Identification/Information Page
Identification/Information Page - IS REQUIRED - includes the consumer’s personal information, diagnosis legal status, physicians, SSN, employment/Dayhab, emergency contact (s), AAHCS nurse, Case Manager/AAHCS Office contact name and phone number, Pharmacy, HCL Model (such as “SL”) and LON. This page should not be shared with unauthorized personnel. All information subject change.
Client – the consumer’s name in full, legal name
Date of Birth – the birthdate of the consumer
Address – is the current location in which the consumer resides
Case# - is generated by the office case manager and or management
Phone# - is the phone number of a contact person. Usually if the consumer is their own guardian and they have a cell phone or contact number, that number is listed
Date of Admission – the date the consumer was enrolled
HCS Model – Service in which the consumer receives (Supervised Living, ect.)
LON – Level of Need
Social Security Number – the consumer’s social security number
Income – the consumer’s source of income
Religion – is their religion preference
Diagnosis – what the consumer was diagnosed with by a professional
Allergies – was the consumer is allergic to
Legal Status – if the consumer is their own guardian or not
Physician – the primary doctor or other specified
Surgeon –
Psychologist – This is a professional who evaluates and studies behavior a mental process
Pharmacy – is a pharmacy that is selected for regularly filling the consumer’s medication
Day Habilitation – is assistance with getting, keeping or improving self-help, socialization and adaptive aids necessary to live successfully in the community and to participate in home and community life
Medicaid – the insurance information of the consumer
Pre-Paid Funeral Plan – if the consumer has it or not
In case of an emergency – typically the parent, relative or other specified
RN/LVN – A nurse hired by the Provider
Executive Director -
Case Manager -
Administrator -
Parent/Guardian/Other Contact - also in case of an emergency or other specified
Client – the consumer’s name in full, legal name
Date of Birth – the birthdate of the consumer
Address – is the current location in which the consumer resides
Case# - is generated by the office case manager and or management
Phone# - is the phone number of a contact person. Usually if the consumer is their own guardian and they have a cell phone or contact number, that number is listed
Date of Admission – the date the consumer was enrolled
HCS Model – Service in which the consumer receives (Supervised Living, ect.)
LON – Level of Need
Social Security Number – the consumer’s social security number
Income – the consumer’s source of income
Religion – is their religion preference
Diagnosis – what the consumer was diagnosed with by a professional
Allergies – was the consumer is allergic to
Legal Status – if the consumer is their own guardian or not
Physician – the primary doctor or other specified
Surgeon –
Psychologist – This is a professional who evaluates and studies behavior a mental process
Pharmacy – is a pharmacy that is selected for regularly filling the consumer’s medication
Day Habilitation – is assistance with getting, keeping or improving self-help, socialization and adaptive aids necessary to live successfully in the community and to participate in home and community life
Medicaid – the insurance information of the consumer
Pre-Paid Funeral Plan – if the consumer has it or not
In case of an emergency – typically the parent, relative or other specified
RN/LVN – A nurse hired by the Provider
Executive Director -
Case Manager -
Administrator -
Parent/Guardian/Other Contact - also in case of an emergency or other specified
POSITION TITLES VARY BY PROVIDER/COMPANY.
Some companies add pictures of the consumer.
Some companies add pictures of the consumer.
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