client s Living Dropdown No Select from list as appropriate Dropdown No Select from list as appropriate, not accessible unless primary is populated Dropdown No Select from list as appropriate, not accessible unless secondary is populated Dropdown No Select from list as appropriate Arrangements Disabilities 1 Radio No Select applicable button Disabilities 2 Radio No Select applicable button, not accessible unless Disability 1 is populated Disabilities 3 Radio No Select applicable button, not accessible unless Disability 2 Is populated Current Medications-1 Dropdown No Select applicable medications May 2010 CBHS 29

30 Current Medications-2 Current Medications-3 Dropdown No Select applicable medications, not accessible unless Med-1 is populated Menu No Select applicable medication, not accessible unless Med-2 is populated Admissions Tab Page 3 Label Field Required Comments Type Received Copy Radio No Select Yes or No of Client s Rights Advanced Button No Select Yes or No Directive Advanced Text No Enter notes if appropriate Directive Notes Admission Notes Text No Enter notes if appropriate Admission Time No Enter if appropriate Departure Time Out Primary Care Provider Text No Enter if appropriate May 2010 CBHS 30

31 Demographics Tab - Page 1 Label Field Required Comments Type Client Last Name Text No Client s last name defaults into the field, See name conventions Client s First Text No Client s first name defaults into the field Name Client s Middle Text No Clients middle initial defaults into the field Initial Suffix Radio No Select the applicable suffix if appropriate Prefix Radio No Select the applicable button in the field Client s Address- Street Text No Enter the street address of the client, see address conventions Enter Client s Zip Code Numeric No Enter client s Zip Code When Zip Code is entered the city and state auto-populate in the city and state fields Client s Address Text No Field auto populates based on Zip Code information May 2010 CBHS 31

32 City Client s Address Dropdown No Select California County from the list County Client s Address Text No Field auto populates based on Zip Code information State Client s Home Phone Numeric No Enter client s home phone number ( ), enter at least one phone number for the client Client s Work Numeric No Enter client s work phone number ( ) Phone Primary Dropdown No Select Client s primary language from list Language Client s Race Dropdown No Select Client s Race from list Ethnic Origin Dropdown No Select Client s Ethnic Origin from list Religion Dropdown No Select Client s Religion from list Primary Care Physician/Phone Text No Enter the Client s Primary Care Provider and the phone number Country of Origin Dropdown No Select Client s Country of Origin from the list Maiden Name Text No If applicable, enter Client s Maiden Name Marital Status Dropdown No Select Client s Marital Status from the list Education Dropdown No Select Clients Education Level from the list Employment Dropdown No Select Client s Employment Status from list Status Occupation Dropdown No Select Client s Occupation from the list Guidelines for adding or updating client addresses: Use USPS standard two letter abbreviations for street type, with no punctuation: Ex: St, Av, Rd, Bl, Wy, Hy, Pl Enter Street number, name and type in the Client s Address Street field Use Client s Address Street 2 for an apartment number or suite number (Apt 1010 or Ste 2020) Enter the ZIP code. The City, County and State will default in May 2010 CBHS 32

33 If the address is General Delivery, enter General Delivery in the Client s Address Street field Enter Post Office Box as PO Box (no spaces, no periods) If a client resides in a hotel, board & care home etc, enter C/O hotel/care home name in the Client s Address Street field with the home s address in the Client s Address Street 2 field HOMELESS Clients: Enter 1380 Howard St 6 th floor in the Client s Address Street field Use the ZIP code May 2010 CBHS 33

34 Demographics Page 2 Label Field Required Comments Type Alias 1-10 Text No Enter alias names if applicable When fields are completed, click Submit CSI Admission May 2010 CBHS 34

35 ** CSI information is required on Mental Health Admissions. If this is a Substance Abuse Admission, please jump to page 39 for CALoms instructions. ** Purpose: Use this option to enter required information for a client who has been admitted to a Client Services Information System (CSI) program in either the Admission or Admission (Outpatient) option. CSI data is required by the California Department of Mental Health. A client and episode must be chosen to access this option The fields may not be required in Avatar but they are required for accurate and complete CSI reporting CSI information can be defaulted from other episodes. Make sure data is correct in the episode after defaulting and prior to submitting. Menu Path: Avatar PM>Client Management>Client Information>CSI Admission May 2010 CBHS 35

36 CSI Admission Tab - Page 1 Label Field Required Comments Type Birth Name (Last) Text No Client s last name at birth Birth Name (First) Text Yes Client s first name at birth Birth Name Text No (Middle) Client s middle name at birth Birth Name Radio No Choose if applicable (Suffix) Mother s first Text No First name of the client s mother Name Fiscally Dropdown No Choose from dropdown Responsible County For Client Place of Birth- Dropdown No If known, choose an CA county, Unknown if born in CA, May 2010 CBHS 36

37 County Place of Birth- State Place of Birth- Country Not California County if born in another state or country Dropdown No CA defaults if the client s place of birth was a CA county, select US state or Not US State Search No If Not US State was selected, enter the first few letters of the country, Process Search, then the country of the client s Birth can be selected CSI Ethnicity Radio No Select the correct response Special Population Radio No Select the correct response, default is No Special Population Services Legal Class Dropdown No Use Voluntary unless other selection is more appropriate County School Dropdown No Required for client s receiving AB 3632 services Admission Necessity Code Radio No CSI Admission Tab - Page 2 May 2010 CBHS 37

38 Label Is Substance Abuse Affecting Mental Health? Are Developmental Disabilities Affecting Mental Health? Are Physical Health disorders Affecting Mental Health? Conservatorship/Court Status Field Required Comments Type Radio No Select response Radio No Select response Radio No Select response Radio No Preferred Language Dropdown No Select response Race (Select Up to Multiple No Select response, can choose up to five Five) Select Number of children less than 18 years of age that the client cares for/is responsible for at least 50% of the time Numeric No Enter number, must be less than 99 Number of dependent adults 18 years of age and above that the client cares for / is responsible for at least 50% of the time Numeric No Enter number, must be less than 99 Once you have completed all the pages in the Tabs, click Submit If opening a second CSI eligible episode, Avatar gives you the ability to default information from a previous episode. After the admission has been completed, the following will pop up: Choose Yes or No May 2010 CBHS 38

39 Select the episode to default information from Information is populated and can be changed if needed or submitted as is. Once you have completed all the pages in the Tab, click Submit May 2010 CBHS 39

40 Cal-OMS Admission CalOMS information is collected for Substance Abuse Admissions. Purpose: Use this option to enter Cal-OMS reportable data for programs that require a Cal-OMS admission record. When a client is entered into a Cal-OMS program, they are flagged for submission. The California Outcomes Measurement System (CalOMS) is a statewide data collection and measurement system and is required for California DADP (Department of Alcohol & Drug Programs) reporting. Please refer to your CalOMS data guide for acceptable data elements. An active client and episode must be selected before this option can be accessed A client must have been admitted to a Cal-OMS inpatient or outpatient program in order to access this option Once the required fields have been populated, the Cal-OMS Admission can be submitted at any time during entry and returned to for completion The fields may not be required in Avatar but they are required for accurate Cal-OMS reporting Menu Path: Avatar PM>Client Management>Client Information>Cal-OMS Admission May 2010 CBHS 40

41 Client Identification and Demographic Data Tab - Page 1 Help messages are attached to individual fields for further explanation. Label Field Type Required Comments Birth First Name Text No Birth first name of the client, for None of Not Applicable, for Client unable to answer Birth Last Name Text No Birth last name of the client or for Client unable to answer Current First Name Text No Current first name of the client defaults from the admission but can be edited Current Last Text No Current last name of the client defaults from the Name Social Security Number Zip code at current residence Place of Birth County admission but can be edited Numeric No Social Security Number of the client. Enter as , for Client declines to state, for None or Not Applicable or for Client unable to answer Numeric No Zip code at the client s current residence. Must be a valid 5 digit zip code, for homeless, XXXXX for Client declined to state or ZZZZZ for Client unable to answer Dropdown No Client s county of birth if the client was born in California. Choose Other if the client was born outside of CA. May 2010 CBHS 41

42 Place of Birth State Driver s License Number Dropdown No Choose a country or Other if born outside of the US Numeric/Text No Client s driver s license number or enter to indicate that the client declines to state their driver s license number, to indicate that the client has no or no applicable driver s license number, or to indicate that the client is unable to answer Dropdown No Choose from the dropdown Driver s License State Mother s First Text No Free text field to enter the client s mother s name Name Race 1 Radio No Client s Race, choose one Client Identification and Demographic Data Tab Page 2 Label Field Required Comments Type Race 2 Radio No Client s Race, choose one, if necessary Race 3 Radio No Client s Race, choose one, if necessary Race 4 Radio No Client s Race, choose one, if necessary May 2010 CBHS 42

43 Client Identification and Demographic Data Tab - Page 3 Label Field Required Comments Type Race 5 Radio No Client s Race, choose one if necessary Ethnicity Radio No Identifies the Client s ethnicity, choose one Veteran Radio No Identifies if the Client is a US Veteran. Choice Client Unable to answer is used ONLY if the provider is Detox or Residential Detox Disability Multi Select No The Client may have more than one disability. Choice Client Unable to answer is used ONLY if the provider is Detox or Residential Detox May 2010 CBHS 43

44 Client Identification and Demographic Data Tab Page 4 Label Field Required Comments Type Consent Radio No Identifies whether a client has given consent to be contacted in the future May 2010 CBHS 44

45 Transaction Data Tab- Page 1 Label Admission Transaction Type Field Type Required Comments Radio No Used to indicate the type of admission, whether it be an initial admission, or a change in service May 2010 CBHS 45

46 Admission Data Tab - Page 1 Label Source of Referral Days Waited to Enter Treatment Number of Prior Episodes CalWORKs Recipient Field Required Comments Type Radio No Principal Source of Referral, select one Numeric No Number of days the client was on a waiting list before being admitted into the treatment program due to limited program capacity and count should not include things as waits due to days in jail, etc. Enter 0-999, for Not Sure/don t know or for Client unable to answer. Numeric No Total number of treatment episodes the client has participated in as a primary client, not as a co-dependent. Enter 0-999, for Not Sure/don t know or for Client unable to answer. Radio No Identifies if the client is a CalWORKs recipient, choose one May 2010 CBHS 46

47 Substance Abuse Treatment Under CalWORKs Special Services Contract County Code Special Services Contract ID Radio No Identifies if the client is undergoing substance abuse treatment under CalWORKs Dropdown No A provider supplied field to identify the county that s paying for the client s treatment services when the paying county is NOT the county in which the provider s facility is located. Numeric Yes If Special Services Contract County code is selected, this field becomes a required field. Contract ID should be or for None or Not-Applicable Alcohol and Drug Use Tab - Page 1 Label Primary Drug (Code) Field Required Comments Type Dropdown No Client s primary drug problem, select one May 2010 CBHS 47

48 Primary Drug name Primary Drug Frequency Primary Drug Route of Administration Primary Drug Age of First Use Secondary Drug questions Alcohol Frequency Text No/Yes If Other drugs are selected, this field becomes required and will be used to record the primary drug name Numeric Records the frequency of use for the primary drug. Enter 0-30, for None or Not Applicable or for Client unable to answer Radio No Record the route of administration used for the primary drug Numeric No Number in the range of or for Client unable to answer Same as Primary questions and answer if needed Numeric No Record the frequency of alcohol use in the last 30 days if the primary or secondary drugs are NOT alcohol. If alcohol was the primary drug, this field will be populated automatically with Enter 0-30, for None or for Client unable to answer IV User Numeric No Will activate if a drug can be injected, enter 0-30, for Client declined to state or for Client unable to answer Alcohol and Drug Use Tab - Page 2 Label Field Required Comments Type Needle Use in Radio No Record if the client has used needles to inject drugs in the May 2010 CBHS 48

49 Last 12 months past 12 months. Client Unable to Answer is used ONLY if the provider is Detox or Residential Detox Employment Data Tab - Page 1 Label Enrolled in School Highest School Grade Completed Employment Status Enrolled in Job Training Work Past 30 Days Field Type Required Comments Radio No Record if the client is currently enrolled in school. Client unable to answer is used ONLY if the provider is Detox or Residential Detox Dropdown No Record the client s highest school grade completed by the client Radio No Record the client s current employment status Radio No Record if the client is currently enrolled in job training. Client Unable to Answer is used ONLY if the provider is Detox or Residential Detox Numeric No Record the number of days the client has worked in the last 30 days. Enter 0-30, for Client declined to state or for Client unable to answer Criminal Justice Data Tab - Page 1 May 2010 CBHS 49

50 Label Field Type Required Comments Criminal Justice Status CDC Identification Number Number of Arrests Last 30 Days Number of Jail Days Last 30 Days Number of Prison Days Last Radio No Criminal Justice Status relates to the Source of Referral field. Client Unable to Answer is used ONLY if the provider is Detox or Residential Detox Alphanumeric No CA Department of Corrections and Rehabilitation Identification number. 6 Character string, for Client declined to state, for Not sure/don t know, for Non or N/A or for Client unable to answer Numeric No Enter 0-30 or for Client unable to answer Numeric No Enter 0-30 or for Client unable to answer Numeric No Enter 0-30 or for Client unable to answer May 2010 CBHS 50

51 30 Days Parolee Services Network (PSN) Radio No Record if the client is a parolee in the Parolee Services Network. Client Unable to Answer is used ONLY if the provider is Detox or Residential Detox FOTP parolee Radio No Female Offender Treatment Program, Counties in which these services are provided are Los Angeles, Orange, Riverside, and San Bernardino. Client Unable to Answer is used ONLY if the provider is Detox or Residential Detox FOTP Priority Status Radio No Only accessible is the client is female, used to record a client s Female Offender Treatment Program status. Client Unable to Answer is used ONLY if the provider is Detox or Residential Detox Medical/Physical Health Data Tab - Page 1 May 2010 CBHS 51

52 Label Medi-Cal Beneficiary Emergency Room Last 30 Days Hospital Overnight Last 30 Days Medical Problems Last 30 Days Pregnant at Admission Medication Prescribed as Part of Treatment Communicable Diseases: Tuberculosis Communicable Diseases: Hepatitis C Communicable Diseases: Sexually Transmitted Diseases Field Type Required Comments Radio No Client Unable to Answer is used ONLY if the provider is Detox or Residential Detox Numeric No Number of times in the past 30 days the client has visited an emergency room for physical health problems. Enter 0-30 or for Client unable to answer Numeric No Number of days in the past 30 days the client has stayed overnight for physical health problems. Enter 0-30 or for Client unable to answer Numeric No Number of days in the past 30 days the client has experienced physical health problems. Enter 0-30 or for Client unable to answer Radio No Indicates if the client was pregnant at the time of admission Radio No Indicates if medication has been prescribed as part of the treatment Radio No Record if the client has been diagnosed with Tuberculosis, Client Unable to Answer is used ONLY if the provider is Detox or Residential Detox Radio No Record if the client has been diagnosed with Hepatitis C, Client Unable to Answer is used ONLY if the provider is Detox or Residential Detox Radio No Record if the client has been diagnosed with a sexually transmitted disease, Client Unable to Answer is used ONLY if the provider is Detox or Residential Detox May 2010 CBHS 52

53 Medical/Physical Health Data Tab - Page 2 Label Field Required Comments Type HIV Tested Radio No Indicates if the client has been tested for HIV/AIDS. Client Unable to Answer is used ONLY if the provider is Detox or Residential Detox HIV Test Results Radio No Indicates if the client has received the results for HIV/AIDS test. Client Unable to Answer is used ONLY if the provider is Detox or Residential Detox May 2010 CBHS 53

54 Mental Illness Tab - Page 1 Label Field Required Comments Type Mental Illness Radio No Indicates if the client has ever been diagnosed with a mental illness Emergency room Use/Mental Health Numeric No Number of times in the last 30 days the client has received outpatient emergency services for mental health needs, enter 0-30 or for Client unable to answer Psychiatric Facility Use Mental Health Medications Numeric No Number of days in the last 30 days the client has stayed for more than 24 hours in a hospital or psychiatric facility for mental health issues, enter 0-30 or for Client unable to answer but Client Unable to Answer is used ONLY if the provider is Detox or Residential Detox Radio No Indicates if the client has taken prescribed medication for mental health needs in the last 30 days May 2010 CBHS 54

55 Family/Social Data Tab - Page 1 Label Field Required Comments Type Social Support Numeric No Number of days in the last 30 days the client has participated in any social support activities, enter a number in the range of 0-30 Current Living Radio No Indicates the client s living arrangements Arrangements Living with Someone Numeric No Number of days in the last 30 days the client has lived with someone who uses alcohol or drugs. Enter 0-30, for Family Conflict Last 30 Days Client declined to state or for Client unable to answer Numeric No Number of days in the last 30 days the client had serious conflicts with their family. Enter 0-30, for Client declined to state or for Client unable to answer May 2010 CBHS 55

56 Number of Children Age 17 or Younger Number of children Age 5 or Younger Number of Children Living With Someone else Number of Children Living with Someone Else and Parental Rights Terminated Numeric No Number of children the client has that are aged 17 or younger (birth or adopted). Enter 0-30 or for Client unable to answer Numeric No Number of children the client has that are aged 5 or younger (birth or adopted). Enter 0-30 or for Client unable to answer Numeric No Number of the client s children (birth or adopted) living with someone else because of a child protection court order. Enter 0-30 or for Client unable to answer Numeric No Number of the client s children (birth or adopted) living with someone else because of a child protection court order and for whom their parental rights have been terminated. Enter 0-30 or for Client unable to answer Once you have completed all the pages in the Tabs, click Submit May 2010 CBHS 56

57 Financial Eligibility Purpose: Use this option to create and maintain a record of guarantor sources for liability distribution for the selected client. The term guarantor is used to identify any expected source of reimbursement for services provided to a client. Guarantor can include self pay, third party private insurance, or entitlements such as Medi-Cal or Medicare. From here the user selects the guarantors and connects them to benefit plans. The user also has the capability to customize the plan to meet the individual client requirements. Up to a maximum of 20 guarantors can be assigned to an episode for each client. A client and episode must be selected to access this option Financial Eligibility is episode based and can be different on each episode Liability distributes according to the order selected in the Financial Eligibility tab Guarantor # fields. Fields highlighted in red are required and the option won t save without these fields completed. Menu Path: Avatar PM > Client Management > Account Management > Financial Eligibility May 2010 CBHS 57

58 Select the client. Active client name appears highlighted in red under My Session of the home screen. The Financial Eligibility option is included in the Admission bundles or can be selected using the menu path above, through Search for Options or can be set up in My Favorites. If a client has multiple episodes, choose the appropriate episode. Financial Eligibility Tab Page 1 May 2010 CBHS 58

59 This tab defines the order that Avatar PM distributes liability based on the benefit plans assigned to each guarantor for each client. It displays the current guarantor assignments. Additionally, it s possible to default existing guarantor information from previous episodes. When this screen is accessed for the first time, all fields except Coverage Comments will be inaccessible Coverage Comments is a free text field, uses the text editor features and can be used at any time. Adding the date of the comment and user entering the comment is recommended each time a comment is created. Coverage Comments will not default or link from episode to episode Up to 20 guarantors can be entered Guarantor Selection Tab - Page 1 May 2010 CBHS 59

60 Guarantor Information- This multiple iteration table consists of a Guarantor Information Table and two command buttons, Add New Item and Edit Selected Item. CBHS Billing Use ONLY will not be used at this time. Guarantor Information Table- This table displays the current information entered in this tab. An existing entry can be selected for editing by clicking the line item to activate then clicking Edit Selected Item. Add New Item - Click to add a new yellow/active row to the Guarantor Information Table. The remaining fields are clear for new information. Edit Selected Item - Select an existing entry and click Edit Selected Item. The fields display the information from the selected row of the Guarantor Information Table. Click Add New Item to create a new Guarantor row or to add another guarantor. Label Field Type Required Comments May 2010 CBHS 60

61 Guarantor # Text Yes Enter first few letters of guarantor name or guarantor number if known Guarantor Name Text No Defaults in, Do Not Use or Change Guarantor Plan Dropdown Yes Defaults in but can be changed if needed Customize Radio Yes Defaults in, Do Not Use or Change Guarantor Plan Guarantor s Text No Defaults in, Do Not Use or Change Address Line 1 Guarantors Text No Address Line 2 Guarantor s Numeric No Defaults in, Do Not Use or Change Address Zip Code Guarantor s Text No Defaults in, Do Not Use or Change Address City Guarantors Dropdown Defaults in, Do Not Use or Change Address - State Guarantor s Numeric No Defaults in, Do Not Use or Change Phone Number Inhibit Billing by Radio No Select Yes to prevent sending a self pay bill to the Mail selected client, only used for paper billing Effective Date of Date Yes Defaults in, Do Not Use or Change Contract Expiration Date of Date No Do Not Use or Change Contract Guarantor Selection Tab - Page 2 May 2010 CBHS 61

62 Label Field Required Comments Type Is This a Managed Do Not Use Care Contract Insurance Code Do Not Use Eligibility Verified Radio Yes Choose Yes or No, choosing No will prevent billing Coverage Effective Date Date Yes Services won t distribute to this guarantor prior to this date Coverage Expiration Date Date No Use to end date coverage, services won t distribute to this guarantor after this date Client s Relationship to Subscriber Dropdown Yes Self will default but can be changed. Choosing Self will default information from the client demographics, choosing another response will require entry of the Subscriber s information Subscriber s Name Text Yes Last Name,First Name no space May 2010 CBHS 62

63 Subscriber s Address Street Subscriber s Address - Zip Subscriber s Address - City Subscriber s Address County Subscriber s Address - State Text Yes Enter the address Numeric Yes Enter the zip, will populate the correct City, County and State. If not, verify the zip or notify your supervisor so the dictionary can be populated Text Yes Defaults in but can be changed if needed Dropdown No Defaults in but can be changed if needed Dropdown Yes Defaults in but can be changed if needed Subscriber s Phone Numeric Yes Defaults in but can be changed if needed Number Subscriber s SSN Numeric Yes Enter with the format xxx-xx-xxxx or xxx-xx-xxxp Subscriber Sex Radio Yes Select Subscriber s Dropdown No Select Employment Status Subscriber s Birth Date No Defaults in but can be changed if needed Date Subscriber Employee Text No Enter if available ID# Subscriber Employer Name Text No Enter if available May 2010 CBHS 63

64 Guarantor Selection Tab - Page 3 Label Subscriber Employer ID Number Subscriber Employer s Add Street Subscriber Employer s Add Zip Subscriber Employer s Add City Field Required Comments Type Text No Enter if available Text No Enter if available Numeric No Enter if available Text No Enter if available May 2010 CBHS 64

65 Subscriber Employer s Text No Enter if available Add County Subscriber Employer s Text No Enter if available Add State Subscriber Work Numeric No Enter if available Phone Subscriber Group Text No Enter if available Name Subscriber Group # Text No Enter if available Subscriber Policy # Text No Enter if available Subscriber Policy Do Not Use Number Override Subscriber MEDS ID# Numeric Complete if a Medi-Cal Guarantor, leave blank for all others Subscriber Client Index # Numeric Complete if a Medi-Cal Guarantor, leave blank for all others Subscriber Dropdown No Select Branch/service Subscriber Military Dropdown No Select Status Subscriber Treatment Auth Radio No Select May 2010 CBHS 65

66 Subscriber Assignment of Benefits Subscriber release of Information Coordination of Benefits Radio No Select Radio No Select Radio No Select Page 5 of the Guarantor Selection Tab are not used at this time. May 2010 CBHS 66

67 Guarantor Selection Tab Entering Another Guarantor to the Episode To add additional guarantors, click the back arrow to return to the first page of the Guarantor Selection Tab. Click Add New Item to activate another record for a guarantor and complete as above. Repeat steps for up to 20 guarantors. May 2010 CBHS 67

68 Financial Eligibility Tab Page 1 Once the guarantors and information have been entered into the table on the Guarantor Selection Tab, return to the Financial Eligibility tab to select the order in which the guarantors should be billed. Begin with the first Guarantor to be billed, if the client has private insurance it is typically billed first. Medi- Care is billed before Medi-Cal. Medi-Cal is billed before General Fund. Each of the fields contains all of the client s assigned guarantors, minus the ones selected in the previous Guarantor # fields. The first four guarantor fields appear on page 1 and remaining guarantors can be selected on page 2 until all from the list have been selected. If during this process an incorrect selection was made, click Clear Previous Guarantor Order and re-order the list. Guarantor order will default if defaulting eligibility form a previous episode. Please review previous eligibility for accuracy and edit as necessary if using the default copy function. Further training on billing precedence will be provided. May 2010 CBHS 68

69 If more than four guarantors are entered, forward to page 2 to finish the order. May 2010 CBHS 69

70 Once you ve completed the above pages in the Tabs, click Submit Other Financial Eligibility Options/Features: Guarantor information can be copied from another episode. On the Financial Eligibility Tab, Page 1, select Yes on Default Guarantor Information from Different Episode. The following warning will appear, choose OK to continue. May 2010 CBHS 70

71 Select the episode to default information from. Submit to complete the operation as the copied information will not be applied until filed. Click Submit Note: It s not recommended to default from another episode without reviewing for accuracy. May 2010 CBHS 71

72 Troubleshooting: This pop up is created by not having all required fields completed and indicates which required fields are incomplete. Click OK to return to the option to complete. May 2010 CBHS 72

73 A common error in guarantor setup is an extra, blank line. Removing the blank line can be done by clicking CBHS Billing Use ONLY. Avatar will ask Are You Sure? click Yes. May 2010 CBHS 73

74 The error message for the missing required fields could be many combinations. Avatar will return to the screen where information is missing in the required fields. Populate the fields and when completed, Click Submit May 2010 CBHS 74

75 Admission Referral Information Purpose: Users can record information from various sources which are pertinent to an episode. Admission Referral Information includes primary, secondary and additional sources per episode. The Admission Referral Information option includes the name, address, phone number and a contact name for the facility. A client and episode must be selected in order to access this option. The data entered in this option is for information only. Menu path: Avatar PM>Client Management>Client Information>Admission Referral Information May 2010 CBHS 75

76 Avatar PM Admission Referral Information Primary Referral Tab Label Primary Source of Referral Field Type Required Comments Text Y Enter code (example 1), then click on the Process Search button. A screen message will appear with the name of the corresponding agency. If the agency is correct click on OK. The information for the agency selected will default into the appropriate fields but can be changed if needed. Changing information in this option does not change the original entries in the referral source table. May 2010 CBHS 76

77 Primary Referral Source - Contact Secondary Referral Tab Text N Users may enter a specified contact person in this field if necessary. Button Y Secondary Referral information can be added. Click on the Secondary referral tab to enter information for additional referral sources and complete as above with the Primary Referral Source. Secondary Referral Tab May 2010 CBHS 77

78 Other Referral 1 Label Other Referral 1 Source of Referral Other Referral Source Name Field Type Required Comments Text Y Additional referral sources may be entered in this tab. Text N Enter the referral source name May 2010 CBHS 78

79 Other Referral Source-Specialty Other Referral Source Phone Other Referral Source Agency Other Referral Source Street Address Other Referral Source Address - 2 Other Referral Source Zip Code Text N Click on the Other Referral-1 tab to enter information for additional referral sources Numeric N Enter Phone Number ( ) Text N Enter name of agency Text N Enter Street address Text N Enter additional street address information Text N Enter Zip Code. Note the City and State fields below the Zip Code field will auto-populate when the Zip Code is entered Other Referral Source City Other Referral Source State Other Referral Source Contact Text N Auto-Populated per Zip Code entry Text N Auto-Populated per Zip Code entry Text N Enter the name of the contact person if applicable to the case Other Referral information can be added in the Other Referral 2 screen. Click on the Other Referral 2 tab to enter information for additional referral sources and complete as above with the Other Referral 1. Populate the fields and when completed, Click Submit May 2010 CBHS 79

80 Contact Information Purpose: The Client Contact Information option within the Avatar PM application is used to record one or more contacts for the client. This option also includes demographic information pertinent to the contact. Menu Path: Avatar PM > Client Management > Client Information > Contact Information Client Information Tab Label Field Required Comments Type Date Date yes Date is defaulted in to date field. Contact Information tab Radio Yes Click on Contact Information Tab to enter client s contact information May 2010 CBHS 80

81 Contact Information Tab Page 1 This is a multiple iteration table where many rows of data can be populated. Label Field Required Comment Type Add New Item Radio Y Click on Add New Item, a new set of fields will appear in the Contact Information block. Entries in the fields below will appear in the field when entered Name Text Y Enter the contact name in name field. Contact Relationship to Radio Y Select the relationship which describes the relationship to the client Client Primary Contact Radio Y Select Yes or No Contact Living Radio N Select Yes or No With Client Contact Address Text N Enter address of contact May 2010 CBHS 81

82 Contact City Text N Enter city of contact Contact State Dropdown N Select the applicable state from the list Contact Zip Numeric No Enter contact Zip Code Code Contact Home Numeric No Enter phone number ( ) Phone Contact Work Numeric No Enter phone number ( ) Phone Contact Cell Phone Numeric No Enter phone number ( ) Use the right arrow toward the upper left to move to page 2. Populate the fields and when completed, Click Submit May 2010 CBHS 82

83 Tab Contact Information Page 2 Label Field Required Comment Type Comments Text No Enter comments as applicable This is a free text box and the Text Editor can be used to spell check. Populate the fields and when completed, Click Submit May 2010 CBHS 83

84 Avatar PM Consent Forms Purpose: The Consent Forms Options will display the various types of consent forms in use in the system and allow the user to print each from the option screen. Menu Path: Avatar PM > Client Management > Client Information > Consent Form Label Field Required Comments Type Date Date Yes Defaults to current date, double click for calendar T = Today Y= Yesterday Calendar arrows navigate up and down to applicable date Consent Forms Radio Yes Select applicable consent form to be accessed and printed Submit Icon Icon Yes Click on Submit icon in the menu bar a print preview screen of the selected consent form will appear. The user may select the number of copies desired for printing. Printer Icon Icon Yes Click on the printer icon in the upper left hand corner to print the consent form Close Icon Yes Click on the Close icon in the menu bar to close the Consent Forms Screen Copies of consent forms *See the attached forms to view copies of the various consent forms Print appropriate consent form for signatures. Maintain in paper record May 2010 CBHS 84

85 Populate the fields and when completed, Click Submit Family Registration, UMDAP Purpose Use this option to register a Family in the system. For each family, the user records the Uniform Methods of Determining Ability to Pay (UMDAP) financial information. The user also indicates each of the members of the family. Menu Path: Avatar PM > Client Management > Family and UMDAP Management > Family Registration Entering a new family Use the following steps to open the Family Registration option: 1. Select Family Registration from the Family and UMDAP Management subheading of the Client Management heading. The system displays the Select Family screen. 2. Enter all or part of the Family name or exact Family ID number and click Select Family Name/ID Search. 3. If the family is not currently registered, the Not Found dialog box displays. Click New to display the ID Number Assignment box. Click Ok in the dialog box to display the first tab of the Family Registration option. Click Cancel to exit and redisplay the User Home Page. Click Cancel in the Select Family screen to exit the Family Registration process. Accessing Family Registration Opens Family Registration (Existing Families Only) New Family Registration May 2010 CBHS 85

86 Family Registration Tab Label Field Required Comments Type Family Name Text Yes Last name,first name of the family Family s Address - Street Text No Enter the address of the family, this is the address where the client billing will be sent Family s Address Text No If needed Street -2 Family s Address Numeric No Zip Code Zip Code Family s Address City Text No Will default if zip entered May 2010 CBHS 86

87 Family s Address State Family Activation Date Dropdown No Will default if zip entered Date Yes This is the date the family becomes active Family Members Tab Select Add New Item to create an active line for entering information. Label Field Required Comments Type Client ID# No Enter the client ID or last name,first name to select Family Member Name Text Yes If an active client has been selected, this will default in. If a family member needs to be added who isn t in Avatar, enter this information as Last Name,First Name to register Type of Family Radio No Select the type. If head of household Membership Relationship to Head of Household Dropdown No Select from the dropdown May 2010 CBHS 87

88 Start Date of Family Membership End Date of Family Membership UMDAP Information Page 1 Date Yes Enter the first date that the member became associated with the family. This date must be on or after the Family Activation Date. Date No Only use to end date membership for this person in this family This is a multiple iteration table, select Add New Item to begin adding additional information. Label Start Date of UMDAP Year Gross Monthly Inc Resp Person Gross Monthly Inc Spouse Field Type Required Comments Date Yes Enter the beginning date of the UMDAP Year, the end date will default and cannot be changed Numeric No Enter appropriate information Numeric No Enter appropriate information May 2010 CBHS 88

89 Gross Monthly Income Other # Dependent on Income Numeric No Enter appropriate information Numeric Yes Enter appropriate information UMDAP Information Page 2 Label Field Required Comments Type Savings Numeric No Enter appropriate information Bank Balances Numeric No Enter appropriate information Market Value of Numeric No Enter appropriate information Stocks Market Value of Numeric No Enter appropriate information Bonds Market Value of Mutual Savings Numeric No Enter appropriate information May 2010 CBHS 89

90 Market Value of Other Numeric No Enter appropriate information The remaining three fields are system calculated and cannot be changed. UMDAP Information Page 3 Label Court Ordered Obligations Paid Monthly Monthly Child Care Monthly Dependent Support Payments Monthly Medical Expense Payments Amount of Medical Expenses Field Required Comments Type Numeric No Enter appropriate information Numeric No Enter appropriate information Numeric No Enter appropriate information Numeric No Enter appropriate information Numeric No Enter appropriate information May 2010 CBHS 90

91 Excluded Monthly Deductions for Retirement Plans Numeric No Enter appropriate information UMDAP Information Page 4 Label Field Required Comments Type UMDAP Annual Numeric Yes System Calculated Liability Agreed Monthly Numeric No Enter if the client has agreed to a monthly amount to pay Payments to Satisfy Above Liability Approved By Text Yes Enter the approver information Date Approved Date Yes Enter the date approved Interviewer Text Yes Enter the interviewer information May 2010 CBHS 91