Chapter 12 Waiting List. Table of Contents. I. Document Revision History 2 IIA. General Policies and Considerations 3

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Chapter 12 Waiting List DCF Pamphlet 155-2 Chapter 12 (WAITLIST) Table of Contents I. Document Revision History 2 IIA. General Policies and Considerations 3 IIB. Adding and Updating Waiting List Records 3 I.A. Deleting Waiting List Records 5 I.B. Removing Clients from Waiting List 5 Table 1. Document Revision History... 2 Table 2. Waiting List File Layout... 4 Table 3. Waiting List Deletion File Layout.. 5 Table 4. Removal of Client From Waiting List File Layout... 6 Version 11.1.2 Page 12-1 Effective: July 1, 2015

I. Document Revision History Table 1. Document Revision History Document Revision History Version Number Effective Date Revision Date Description Author 11.1.2 07/01/2015 06/20/2015 Completed Version 11.1.2 SAMH Data Unit Corrected the Level of Care range to reflect 01 through 11 and added a leading zero for the single digit numbers. Corrected the Program range to reflect 1 through 4. 11.1.2 07/01/2015 11/06/2015 Changed the DISCPROVIDERID to REFPROVIDERID (in order to collect the ProviderID of entity providing the referred services to the client) on pages five and six. Removed the Mandatory for this field on page five and added a conditional Mandatory statement on page six. SAMH Data Unit Fixed Position Numbers Version 11.1.2 Page 12-2 Effective: July 1, 2015

IIA. General Policies and Considerations DCF Pamphlet 155-2 Chapter 12 (WAITLIST) 1. Contractors report Waiting List data for all clients waiting to receive recommended substance abuse or mental health services. 2. A demographic record must exist for the same SSN, CONTRACTORID, and PROVIDERID. 3. Create the Demographic records according to the file layout in Chapter 4 of the pamphlet. IIB. Adding and Updating Waiting List Records Create the Waiting List records according to the file layout in Table 2 below. Table 2: Waiting List File Layout Field Name Pos CONTRACTORID 1 CHAR(10) Format: XX-XXXXXXX Contractor must be registered in SAMHIS. Must match CONTRACTORID in DEMO record. PROVIDERID SSN PLACEDATE LEVELCARE PROGRAM PLACEREASON Descriptions and Instructions: Contractor Id - The contractor id is the Federal Employer Identification Number of the entity which holds a contract with DCF. 11 CHAR(10) Format: XX-XXXXXXX Provider must be registered in SAMHIS. Must match ProviderID in DEMO record. Descriptions and Instructions: Provider ID - The Federal Employer Identification Number of the entity which is placing the client on the Waiting List. 21 CHAR(9) Format: XXXXXXXXX Must match SSN in DEMO record. Descriptions and Instructions: Social Security Number Client s Social Security Number. 30 CHAR(8) Format: YYYYMMDD Descriptions and Instructions: Date Placed on Waiting List - Indicate the date the client was placed on the Waiting List. 38 CHAR(2) Must be 01 through 11. Descriptions and Instructions: Level of Care - Indicate the level of care for which the client is being placed on the waiting list. [01] Mental Health Treatment Facility [07] Outpatient Services [02] Crisis stabilization Unit [08] Detox [03] Residential Level 1 [09] Day/Night [04] Residential Level 2 [10] Methadone [05] Residential Level 3 [11] Other [06] Residential Level 4 40 CHAR(1) Must be 1 through 4. Descriptions and Instructions: Program - Indicate the program in which the client is being placed on the Waiting List. [1] ASA [2] CSA [3] AMH [4] CMH 41 CHAR(1) Must be 1 through 3 Descriptions and Instructions: Placement Reason - Indicate the reason the client was placed on the Waiting List. [1] Service is not available/not offered [3] Other [2] Service needed is at capacity Version 11.1.2 Page 12-3 Effective: July 1, 2015

Field Name ASSESSDATE SITEID PREGNANT IVDRUGUSE HOMELESS Pos 42 CHAR(8) Format: YYYYMMDD Must be <= PLACEDATE Descriptions and Instructions: Date of Assessment - Indicate the date of contact when the assessment was made to put the client on the Waiting List. This date should be equal to or prior to the PLACEDATE. 50 CHAR(2) Format: XX right justified/zero filled. Must be registered in SAMHIS for the PROVIDERID. Descriptions and Instructions: Site ID - The physical location of the provider where services will be provided. 52 CHAR(1) Must be 1 through 3. Descriptions and Instructions: Pregnancy Trimester - Indicate the client s pregnancy status at admission. Not Applicable can only be used for males. [1] Pregnant [2] Not Pregnant [3] Not Applicable 53 CHAR(1) Must be 1 or 2. Descriptions and Instructions: IV Drug Use Indicate whether or not the client is an intravenous drug user. [1] Yes [2] No 54 CHAR(1) Must be 1 or 2 Descriptions and Instructions: Homeless Indicate whether or not the client is homeless. [1] Yes [2] No CNTYSERV 55 CHAR(2) Must be a valid county code Descriptions and Instructions: County of Service - Indicate the circuit in which the client is being placed on the Waiting List. Refer to the Florida County Codes Table in Appendix 5 - Data Code Tables. CLIENTID 57 CHAR(10) Left justified/space filled. COUNSELOR LNAME COUNSELOR FNAME COUNSELOR MNAME Descriptions and Instructions: Client ID - Contractor use only. 67 CHAR(35) Left justified/space filled. Descriptions and Instructions: Counselor Last Name - Indicate the last name of the counselor who determined that the client needs to be placed on the Waiting List. 102 CHAR(35) Left justified/space filled. Descriptions and Instructions: Counselor First Name - Indicate the first name of the counselor who determined that the client needs to be placed on the Waiting List. 137 CHAR(14) Left justified/space filled. Descriptions and Instructions: Counselor Middle Name - Indicate the middle name of the counselor who determined that the client needs to be placed on the Waiting List. REMOVEDATE 151 CHAR(8) Format: YYYYMMDD Will be Blank until Removal Record is submitted (Automatically populated from Removal Record) Descriptions and Instructions: Removal Date - Indicate the date that the client is removed from the list. Based on the reason to be removed, enter the appropriate date. Version 11.1.2 Page 12-4 Effective: July 1, 2015

Field Name Pos REMOVEREAS 159 CHAR(1) Must be 1 through 7. Will be Blank until Removal Record is submitted (Automatically populated from Removal Record) Descriptions and Instructions: Removal Reason - Indicate the reason for which the client is being removed from the Waiting List. [1] Receiving Referred Services [5] Died [2] Moved out of State [6] Service no Longer Appropriate [3] Moved out of Circuit [7] Other [4] Declined REFPROVIDERID 160 CHAR(10) Format: XX-XXXXXXX Provider must be registered in SAMHIS. Must match ProviderID in DEMO record. Will be Blank until Removal Record is submitted (Automatically populated from Removal Record) TRANSTYPE Descriptions and Instructions: Referred Provider ID The Federal Employer Identification Number of the entity from which the client is receiving the referred services. 170 CHAR(1) Must be A (Add) or U (Update) Descriptions and Instructions: Transaction Type Indicate if the record is an A = Add or U = Update I.A. Deleting Waiting List Records A waiting list record can be deleted by submitting a record with the same mandatory key fields as shown in Table 3 below. Table 3: Waiting List Deletion File Layout Field Position Length Format CONTRACTORID 1 10 XX-XXXXXXX SSN 11 9 XXXXXXXXX PLACEDATE 21 8 YYYYMMDD PROVIDERID 29 10 XX-XXXXXXX I.B. Removing Clients from Waiting List 1. To remove a client from the waiting list, a deletion record must be submitted according to the file layout in Table 4 below. Field Name CONTRACTORID Table 4: Removal of Clients From Waitlist File Layout Pos 1 CHAR(10) Format: XX-XXXXXXX Contractor must be registered in SAMHIS. Must match CONTRACTORID in Waiting List record. Descriptions and Instructions: Contractor Id - The contractor id is the Federal Employer Identification Number of the entity which holds a contract with DCF. Version 11.1.2 Page 12-5 Effective: July 1, 2015

Field Name PROVIDERID SSN PLACEDATE REMOVEREAS REMOVEDATE Pos 11 CHAR(10) Format: XX-XXXXXXX Provider must be registered in SAMHIS. Must match ProviderID in Waiting List record. Descriptions and Instructions: Provider ID - The Federal Employer Identification Number of the entity which is placing the client on the Waiting List. 21 CHAR(9) Format: XXXXXXXXX Must match SSN in Waiting List record. Descriptions and Instructions: Social Security Number Client s Social Security Number. 30 CHAR(8) Format: YYYYMMDD Must match the PLACEDATE in Waiting List record. Descriptions and Instructions: Date Placed on Waiting List - Indicate the date the client was placed on the Waiting List. 38 CHAR(1) Must be 1 through 7. Descriptions and Instructions: Removal Reason - Indicate the reason for which the client is being removed from the Waiting List. [1] Receiving Referred Services [5] Died [2] Moved out of State [6] Service no Longer Appropriate [3] Moved out of Circuit [7] Other [4] Declined 39 CHAR(8) Format: YYYYMMDD Descriptions and Instructions: Removal Date - Indicate the date that the client is removed from the list. Based on the reason to be removed, enter the appropriate date. REFPROVIDERID 47 CHAR(10) Format: XX-XXXXXXX Provider must be registered in SAMHIS. Must match ProviderID in DEMO record. Mandatory when REMOVEREAS = 1, otherwise blank. Descriptions and Instructions: Referred Service Provider ID The Federal Employer Identification Number of the entity from which the client is receiving the referred services. Leave blank if this provider is the same as the provider removing the client from the waiting list. Version 11.1.2 Page 12-6 Effective: July 1, 2015