MMIS DD SCREENING

The tables below display the ADD2, ADD3 and ADD4 panels of the MMIS DD SCREENING in MMIS.

ADD2-4 panels use the same navigation tools as detailed for the ADD1 panel on the previous page of this course.

Table of MMIS DD SCREENING - ADD2 panel 
 NEXT: ADD3                  MMIS DD SCREENING - ADD2  
                        DOCUMENT NBR: 0000 000 0 000                            
                                                                                
       DOC STAT: A APPROVED          CM NBR: 0000000000                      
  RECIP NAME/ID: LAST              FIRST        I 00000000 SEX: F AGE/LA: 000 00
                                                                                
       SELF PRESERVATION: 02 PROMPTS                   VOCATIONAL: 03 MIN SPPRT 
           SELF CARE (A): 03 INSTR REQ           DAILY LIVING (B): 03 INSTR REQ 
    MONEY MANAGEMENT (C): 03 INSTR REQ       COMMUNITY LIVING (D): 03 INSTR REQ 
  LEISURE RECREATION (E): 03 INSTR REQ           SUPPORT SERVICES: 03 CONT SVC  
                                                                                
EATING NON-NUTRITIVE (A): 01 NONE                   INJURIOUS (B): 01 NONE      
    AGGRESS/PHYSICAL (C): 02 MILD              AGGRESS/VERBAL (D): 02 MILD      
     SEXUAL BEHAVIOR (E): 01 NONE               PROPERTY DEST (F): 01 NONE      
           RUNS AWAY (G): 02 MILD                 BREAKS LAWS (H): 01 NONE      
    TEMPER OUTBURSTS (I): 02 MILD                       OTHER (J): 01 NONE      
                                                                                
                           RISK STATUS: 01 RISK ICFMR                           
 LI EXC ST USER ID  LI EXC ST USER ID  LI EXC ST USER ID  LI EXC ST USER ID     
                                           
                                                                                
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Table of the MMIS DD SCREENING - ADD3 panel 
NEXT: ADD4                   MMIS DD SCREENING - ADD3   
                        DOCUMENT NBR: 0000 000 0 000                          
       DOC STAT: A APPROVED           CM NBR: 0000000000                     
  RECIP NAME/ID: LAST              FIRST        I 00000000 SEX: F AGE/LA:  00 00
                        INFORMED CHOICE(Y/N): Y                                 
                                                                                
    CODE  CURRENT SERVICES                 CODE  PLANNED SERVICES               
 01  01   CASE MANAGEMENT                   01   CASE MANAGEMENT                
 02  06   SLS                               06   SLS                            
 03  38   FOSTER CARE-SHIFT STAFF           38   FOSTER CARE-SHIFT STAFF        
 04  09   DAY TRAINING & HABILITATION       09   DAY TRAINING & HABILITATION    
 05                                         07   CRISIS - RESPITE               
 06                                                                             
 07                                                                             
 08                                                                             
 09                                                                             
 10                                                                             
 11                                                                             
 LI EXC ST USER ID  LI EXC ST USER ID  LI EXC ST USER ID  LI EXC ST USER ID     
                                             
                                                                                
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Table of MMIS DD SCREENING - ADD4 panel 
 NEXT: ADHS                   MMIS DD SCREENING - ADD4  
                        DOCUMENT NBR: 0000 000 0 000                            
       DOC STAT: A APPROVED           CM NBR: 0000000000                     
  RECIP NAME/ID: LAST              FIRST       I 00000000 SEX: F AGE/LA:  00 00
                                                                                
    DT&H SERV AUTH LEVEL: 02 MODERATE             WAIVER NEED INDEX: 004        
   SPEC MEDICAL SERV (A): Y       PHYSICAL THPY (B): N  OCCUPATIONAL THPY (C): N
    COMM/SPEECH THPY (D): N      TRANSPORTATION (E): Y EXCESSIVE BEHAVIOR (F): Y
       MENTAL HEALTH (G): Y  EARLY INTERVENTION (H): N              OTHER (I): N
 FINAL ACTION:                                                                  
   RCP/L REP(A): 04 CL CM WAIV CASE MGR(B): 04 CM CM WAIV QMRP(C): 04 QP CM WAIV
 NF SHORT TERM APPROVAL:   BEGIN DATE:          THROUGH DATE:                   
                                                                  (A)  (B)  (C) 
  MCAID SVC PROG: 01 MA DD                             CO USE ONLY:              
    CASE MGR SIG: Y     QMRP SIG: Y   PERSON/LGL REP SIG: Y     CFR SIG: Y      
     CFR USER ID: 0000000       DHS APP CURR: 0000000   DHS APP PLANNED: 000000
    TIME LTD PMT: N             DHS USE ONLY:            PMT AUTHORIZED: 01     
     CM COMMENTS: Y           RECIP COMMENTS: N            DHS COMMENTS: Y      
 LI EXC ST USER ID  LI EXC ST USER ID  LI EXC ST USER ID  LI EXC ST USER ID     
                                           
                                                                                
ENTER---PF1---PF2---PF3---PF4---PF5---PF6---PF7---PF8---PF9---PF10---PF11--PF12 
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