Home
About Amcord Care Inc.
Services
Adult Day Care
Home Modifications
Home Delivered Meals
Medication Management
Non-Medical Transportation
Nursing Home Transition
Skilled Nursing Services
Personal Care
Waiver Process
Enrollment
Providers
Job Openings
Home
About Amcord Care Inc.
Services
Adult Day Care
Home Modifications
Home Delivered Meals
Medication Management
Non-Medical Transportation
Nursing Home Transition
Skilled Nursing Services
Personal Care
Waiver Process
Enrollment
Providers
Job Openings
InterRAI
interRAI (1)
CDMS_FormID
phw1
Member_ID
First Name
(Required)
Middle Inital
Jr/Sr
Last Name
(Required)
RAIA10a
RAIA2
1
2
Year
Month
Date
RAIA3d
RAIA10b
RAIA24
1
2
3
4
5
6
RAIA11c
RAIA11a
RAIA11b
RAIA12
1
2
3
4
5
6
7
8
9
10
11
12
13
14
RAIA5a4
RAIA5a1
RAIA5a2
RAIA5a3
RAIA5b
RAIA5c
RAIA6
RAIA13a
1
2
3
4
5
6
7
8
RAIA7a
0
1
RAIA7b
0
1
RAIA7c
0
1
RAIA7d
0
1
RAIA7e
0
1
RAIA7f
0
1
RAIA8
1
2
3
4
5
6
7
RAIA13b
0
1
RAIA13c
0
1
2
RAIA14
0
1
2
3
4
5
RAIA9a
RAIA9b
RAIA9c
RAIA9d
RAIB3
1
2
3
4
RAIB1d
RAIB1a
RAIB1b
RAIB1c
RAIB2a
0
1
RAIB4a
0
1
RAIB4b
0
1
RAIB2b
0
1
RAIB4c
0
1
RAIB2c
0
1
RAIB4d
0
1
RAIB2d
0
1
RAIB4e
0
1
RAIB2e
0
1
RAIB2f
0
1
C1
0
1
2
3
4
5
C3a
0
1
2
C3b
0
1
2
C3c
0
1
2
C4
0
1
C2a
0
1
C2b
0
1
C5
0
1
2
8
C2c
0
1
D1
0
1
2
3
4
D3
0
1
2
3
4
D2
0
1
2
3
4
D4
0
1
2
3
4
E1f
0
1
2
3
E1g
0
1
2
3
E1h
0
1
2
3
E1i
0
1
2
3
E1j
0
1
2
3
E1k
0
1
2
3
E1a
0
1
2
3
E1b
0
1
2
3
E1c
0
1
2
3
E1d
0
1
2
3
E2a
0
1
2
3
8
E1e
0
1
2
3
E2b
0
1
2
3
8
E2c
0
1
2
3
8
E3c
0
1
2
3
E3d
0
1
2
3
E3e
0
1
2
3
E3f
0
1
2
3
E3a
0
1
2
3
E3b
0
1
2
3
F3
0
1
2
F4
0
1
2
3
F1a
0
1
2
3
4
8
F1b
0
1
2
3
4
8
F1c
0
1
2
3
4
8
F1d
0
1
2
3
4
8
F1e
0
1
2
3
4
8
F5
0
1
F1f
0
1
2
3
4
8
F2
0
1
Meal Prep Performance
(Required)
0
1
2
3
4
5
6
8
Meal Prep Capacity
(Required)
0
1
2
3
4
5
6
G1bC
0
1
2
3
4
5
6
G1bP
0
1
2
3
4
5
6
8
G1cC
0
1
2
3
4
5
6
G1cP
0
1
2
3
4
5
6
8
G1dC
0
1
2
3
4
5
6
G1dP
0
1
2
3
4
5
6
8
G2a
0
1
2
3
4
5
6
8
G1eP
0
1
2
3
4
5
6
8
G1eC
0
1
2
3
4
5
6
G2b
0
1
2
3
4
5
6
8
G1fC
0
1
2
3
4
5
6
G1fP
0
1
2
3
4
5
6
8
G1gP
0
1
2
3
4
5
6
8
G1gC
0
1
2
3
4
5
6
G2c
0
1
2
3
4
5
6
8
G1hP
0
1
2
3
4
5
6
8
G1hC
0
1
2
3
4
5
6
G2d
0
1
2
3
4
5
6
8
G2e
0
1
2
3
4
5
6
8
G3d
0
1
2
3
4
5
8
G2f
0
1
2
3
4
5
6
8
G2g
0
1
2
3
4
5
6
8
G2h
0
1
2
3
4
5
6
8
G2i
0
1
2
3
4
5
6
8
G2j
0
1
2
3
4
5
6
8
G4a
0
1
2
3
4
G3a
0
1
2
3
G4b
0
1
2
3
G3b
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
77
88
99
G5a
0
1
G5b
0
1
G6
0
1
2
8
G3c
0
1
2
3
4
5
G7a
0
1
G7b
0
1
H1
0
1
2
3
4
5
8
H3
0
1
2
3
4
5
8
H2
0
1
2
3
H4
0
1
I1c
0
1
2
3
I1d
0
1
2
3
I1e
0
1
2
3
I1f
0
1
2
3
I1g
0
1
2
3
I1h
0
1
2
3
I1i
0
1
2
3
I1j
0
1
2
3
I1a
0
1
2
3
I1b
0
1
2
3
meal_sc_tue
meal_sc_thurs
meal_sc_fri
meal_sc_sun
(Required)
meal_sc_sat
(Required)
meal_sc_wed
meal_sc_desc
G1aS3
meal_sc_mon
(Required)
meal_weekly_total
meal_mon
First Choice
Second Choice
Third Choice
meal_fri
First Choice
Second Choice
Third Choice
meal_adj_weekly_total
meal_tue
First Choice
Second Choice
Third Choice
meal_sc
meal_sun
First Choice
Second Choice
Third Choice
meal_wed
First Choice
Second Choice
Third Choice
meal_sat
First Choice
Second Choice
Third Choice
meal_thurs
First Choice
Second Choice
Third Choice
a1
rb_meal_weekly_total
rb_meal_tues
First Choice
Second Choice
Third Choice
rb_meal_sc
rb_meal_sun
First Choice
Second Choice
Third Choice
rb_meal_fri
First Choice
Second Choice
Third Choice
rb_meal_sat
First Choice
Second Choice
Third Choice
rb_meal_thurs
First Choice
Second Choice
Third Choice
rb_meal_adj_weekly_total
rb_meal_wed
First Choice
Second Choice
Third Choice
rb_meal_mon
First Choice
Second Choice
Third Choice
a2
ph_meal_weekly_total
ph_meal_mon
First Choice
Second Choice
Third Choice
ph_meal_tues
First Choice
Second Choice
Third Choice
ph_meal_wed
First Choice
Second Choice
Third Choice
ph_meal_thurs
First Choice
Second Choice
Third Choice
ph_meal_adj_weekly_total
ph_meal_sc
ph_meal_sun
First Choice
Second Choice
Third Choice
ph_meal_sat
First Choice
Second Choice
Third Choice
ph_meal_fri
First Choice
Second Choice
Third Choice
house_sc_desc
G1bS3
house_weekly_total
house_mon
First Choice
Second Choice
Third Choice
house_sat
First Choice
Second Choice
Third Choice
house_fri
First Choice
Second Choice
Third Choice
house_tue
First Choice
Second Choice
Third Choice
house_thurs
First Choice
Second Choice
Third Choice
house_wed
First Choice
Second Choice
Third Choice
house_adj_weekly_total
house_sc
house_sun
First Choice
Second Choice
Third Choice
house_sc_sun
house_sc_tue
house_sc_thurs
house_sc_sat
house_sc_mon
house_sc_fri
house_sc_wed
a3
rb_house_weekly_total
rb_house_mon
First Choice
Second Choice
Third Choice
rb_house_tues
First Choice
Second Choice
Third Choice
rb_house_wed
First Choice
Second Choice
Third Choice
rb_house_thurs
First Choice
Second Choice
Third Choice
rb_house_fri
First Choice
Second Choice
Third Choice
rb_house_sat
First Choice
Second Choice
Third Choice
rb_house_sun
First Choice
Second Choice
Third Choice
rb_house_adj_weekly_total
rb_house_sc
rb_house_adj_weekly_total
a4
ph_house_sat
First Choice
Second Choice
Third Choice
ph_house_weekly_total
ph_house_sun
First Choice
Second Choice
Third Choice
ph_house_tues
First Choice
Second Choice
Third Choice
ph_house_wed
First Choice
Second Choice
Third Choice
ph_house_thurs
First Choice
Second Choice
Third Choice
ph_house_fri
First Choice
Second Choice
Third Choice
ph_house_sc
ph_house_adj_weekly_total
ph_house_adj_weekly_total
ph_house_mon
First Choice
Second Choice
Third Choice
finance_sc_desc
G1cS3
finance_sc_sun
finance_tue
First Choice
Second Choice
Third Choice
finance_sc
finance_adj_weekly_total
finance_sat
First Choice
Second Choice
Third Choice
finance_mon
First Choice
Second Choice
Third Choice
finance_fri
First Choice
Second Choice
Third Choice
finance_thurs
First Choice
Second Choice
Third Choice
finance_wed
First Choice
Second Choice
Third Choice
finance_sun
First Choice
Second Choice
Third Choice
finance_weekly_total
finance_sc_thurs
finance_sc_tue
finance_sc_sat
finance_sc_mon
finance_sc_fri
finance_sc_wed
a5
rb_finance_weekly_total
rb_finance_mon
First Choice
Second Choice
Third Choice
rb_finance_adj_weekly_total
rb_finance_sun
First Choice
Second Choice
Third Choice
rb_finance_sat
First Choice
Second Choice
Third Choice
rb_finance_fri
First Choice
Second Choice
Third Choice
rb_finance_thurs
First Choice
Second Choice
Third Choice
rb_finance_wed
First Choice
Second Choice
Third Choice
rb_finance_tues
First Choice
Second Choice
Third Choice
rb_finance_sc
rb_finance_adj_weekly_total
a6
ph_finance_sat
First Choice
Second Choice
Third Choice
ph_finance_weekly_total
ph_finance_sun
First Choice
Second Choice
Third Choice
ph_finance_adj_weekly_total
ph_finance_thurs
First Choice
Second Choice
Third Choice
ph_finance_sc
ph_finance_wed
First Choice
Second Choice
Third Choice
ph_finance_tues
First Choice
Second Choice
Third Choice
ph_finance_mon
First Choice
Second Choice
Third Choice
ph_finance_fri
First Choice
Second Choice
Third Choice
ph_finance_adj_weekly_total
meds_sc_desc
G1dS3
meds_sc_sun
meds_weekly_total
meds_sc
meds_sun
First Choice
Second Choice
Third Choice
meds_mon
First Choice
Second Choice
Third Choice
meds_sat
First Choice
Second Choice
Third Choice
meds_adj_weekly_total
meds_thurs
First Choice
Second Choice
Third Choice
meds_wed
First Choice
Second Choice
Third Choice
meds_tue
First Choice
Second Choice
Third Choice
meds_fri
First Choice
Second Choice
Third Choice
meds_sc_thurs
meds_sc_tue
meds_sc_sat
meds_sc_mon
meds_sc_wed
meds_sc_fri
a7
rb_meds_weekly_total
rb_meds_tues
First Choice
Second Choice
Third Choice
rb_meds_thurs
First Choice
Second Choice
Third Choice
rb_meds_fri
First Choice
Second Choice
Third Choice
rb_meds_sat
First Choice
Second Choice
Third Choice
rb_meds_sun
First Choice
Second Choice
Third Choice
rb_meds_sc
rb_meds_adj_weekly_total
rb_meds_wed
First Choice
Second Choice
Third Choice
rb_meds_mon
First Choice
Second Choice
Third Choice
a8
ph_meds_weekly_total
ph_meds_sat
First Choice
Second Choice
Third Choice
ph_meds_mon
First Choice
Second Choice
Third Choice
ph_meds_sun
First Choice
Second Choice
Third Choice
ph_meds_tues
First Choice
Second Choice
Third Choice
ph_meds_wed
First Choice
Second Choice
Third Choice
ph_meds_thurs
First Choice
Second Choice
Third Choice
ph_meds_adj_weekly_total
ph_meds_sc
ph_meds_fri
First Choice
Second Choice
Third Choice
phone_sc_desc
G1eS3
phone_sc_sun
phone_weekly_total
phone_sc
phone_tue
First Choice
Second Choice
Third Choice
phone_sun
First Choice
Second Choice
Third Choice
phone_sat
First Choice
Second Choice
Third Choice
phone_fri
First Choice
Second Choice
Third Choice
phone_adj_weekly_total
phone_thurs
First Choice
Second Choice
Third Choice
phone_wed
First Choice
Second Choice
Third Choice
phone_mon
First Choice
Second Choice
Third Choice
phone_sc_tue
phone_sc_sat
phone_sc_mon
phone_sc_thurs
phone_sc_fri
phone_sc_wed
a9
rb_1_weekly_total
rb_1_adj_weekly_total
rb_1_sc
rb_1_sat
First Choice
Second Choice
Third Choice
rb_1_mon
First Choice
Second Choice
Third Choice
rb_1_wed
First Choice
Second Choice
Third Choice
rb_1_thurs
First Choice
Second Choice
Third Choice
rb_1_fri
First Choice
Second Choice
Third Choice
rb_1_sun
First Choice
Second Choice
Third Choice
rb_1_tues
First Choice
Second Choice
Third Choice
a10
ph_1_sat
First Choice
Second Choice
Third Choice
ph_1_weekly_total
ph_1_mon
First Choice
Second Choice
Third Choice
ph_1_wed
First Choice
Second Choice
Third Choice
ph_1_thurs
First Choice
Second Choice
Third Choice
ph_1_tues
First Choice
Second Choice
Third Choice
ph_1_fri
First Choice
Second Choice
Third Choice
ph_1_sun
First Choice
Second Choice
Third Choice
ph_1_sc
ph_1_adj_weekly_total
stairs_sc_desc
G1fS3
stairs_sc_sun
stairs_weekly_total
stairs_sc_thurs
stairs_sc_tue
stairs_tue
First Choice
Second Choice
Third Choice
stairs_mon
First Choice
Second Choice
Third Choice
stairs_wed
First Choice
Second Choice
Third Choice
stairs_sun
First Choice
Second Choice
Third Choice
stairs_thurs
First Choice
Second Choice
Third Choice
stairs_fri
First Choice
Second Choice
Third Choice
stairs_adj_weekly_total
stairs_sc
stairs_sat
First Choice
Second Choice
Third Choice
stairs_sc_mon
stairs_sc_sat
stairs_sc_wed
stairs_sc_fri
a11
rb_2_weekly_total
rb_2_sat
First Choice
Second Choice
Third Choice
rb_2_sun
First Choice
Second Choice
Third Choice
rb_2_fri
First Choice
Second Choice
Third Choice
rb_2_sc
rb_2_adj_weekly_total
rb_2_mon
First Choice
Second Choice
Third Choice
rb_2_tues
First Choice
Second Choice
Third Choice
rb_2_wed
First Choice
Second Choice
Third Choice
rb_2_thurs
First Choice
Second Choice
Third Choice
a12
ph_2_sat
First Choice
Second Choice
Third Choice
ph_2_weekly_total
ph_2_adj_weekly_total
ph_2_sc
ph_2_sun
First Choice
Second Choice
Third Choice
ph_2_mon
First Choice
Second Choice
Third Choice
ph_2_tues
First Choice
Second Choice
Third Choice
ph_2_wed
First Choice
Second Choice
Third Choice
ph_2_thurs
First Choice
Second Choice
Third Choice
ph_2_fri
First Choice
Second Choice
Third Choice
shopping_sc_desc
shopping_weekly_total
shopping_mon
First Choice
Second Choice
Third Choice
shopping_sc_sun
shopping_sc_sat
shopping_sat
First Choice
Second Choice
Third Choice
shopping_sc_fri
shopping_fri
First Choice
Second Choice
Third Choice
shopping_sc_thurs
shopping_thurs
First Choice
Second Choice
Third Choice
shopping_sc_wed
shopping_wed
First Choice
Second Choice
Third Choice
shopping_sc
shopping_adj_weekly_total
shopping_sc_mon
G1gS3
shopping_sun
First Choice
Second Choice
Third Choice
shopping_tue
First Choice
Second Choice
Third Choice
shopping_sc_tue
a13
rb_3_weekly_total
rb_3_thurs
First Choice
Second Choice
Third Choice
rb_3_mon
First Choice
Second Choice
Third Choice
rb_3_tues
First Choice
Second Choice
Third Choice
rb_3_wed
First Choice
Second Choice
Third Choice
rb_3_sat
First Choice
Second Choice
Third Choice
rb_3_fri
First Choice
Second Choice
Third Choice
rb_3_sun
First Choice
Second Choice
Third Choice
rb_3_sc
rb_3_adj_weekly_total
a14
ph_3_weekly_total
ph_3_sat
First Choice
Second Choice
Third Choice
ph_3_tues
First Choice
Second Choice
Third Choice
ph_3_sun
First Choice
Second Choice
Third Choice
ph_3_adj_weekly_total
ph_3_sc
ph_3_fri
First Choice
Second Choice
Third Choice
ph_3_thurs
First Choice
Second Choice
Third Choice
ph_3_wed
First Choice
Second Choice
Third Choice
ph_3_mon
First Choice
Second Choice
Third Choice
trans_sc_desc
G1hS3
trans_weekly_total
trans_mon
First Choice
Second Choice
Third Choice
trans_sat
First Choice
Second Choice
Third Choice
trans_wed
First Choice
Second Choice
Third Choice
trans_fri
First Choice
Second Choice
Third Choice
trans_sc
trans_thurs
First Choice
Second Choice
Third Choice
trans_adj_weekly_total
trans_sun
First Choice
Second Choice
Third Choice
trans_tue
First Choice
Second Choice
Third Choice
trans_sc_sun
trans_sc_tue
trans_sc_thurs
trans_sc_mon
trans_sc_sat
trans_sc_fri
trans_sc_wed
rb_trans_sc_desc
rb_4_weekly_total
rb_4_tues
First Choice
Second Choice
Third Choice
rb_4_mon
First Choice
Second Choice
Third Choice
rb_4_wed
First Choice
Second Choice
Third Choice
rb_4_thurs
First Choice
Second Choice
Third Choice
rb_4_fri
First Choice
Second Choice
Third Choice
rb_4_sat
First Choice
Second Choice
Third Choice
rb_4_sun
First Choice
Second Choice
Third Choice
rb_4_sc
rb_4_adj_weekly_total
ph_trans_sc_desc
ph_4_weekly_total
ph_4_sat
First Choice
Second Choice
Third Choice
ph_4_thurs
First Choice
Second Choice
Third Choice
ph_4_wed
First Choice
Second Choice
Third Choice
ph_4_tues
First Choice
Second Choice
Third Choice
ph_4_adj_weekly_total
ph_4_fri
First Choice
Second Choice
Third Choice
ph_4_sc
ph_4_sun
First Choice
Second Choice
Third Choice
ph_4_mon
First Choice
Second Choice
Third Choice
bath_sc_desc
G2aS3
bath_sc_sun
bath_weekly_total
bath_sc_thurs
bath_sc_tue
bath_tue
First Choice
Second Choice
Third Choice
bath_fri
First Choice
Second Choice
Third Choice
bath_sat
First Choice
Second Choice
Third Choice
bath_wed
First Choice
Second Choice
Third Choice
bath_thurs
First Choice
Second Choice
Third Choice
bath_mon
First Choice
Second Choice
Third Choice
bath_adj_weekly_total
bath_sun
First Choice
Second Choice
Third Choice
bath_sc
bath_sc_sat
bath_sc_mon
bath_sc_wed
bath_sc_fri
rb_bath_sc_desc
rb_5_weekly_total
rb_5_mon
First Choice
Second Choice
Third Choice
rb_5_tues
First Choice
Second Choice
Third Choice
rb_5_wed
First Choice
Second Choice
Third Choice
rb_5_thurs
First Choice
Second Choice
Third Choice
rb_5_fri
First Choice
Second Choice
Third Choice
rb_5_sat
First Choice
Second Choice
Third Choice
rb_5_sun
First Choice
Second Choice
Third Choice
rb_5_sc
rb_5_adj_weekly_total
ph_bath_sc_desc
ph_5_sat
First Choice
Second Choice
Third Choice
ph_5_weekly_total
ph_5_mon
First Choice
Second Choice
Third Choice
ph_5_tues
First Choice
Second Choice
Third Choice
ph_5_wed
First Choice
Second Choice
Third Choice
ph_5_thurs
First Choice
Second Choice
Third Choice
ph_5_fri
First Choice
Second Choice
Third Choice
ph_5_sun
First Choice
Second Choice
Third Choice
ph_5_adj_weekly_total
ph_5_sc
hyg_sc_desc
G2bS3
hyg_sc_sun
hyg_sc_thurs
hyg_sc_tue
hyg_mon
First Choice
Second Choice
Third Choice
hyg_tue
First Choice
Second Choice
Third Choice
hyg_wed
First Choice
Second Choice
Third Choice
hyg_thurs
First Choice
Second Choice
Third Choice
hyg_adj_weekly_total
hyg_sc
hyg_sun
First Choice
Second Choice
Third Choice
hyg_sat
First Choice
Second Choice
Third Choice
hyg_fri
First Choice
Second Choice
Third Choice
hyg_weekly_total
hyg_sc_mon
hyg_sc_sat
hyg_sc_wed
hyg_sc_fri
rb_hyg_sc_desc
rb_6_weekly_total
rb_6_adj_weekly_total
rb_6_wed
First Choice
Second Choice
Third Choice
rb_6_fri
First Choice
Second Choice
Third Choice
rb_6_sat
First Choice
Second Choice
Third Choice
rb_6_sc
rb_6_sun
First Choice
Second Choice
Third Choice
rb_6_tues
First Choice
Second Choice
Third Choice
rb_6_mon
First Choice
Second Choice
Third Choice
rb_6_thurs
First Choice
Second Choice
Third Choice
ph_hyg_sc_desc
ph_6_sat
First Choice
Second Choice
Third Choice
ph_6_weekly_total
ph_6_sun
First Choice
Second Choice
Third Choice
ph_6_tues
First Choice
Second Choice
Third Choice
ph_6_wed
First Choice
Second Choice
Third Choice
ph_6_thurs
First Choice
Second Choice
Third Choice
ph_6_fri
First Choice
Second Choice
Third Choice
ph_6_adj_weekly_total
ph_6_mon
First Choice
Second Choice
Third Choice
ph_6_sc
ubod_sc_desc
G2cS3
ubod_weekly_total
ubod_sc_sun
ubod_adj_weekly_total
ubod_fri
First Choice
Second Choice
Third Choice
ubod_sun
First Choice
Second Choice
Third Choice
ubod_sat
First Choice
Second Choice
Third Choice
ubod_sc
ubod_thurs
First Choice
Second Choice
Third Choice
ubod_wed
First Choice
Second Choice
Third Choice
ubod_tue
First Choice
Second Choice
Third Choice
ubod_mon
First Choice
Second Choice
Third Choice
ubod_sc_thurs
ubod_sc_tue
ubod_sc_mon
ubod_sc_sat
ubod_sc_fri
ubod_sc_wed
rb_ubod_sc_desc
rb_7_weekly_total
rb_7_tues
First Choice
Second Choice
Third Choice
rb_7_adj_weekly_total
rb_7_mon
First Choice
Second Choice
Third Choice
rb_7_sc
rb_7_sun
First Choice
Second Choice
Third Choice
rb_7_sat
First Choice
Second Choice
Third Choice
rb_7_fri
First Choice
Second Choice
Third Choice
rb_7_thurs
First Choice
Second Choice
Third Choice
rb_7_wed
First Choice
Second Choice
Third Choice
ph_ubod_sc_desc
ph_7_sat
First Choice
Second Choice
Third Choice
ph_7_weekly_total
ph_7_mon
First Choice
Second Choice
Third Choice
ph_7_tues
First Choice
Second Choice
Third Choice
ph_7_wed
First Choice
Second Choice
Third Choice
ph_7_thurs
First Choice
Second Choice
Third Choice
ph_7_fri
First Choice
Second Choice
Third Choice
ph_7_sun
First Choice
Second Choice
Third Choice
ph_7_sc
ph_7_adj_weekly_total
lbod_sc_desc
G2dS3
lbod_sc_sun
lbod_weekly_total
lbod_adj_weekly_total
lbod_sc
lbod_sun
First Choice
Second Choice
Third Choice
lbod_mon
First Choice
Second Choice
Third Choice
lbod_fri
First Choice
Second Choice
Third Choice
lbod_tue
First Choice
Second Choice
Third Choice
lbod_wed
First Choice
Second Choice
Third Choice
lbod_sat
First Choice
Second Choice
Third Choice
lbod_thurs
First Choice
Second Choice
Third Choice
lbod_sc_tue
lbod_sc_thurs
lbod_sc_mon
lbod_sc_sat
lbod_sc_fri
lbod_sc_wed
rb_lbod_sc_desc
rb_8_weekly_total
rb_8_adj_weekly_total
rb_8_sc
rb_8_sun
First Choice
Second Choice
Third Choice
rb_8_sat
First Choice
Second Choice
Third Choice
rb_8_fri
First Choice
Second Choice
Third Choice
rb_8_thurs
First Choice
Second Choice
Third Choice
rb_8_wed
First Choice
Second Choice
Third Choice
rb_8_tues
First Choice
Second Choice
Third Choice
rb_8_mon
First Choice
Second Choice
Third Choice
ph_lbod_sc_desc
ph_8_weekly_total
ph_8_sat
First Choice
Second Choice
Third Choice
ph_8_thurs
First Choice
Second Choice
Third Choice
ph_8_wed
First Choice
Second Choice
Third Choice
ph_8_mon
First Choice
Second Choice
Third Choice
ph_8_adj_weekly_total
ph_8_fri
First Choice
Second Choice
Third Choice
ph_8_sun
First Choice
Second Choice
Third Choice
ph_8_sc
ph_8_tues
First Choice
Second Choice
Third Choice
walk_sc_desc
walk_mon
First Choice
Second Choice
Third Choice
walk_sc
walk_tue
First Choice
Second Choice
Third Choice
walk_wed
First Choice
Second Choice
Third Choice
walk_adj_weekly_total
walk_fri
First Choice
Second Choice
Third Choice
walk_thurs
First Choice
Second Choice
Third Choice
walk_sat
First Choice
Second Choice
Third Choice
walk_sun
First Choice
Second Choice
Third Choice
G2eS3a
walk_sc_thurs
walk_weekly_total
walk_sc_sat
walk_sc_tue
walk_sc_mon
walk_sc_sun
walk_sc_fri
walk_sc_wed
rb_walk_sc_desc
rb_9_weekly_total
rb_9_thurs
First Choice
Second Choice
Third Choice
rb_9_tues
First Choice
Second Choice
Third Choice
rb_9_sun
First Choice
Second Choice
Third Choice
rb_9_sat
First Choice
Second Choice
Third Choice
rb_9_fri
First Choice
Second Choice
Third Choice
rb_9_wed
First Choice
Second Choice
Third Choice
rb_9_mon
First Choice
Second Choice
Third Choice
rb_9_sc
rb_9_adj_weekly_total
ph_walk_sc_desc
ph_9_weekly_total
ph_9_sat
First Choice
Second Choice
Third Choice
ph_9_mon
First Choice
Second Choice
Third Choice
ph_9_tues
First Choice
Second Choice
Third Choice
ph_9_sun
First Choice
Second Choice
Third Choice
ph_9_thurs
First Choice
Second Choice
Third Choice
ph_9_wed
First Choice
Second Choice
Third Choice
ph_9_sc
ph_9_adj_weekly_total
ph_9_fri
First Choice
Second Choice
Third Choice
loco_sc_desc
loco_sc_sun
loco_weekly_total
loco_fri
First Choice
Second Choice
Third Choice
loco_sc
loco_thurs
First Choice
Second Choice
Third Choice
loco_wed
First Choice
Second Choice
Third Choice
loco_tue
First Choice
Second Choice
Third Choice
loco_mon
First Choice
Second Choice
Third Choice
loco_adj_weekly_total
loco_sun
First Choice
Second Choice
Third Choice
loco_sat
First Choice
Second Choice
Third Choice
loco_sc_mon
loco_sc_tue
loco_sc_sat
loco_sc_thurs
loco_sc_fri
loco_sc_wed
G2fS3a
desc1
rb_10_weekly_total
rb_10_wed
First Choice
Second Choice
Third Choice
rb_10_adj_weekly_total
rb_10_mon
First Choice
Second Choice
Third Choice
rb_10_thurs
First Choice
Second Choice
Third Choice
rb_10_fri
First Choice
Second Choice
Third Choice
rb_10_sat
First Choice
Second Choice
Third Choice
rb_10_sun
First Choice
Second Choice
Third Choice
rb_10_sc
rb_10_tues
First Choice
Second Choice
Third Choice
desc2
ph_10_sat
First Choice
Second Choice
Third Choice
ph_10_weekly_total
ph_10_tues
First Choice
Second Choice
Third Choice
ph_10_sun
First Choice
Second Choice
Third Choice
ph_10_wed
First Choice
Second Choice
Third Choice
ph_10_thurs
First Choice
Second Choice
Third Choice
ph_10_fri
First Choice
Second Choice
Third Choice
ph_10_adj_weekly_total
ph_10_sc
ph_10_mon
First Choice
Second Choice
Third Choice
trans_toilet_sc_desc
trans_toilet_weekly_total
trans_toilet_sc_thurs
trans_toilet_sc_tue
trans_toilet_sc_sun
trans_toilet_mon
First Choice
Second Choice
Third Choice
trans_toilet_sc
trans_toilet_adj_weekly_total
trans_toilet_sun
First Choice
Second Choice
Third Choice
trans_toilet_tue
First Choice
Second Choice
Third Choice
trans_toilet_sat
First Choice
Second Choice
Third Choice
trans_toilet_fri
First Choice
Second Choice
Third Choice
trans_toilet_wed
First Choice
Second Choice
Third Choice
trans_toilet_thurs
First Choice
Second Choice
Third Choice
trans_toilet_sc_mon
trans_toilet_sc_wed
trans_toilet_sc_fri
trans_toilet_sc_sat
G2gS3a
desc3
rb_11_weekly_total
rb_11_mon
First Choice
Second Choice
Third Choice
rb_11_tues
First Choice
Second Choice
Third Choice
rb_11_sun
First Choice
Second Choice
Third Choice
rb_11_sc
rb_11_thurs
First Choice
Second Choice
Third Choice
rb_11_adj_weekly_total
rb_11_wed
First Choice
Second Choice
Third Choice
rb_11_sat
First Choice
Second Choice
Third Choice
rb_11_fri
First Choice
Second Choice
Third Choice
desc4
ph_11_weekly_total
ph_11_sat
First Choice
Second Choice
Third Choice
ph_11_tues
First Choice
Second Choice
Third Choice
ph_11_mon
First Choice
Second Choice
Third Choice
ph_11_thurs
First Choice
Second Choice
Third Choice
ph_11_wed
First Choice
Second Choice
Third Choice
ph_11_sun
First Choice
Second Choice
Third Choice
ph_11_adj_weekly_total
ph_11_sc
ph_11_fri
First Choice
Second Choice
Third Choice
toiletuse_sc_desc
toiletuse_weekly_total
toiletuse_adj_weekly_total
toiletuse_tue
First Choice
Second Choice
Third Choice
toiletuse_wed
First Choice
Second Choice
Third Choice
toiletuse_sat
First Choice
Second Choice
Third Choice
toiletuse_fri
First Choice
Second Choice
Third Choice
toiletuse_mon
First Choice
Second Choice
Third Choice
toiletuse_thurs
First Choice
Second Choice
Third Choice
toiletuse_sun
First Choice
Second Choice
Third Choice
toiletuse_sc
toiletuse_sc_sun
G2hS3a
toiletuse_sc_tue
toiletuse_sc_thurs
toiletuse_sc_mon
toiletuse_sc_sat
toiletuse_sc_fri
toiletuse_sc_wed
desc5
rb_12_weekly_total
rb_12_thurs
First Choice
Second Choice
Third Choice
rb_12_sun
First Choice
Second Choice
Third Choice
rb_12_sat
First Choice
Second Choice
Third Choice
rb_12_fri
First Choice
Second Choice
Third Choice
rb_12_tues
First Choice
Second Choice
Third Choice
rb_12_wed
First Choice
Second Choice
Third Choice
rb_12_mon
First Choice
Second Choice
Third Choice
rb_12_sc
rb_12_adj_weekly_total
desc6
ph_12_weekly_total
ph_12_sat
First Choice
Second Choice
Third Choice
ph_12_mon
First Choice
Second Choice
Third Choice
ph_12_sun
First Choice
Second Choice
Third Choice
ph_12_fri
First Choice
Second Choice
Third Choice
ph_12_thurs
First Choice
Second Choice
Third Choice
ph_12_wed
First Choice
Second Choice
Third Choice
ph_12_tues
First Choice
Second Choice
Third Choice
ph_12_sc
ph_12_adj_weekly_total
bed_sc_desc
G2iS3a
bed_sc_sun
bed_weekly_total
bed_sc_tue
bed_sc_thurs
bed_sun
First Choice
Second Choice
Third Choice
bed_sc
bed_thurs
First Choice
Second Choice
Third Choice
bed_adj_weekly_total
bed_wed
First Choice
Second Choice
Third Choice
bed_sat
First Choice
Second Choice
Third Choice
bed_tue
First Choice
Second Choice
Third Choice
bed_mon
First Choice
Second Choice
Third Choice
bed_fri
First Choice
Second Choice
Third Choice
bed_sc_sat
bed_sc_mon
bed_sc_wed
bed_sc_fri
desc7
rb_13_weekly_total
rb_13_wed
First Choice
Second Choice
Third Choice
rb_13_tues
First Choice
Second Choice
Third Choice
rb_13_mon
First Choice
Second Choice
Third Choice
rb_13_thurs
First Choice
Second Choice
Third Choice
rb_13_fri
First Choice
Second Choice
Third Choice
rb_13_sat
First Choice
Second Choice
Third Choice
rb_13_sun
First Choice
Second Choice
Third Choice
rb_13_sc
rb_13_adj_weekly_total
desc8
ph_13_sat
First Choice
Second Choice
Third Choice
ph_13_weekly_total
ph_13_mon
First Choice
Second Choice
Third Choice
ph_13_thurs
First Choice
Second Choice
Third Choice
ph_13_tues
First Choice
Second Choice
Third Choice
ph_13_wed
First Choice
Second Choice
Third Choice
ph_13_fri
First Choice
Second Choice
Third Choice
ph_13_sun
First Choice
Second Choice
Third Choice
ph_13_adj_weekly_total
ph_13_sc
eat_sc_desc
eat_sc_mon
eat_sc_thurs
G2jS3a
eat_sc_tue
eat_weekly_total
eat_mon
First Choice
Second Choice
Third Choice
eat_sat
First Choice
Second Choice
Third Choice
eat_sun
First Choice
Second Choice
Third Choice
eat_wed
First Choice
Second Choice
Third Choice
eat_adj_weekly_total
eat_tue
First Choice
Second Choice
Third Choice
eat_sc
eat_fri
First Choice
Second Choice
Third Choice
eat_thurs
First Choice
Second Choice
Third Choice
eat_sc_fri
eat_sc_sun
eat_sc_sat
eat_sc_wed
desc9
rb_14_weekly_total
rb_14_tues
First Choice
Second Choice
Third Choice
rb_14_wed
First Choice
Second Choice
Third Choice
rb_14_thurs
First Choice
Second Choice
Third Choice
rb_14_fri
First Choice
Second Choice
Third Choice
rb_14_sat
First Choice
Second Choice
Third Choice
rb_14_sun
First Choice
Second Choice
Third Choice
rb_14_sc
rb_14_adj_weekly_total
rb_14_mon
First Choice
Second Choice
Third Choice
desc10
ph_14_sat
First Choice
Second Choice
Third Choice
ph_14_weekly_total
ph_14_wed
First Choice
Second Choice
Third Choice
ph_14_thurs
First Choice
Second Choice
Third Choice
ph_14_sun
First Choice
Second Choice
Third Choice
ph_14_sc
ph_14_adj_weekly_total
ph_14_fri
First Choice
Second Choice
Third Choice
ph_14_tues
First Choice
Second Choice
Third Choice
ph_14_mon
First Choice
Second Choice
Third Choice
additional 1
cis_mon
cis_thurs
cis_weekly_total
cis_sun
cis_sat
cis_fri
cis_adj_weekly_total
cis_tue
cis_wed
additional 3
ifs_weekly_total
ifs_mon
ifs_tue
ifs_wed
ifs_thurs
ifs_fri
ifs_adj_weekly_total
ifs_sat
ifs_sun
test_tuesday
test_sat
test_fri
test_sun
test_wed
test_weekly_total
test_adj_weekly_total
test_sc_weekly_total
test_monday
test_thurs
rb_test_adj_weekly_total
rb_test_wed
rb_test_sat
rb_test_tuesday
rb_test_sun
rb_test_fri
test_rb_weekly_total
rb_test_thurs
rb_test_weekly_total
rb_test_monday
ph_test_wed
ph_test_sat
ph_test_fri
ph_test_sun
ph_test_tuesday
ph_test_adj_weekly_total
ph_test_monday
ph_test_thurs
ph_test_weekly_total
test_ph_weekly_total
additional 2
ars_mon
ars_adj_weekly_total
ars_weekly_total
ars_tue
ars_wed
ars_thurs
ars_fri
ars_sat
ars_sun
additional 2_rb
ars_weekly_total_rb
ars_weekly_total_rb
ars_sun_rb
ars_fri_rb
ars_mon_rb
ars_tue_rb
ars_wed_rb
ars_thurs_rb
ars_sat_rb
additional 2_md
ars_sun_md
ars_weekly_total_md
ars_adj_weekly_total_md
ars_mon_md
ars_sat_md
ars_fri_md
ars_thurs_md
ars_wed_md
ars_tue_md
additional 4
test_weekly_ftotal
test_adj_weekly_ftotal
test_sc_weekly_ftotal
I1k
0
1
2
3
I1l
0
1
2
3
I2aICD3
I2aDC
I2aDIAG
I2aICD1
I2aICD2
I1m
0
1
2
3
I1n
0
1
2
3
I1o
0
1
2
3
I1p
0
1
2
3
I1q
0
1
2
3
I1r
0
1
2
3
I1s
0
1
2
3
I1t
0
1
2
3
I1u
0
1
2
3
J4
0
1
2
3
J1
0
1
2
3
J2
0
1
J5
0
1
2
3
4
J3a
0
1
2
3
4
J6a
0
1
2
3
J3b
0
1
2
3
4
J3c
0
1
2
3
4
J3d
0
1
2
3
4
J3e
0
1
2
3
4
J3f
0
1
2
3
4
J6b
0
1
2
3
4
J3g
0
1
2
3
4
J3h
0
1
2
3
4
J3i
0
1
2
3
4
J6c
0
1
2
3
J3j
0
1
2
3
4
J3k
0
1
2
3
4
J3l
0
1
2
3
4
J6d
0
1
J3m
0
1
2
3
4
J3n
0
1
2
3
4
J6e
0
1
2
3
4
5
J3o
0
1
2
3
4
J3p
0
1
2
3
4
J3q
0
1
2
3
4
J3r
0
1
2
3
4
J3s
0
1
2
3
4
J3t
0
1
2
3
4
J3u
0
1
2
3
4
J9a
0
1
2
J7a
0
1
J7b
0
1
J9b
0
1
2
3
J7c
0
1
J8
0
1
2
3
8
K1b
K1a
K2a
0
1
K2b
0
1
K2c
0
1
K2d
0
1
K3
0
1
2
3
4
5
6
7
8
9
K4a
0
1
K4b
0
1
K4c
0
1
K4d
0
1
L5
0
1
L1
0
1
2
3
4
5
L6
0
1
L2
0
1
L7
0
1
2
3
4
L3
0
1
L4
0
1
M1g1b
M1g1g
M1g1c
GTTS – DROPS
GM – GRAMS
L – LITERS
MCG – MICRORAM
MEQ – milli equivalent
MG-milligram
ML-milliliter
oz-Ounce
Puffs
%
units
OTH (other)
M1g1a
M1g1d
Q1H
Q2H
Q3H
Q4H
Q6H
Q8H
Daily
BED
BID
TID
QID
5D
Q2D
Q3D
Weekly
2W
3W
4W
5W
6W
1M
2M
OTH
M1g1f
0 – No
1 – Yes
M1g1e
0 – No
1 – Yes
M1g2c
GTTS – DROPS
GM – GRAMS
L – LITERS
MCG – MICRORAM
MEQ – milli equivalent
MG-milligram
ML-milliliter
oz-Ounce
Puffs
%
units
OTH (other)
M1g2d
REC
ET
SL
PO
TOP
TD
IM
IH
EYE
IV
NAS
Sub-Q
OTH
M1g2a
M1g2f
0 – No
1 – Yes
M1g2b
M1g2g
M1g2e
Q1H
Q2H
Q3H
Q4H
Q6H
Q8H
Daily
BED
BID
TID
QID
5D
Q2D
Q3D
Weekly
2W
3W
4W
5W
6W
1M
2M
OTH
M1g3c
GTTS – DROPS
GM – GRAMS
L – LITERS
MCG – MICRORAM
MEQ – milli equivalent
MG-milligram
ML-milliliter
oz-Ounce
Puffs
%
units
OTH (other)
M1g3e
Q1H
Q2H
Q3H
Q4H
Q6H
Q8H
Daily
BED
BID
TID
QID
5D
Q2D
Q3D
Weekly
2W
3W
4W
5W
6W
1M
2M
OTH
M1g3g
M1g3b
M1g3f
0 – No
1 – Yes
M1g3d
REC
ET
SL
PO
TOP
TD
IM
IH
EYE
IV
NAS
Sub-Q
OTH
M1g3a
M1g4a
M1g4f
0 – No
1 – Yes
M1g4d
REC
ET
SL
PO
TOP
TD
IM
IH
EYE
IV
NAS
Sub-Q
OTH
M1g4g
M1g4c
GTTS – DROPS
GM – GRAMS
L – LITERS
MCG – MICRORAM
MEQ – milli equivalent
MG-milligram
ML-milliliter
oz-Ounce
Puffs
%
units
OTH (other)
M1g4b
M1g4e
Q1H
Q2H
Q3H
Q4H
Q6H
Q8H
Daily
BED
BID
TID
QID
5D
Q2D
Q3D
Weekly
2W
3W
4W
5W
6W
1M
2M
OTH
M1g5c
GTTS – DROPS
GM – GRAMS
L – LITERS
MCG – MICRORAM
MEQ – milli equivalent
MG-milligram
ML-milliliter
oz-Ounce
Puffs
%
units
OTH (other)
M1g5d
REC
ET
SL
PO
TOP
TD
IM
IH
EYE
IV
NAS
Sub-Q
OTH
M1g5b
M1g5g
M1g5e
Q1H
Q2H
Q3H
Q4H
Q6H
Q8H
Daily
BED
BID
TID
QID
5D
Q2D
Q3D
Weekly
2W
3W
4W
5W
6W
1M
2M
OTH
M1g5a
M1g5f
0 – No
1 – Yes
M2
0
1
M3
0
1
2
8
N1a
0
1
N1b
0
1
N3aWEEK
N3aDAY
N1c
0
1
N3bDAY
N3bWEEK
N1d
0
1
N3cWEEK
N3cDAY
N1e
0
1
N3dDAY
N1f
0
1
N3eDAY
N3eWEEK
N1g
0
1
N3fWEEK
N3fDAY
N1h
0
1
N3gDAY
N3gWEEK
N3hDAY
N3hWEEK
N4a
N4b
N2a
0
1
2
3
N4c
N2b
0
1
2
3
N5
0
1
N2c
0
1
2
3
N2d
0
1
2
3
N2e
0
1
2
3
N2f
0
1
2
3
N2g
0
1
2
3
N2h
0
1
2
3
N2i
0
1
2
3
N2j
0
1
2
3
N2k
0
1
2
3
N2l
0
1
2
3
N2m
0
1
2
3
N2n
0
1
2
3
O1
0
1
P1a
1
2
3
4
5
6
7
8
9
P1a2
1
2
3
4
5
6
7
8
9
P1c2
0
1
8
P1c
0
1
8
P1d2
0
1
8
P1d
0
1
8
P2a
0
1
P2b
0
1
P2c
0
1
P1b2
0
1
2
8
P1b
0
1
2
8
P3
P4
0
1
Q2
0
1
Q1a
0
1
Q3a
0
1
Q3b
0
1
Q1b
0
1
Q3c
0
1
Q1c
0
1
Q4
0
1
Q1d
0
1
Q1e
0
1
R1
0
1
R3
R4
R2
0
1
2
R5
0
1
2
3
4
8
S1Date
S1Month
S1
S1Day
S2
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
T2Day
T2Month
T2Year
T2Date
T1
DueDateDate
AssessmentType
I-Initial
R-Reassessment
SC-Significant change
DueDateDay
DueDateYear
DueDateMonth
RequestDateDate
RequestDateDay
RequestDateMonth
RequestDateYear
AssessmentLateReason
I: Inaccurate contact information given at time of referral
P: Participant/participant family member requests a delay
E: Emergency declaration by government entity
A: Assessor unavailable within required timeframe
AC: Assessor cancellation
OT: Other
OtherReasonAssessmentLate
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CLEARSPACE_1
end_eval_1
end_eval_1
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CNC Revision
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