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701S with no Enrollments PSA ALL
Owner All Owners
Assessment Dates between 01012017 12312017
Priority Referral ADL ADL IADL IADL Nutr PSA Client ID Client Name Owner Asmt Date Assessor Name Score Rank Source Count Score Count Score Score
03 4062797101 Test Name 1393 09192017 26 2 SELFFAMILY 5 17 7 26 8
03
Test Assessor
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701S with no Enrollments PSA ALL
Owner All Owners
Assessment Dates between 01012017 12312017
Priority Referral ADL ADL IADL IADL Nutr PSA Client ID Client Name Owner Asmt Date Assessor Name Score Rank Source Count Score Count Score Score
03 4062182441 Test Name 1149 12282017 46 6 16 5 20 9
1001141832
Test AssessorAND FAMILIES
5 OTHER
Count 43
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Active Clients Careplan PSA ALL Provider ALL PROVIDERS Location 0000 Worker SSN All SSNs
Services Needed Services Planned
RecommendedClient ID Client Name Service Date End Date Frequency Program Frequency
4061653427 Test Name CNML 09102013 O3C1
Begin Date End Date
09102013 5 MEL PER WK 5 MEL PER WK
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Active Clients with Contact Information PSA ALL Program AC County All Counties Worker All Workers Zip Code All Zip Codes Provider All Providers Location 0000 Order by Zip Client_Name
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Active AC Consumers Receiving an APS Referral PSA ALL Owner All Owners Risk Level H Program AC Referral Start Date 01012017 Referral End Date 12312017
Start Enroll Risk Referral PSA Client ID Client Name Owner ID Date Prog Provider Workers Level Date
Total Count 0
Total Clients 0
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Active MLTC Clients Who are ACTV APCL or APPL in Another Program
PSA ALL Provider ALL
Program Status ACTV
Include NDP Y
Active MLTC Clients Information
PSA Owner ID Client ID Client Name
02 4061692109 Test NamePSA Count 1
Total Count 1
Unduplicated Client Count 1
MLTC Start Enrollment Date
11012013
Worker
CIRTS15124
Provider
1065
Other Programs Information
Location Program Program Status
0043 O3C1 ACTV
Start Enrollment Date
04042014
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Active or APCL Clients with Caregiver Information PSA ALL Provider ALL PROVIDERS Program AC Program Status ACTV Sort by PROVIDER
Provider Location Program
Program Status Worker Clinet ID Client Name
Most recent Asmt Date Asmt Priority with CaregiverType Score
Risk Score Caregiver Name
HCE Relationship Indicator
1380 0181AC ACTV CIRTS16813 4062414494 Test Name 04232014 701A 40 Test OR N
Count 1
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Active PACE Clients Who are ACTV APCL or APPL in Another Program PSA ALL
Provider ALL
-------- Active PACE Clients Information -------- ------ Other Programs Information ----
PSA Owner ID Client ID Client Name Provider Location Program Program Status
Total Count 0
Unduplicated Client Count 0
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ACTV CCE HCE and ADI Clients with No Care Plan PSA ALL
Program ALL PROGRAMS Provider ALL PROVIDERS
Owner All Owners
Enrollment Information PSA Client ID Name Owner Provider Loc Program Start Date Worker
01 4062521310 Test Name 1911 1911 0932 CCE 03272014 CIRTS29059
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ACTV CCE HCE and ADI Clients with No Care Plan PSA ALL
Program ALL PROGRAMS Provider ALL PROVIDERS
Owner All Owners
PSA Client ID Name Owner Enrollment Information
Provider Loc Program Start Date Worker
4061605936 Test Name 1785 1927 0072 ADI 07202006 CIRTS26739
11
Duplicated Count 72 Unduplicated Counts 70
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ACTV APPL APCL Clients who have moved to another PSA PSA ALL
Provider ALL PROVIDERS
Address Enrollment Client ID Client Name Provider Loc Program Program Start PSA PSA Status Enrollment
01A 02 4062760605 1191 0072 CCE ACTV 11082011 Test Name
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Aging Network Provider Information Report PSA ALL
Address PSA Provider Loc Provider Name Type Provider Address Telephone
01 1147 B
1147
0072 Provider Name
0073 Provider Name B
1147
1147
0100 Provider Name
0179 Provider Name B
1271 B
1271 B
1271
0000 Provider Name
0001 Provider Name
0002 Provider Name B
1271 B
1271
0003 Provider Name
0004 Provider Name B
1271 B
1271
0072 Provider Name
0073 Provider Name B
1271 0100 Provider Name B
1271 B
1271 B
1271 B
1271 B
1271
0101 Provider Name
0138 Provider Name
0179 Provider Name
0286 Provider Name
0287 Provider Name B
123 Provider CALICO DRIVE STAYTON FL 59255
123 Provider TERRA COTTA STREET DARRINGTON
FL 57399
123 Provider LANGTOWN ROAD DARRINGTON FL 57399
123 Provider POINTE LANE Bonum integritas corporis misDARRINGTON FL 58398
123 Provider OAK DRIVE SUNNYVALE MO 83407
123 Provider HOTT STREET DARRINGTON FL 58398
123 Provider GRASSELLI STREET DARRINGTON FL 68396
123 Provider HEAVENS WAY MORRISONS CROSSROADS AL 33165
123 Provider GOOSETOWN DRIVE MIDVILLE
FL 93176
123 Provider PIKE STREET BELLOWS FALLS
FL 48405
123 Provider GLENVIEW DRIVE SUSSEX FL
123 Provider JONES AVENUE BLYTHEVILLE
FL 14027
123 Provider HENERY STREET SUSSEX FL
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Aging Network Provider Information Report PSA ALL
PSA Provider Loc Provider Name Address Type Provider Address Telephone
11 1952 B
1952 B
1952 B
1952 B
1952 B
1952 B
1952 B
123 Test Street ELLSINORE FL 38234 3789 WHITE
123 Test Street OHATCHEE FL 45235 3408 NORMA
123 Test Street WHITE CLOUD FL 46226
123 Test Street NEOSHO FL 06231
123 Test Street WHITE CLOUD FL 16168 3678 OLD
123 Test StreetWHITE CLOUD FL 06231 184 GRANT
123 Test Street WHITE CLOUD FL 93236
1952
1955
1956
B 3123 Test Street Quid censes in Latino fore IaWHITE CLOUD FL 70226
1957
0Provider Name
0Provider Name
0Provider Name
0Provider Name
0Provider Name
0Provider Name
0Provider Name
0Provider Name
0Provider Name
0Provider Name
0Provider Name B 123 Test Street Sed ad rem redeamus ComprehenWHITE CLOUD FL 38227
1957
1958
Count
0474 Provider Name
0072 Provider Name
427
B 123 Test Street BRANCH ROAD Quid ergo hoc loco intellegit WHITE CLOUD FL 25224
Count Total 3117
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Aging Network Providers Report PSA ALL
PSA 01
Provider 1271 Provider Name Provider Name
Location 0000 Location Name Provider Name
Location Business Address 3123 Test Drive DARRINGTON FL 58398
County Served OKALOOSA Phone Fax Location Contact
Provider Director Provider Profit Status Non-Profit
ACCESS_PT CCE_LA N HCE OAA OTHER
ADI EHEAP LSP RELF
CCE Y FOCAL_PT NSIP SR_CTR
Provider 1271 Provider Name Provider Name
Location 0001 Location Name Provider Name
Location Business Address 1234 Test OAK DRIVE SUNNYVALE MO 83407
Phone Fax Location Contact County Served OKALOOSA
Provider Director Provider Profit Status Non-Profit
ACCESS_PT CCE_LA N HCE OAA OTHER
ADI EHEAP LSP RELF
CCE Y FOCAL_PT NSIP SR_CTR
Provider 1271 Provider Name Provider Name
Location 0004 Location Name Provider Name
Location Business Address 1123 Test HEAVENS WAY MORRISONS CROSSROADS AL
33165 Phone County Served OKALOOSA Fax Location Contact
Provider Director Provider Profit Status Non-Profit
ACCESS_PT CCE_LA N HCE Y OAA OTHER
ADI EHEAP LSP RELF
CCE FOCAL_PT NSIP SR_CTR
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Start End Worker Most Recent Nutr Medicaid Program Provider Location Client ID Client Name Status Enrollment Enrollment Worker Active Score Number
O3C1 1036 0000 4061653427 Test Name ACTV 09102013 CIRTS20804 Y 1
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Start End Worker Most Recent Nutr Medicaid Program Provider Location Client ID Client Name Status Enrollment Enrollment Worker Active Score Number
O3C1 1036 0000 4061638016 Test Name ACTV 09122013 CIRTS20804 Y 2
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Start End Worker Most Recent Nutr Medicaid Program Provider Location Client ID Client Name Status Enrollment Enrollment Worker Active Score Number
O3C2 1036 0000 4062000152 Test Name ACTV 02072011 CIRTS23407 N 3
1036 0000 4061594062 ISAACS HATTIE ACTV 11192012 CIRTS20804 Y 5
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Start End Worker Most Recent Nutr Medicaid Program Provider Location Client ID Client Name Status Enrollment Enrollment Worker Active Score Number
O3C2 1036 0000 4062379505 Test Name ACTV 11192012 CIRTS20804 Y 5
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Start End Worker Most Recent Nutr Medicaid Program Provider Location Client ID Client Name Status Enrollment Enrollment Worker Active Score Number
O3C2 1036 0000 4062401063 Test Name ACTV 10162013 CIRTS20804 Y 3
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Provider Location Client ID Client Name Program Status
Start Enrollment
End Enrollment Worker
Worker Active
Most Recent Nutr Score
Medicaid Number
O3C2 1036 0000 4062538939 ACTV 12082000 CIRTS20388 Y Test Name
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All Enrollments Counts During Date Range PSA ALL Start Date 01012017 End Date Location 0000 Provider Program Program Status
12312017 ALL PROVIDERS
ACTV
Group By Program Provider Location
Program Provider Location Client Count O3C1 1036 0000 45
1951 0000 3
O3C2 1036 0000 113
OA3E 1821 0000 2
OA3ES 1821 0000 1
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C1 1036 0000 4061950299 Test Name ACTV 04072011 CIRTS23407 N 11
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C1 1036 4062586019 Test Name ACTV 12292008 CIRTS23407 N 1
Total for Location 45
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C1 1951 0000 4062452921 Test Name ACTV 03301989 CIRTS22695 N 10
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4062786256 Test Name ACTV 09232013 CIRTS20804 Y 4 1
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4062380426 Test Name ACTV 04112012 CIRTS23407 N 55 2
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4061608826 Test Name ACTV 08102011 CIRTS18634 Y 7 3
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4062615533 Test Name ACTV 10032013 CIRTS20804 Y 6 3
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start Enrollment
End Enrollment Worker
Worker Active
Medicaid Number
Most Recent Nutr Score Rank
O3C2 1036 4062466582 Test Name ACTV 10262010 CIRTS23407 N 105 2
Total for Location 113
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PSA
APCL Clients With No Services ALL Owner All Owners Provider ALL PROVIDERS
Start Date 01012017 End Date 12312017
Includes Clients Receiving Only CM INSC SCAS CA REFE Services
PSA Client ID Client Name Owner Provider Program
Count 0
Unduplicated Clients Count 0
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APCL Clients With Services PSA ALL Owner All Owners Provider ALL PROVIDERS Start Date 01012017 End Date 12312017
Exclude CM CA INSC REFE SCAS
PSA Client ID Name Owner Provider Program 10 4062527553 Test Name 1539 1929 CCE
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APCL Clients With Services PSA ALL Owner All Owners Provider ALL PROVIDERS Start Date 01012017 End Date 12312017
Exclude CM CA INSC REFE SCAS
PSA Client ID Name Owner Provider Program 11 4062732638 Test Name 1177 1177 LTCC
Total 21067
Unduplicated clients count 12460
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APS Assessments PSA ALL Risk Level ALL Owner All Owners Referral Date From 01012017 To 12312017
Order by Referral Date and Owner ID
PSA 03
Ref Date Owner ID Client ID Client Name Risk Level Asmt Type Asmt Date
03032017 1390 4062058415 L 701A 03302018 Test Name
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APS Assessments PSA ALL Risk Level ALL Owner All Owners Referral Date From 01012017 To 12312017
Order by Referral Date and Owner ID
12042017 1980 4061617559 H 701B 12072017 Test Name
Assessment Count for the PSA 52
PSA 04A
Ref Date Owner ID Client ID
09102017 4062308458
Client Name
Test Name
Risk Level
H
Asmt Type
O
Asmt Date
09162017
Assessment Count for the PSA 2
Risk Level H
M
L
Count of Assessments 138
23
21
Total Count of Assessments 182
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APS Repeat Referrals in a Time Range
PSA ALL Owner All Owners
Start Date 01012017 End Date 12312017
Current DOEA CIRTS Cirts SSN if Risk Date Created PSA Owner Abuse No different than DCF DCF SSN Name County Level Date of Birth Date Sent by DCF
Count 0
Unduplicated Client Count by PSA
PSA Count SSN
Total
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Assessed Prioritized Consumer List PSA ALL Provider ALL PROVIDERS Program AC County ALL COUNTIES
County Program Consumer Name Client ID
Total Count 0
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Assessment Due Report PSA 01 Start Date 01012017 End Date 08312018 Owner ALL PROVIDERS Worker ALL WORKERS Program Status ACTV and APCL Assessment Type Needed ALL
Overdue and missing assessments are always listed
Owner ID 1065
Client ID Client Name
Owner Assessor ID
Date of Birth
06281928
CIRTS28099
County of Service
GULF
Worker Name HARPER KENNY
Zip Assessment PSA Date
32534 01 01022014
Type
701A
Active Y
Nutr PriorityScore Score
11 58
Rank
5
Due Date
01022015
Status
701S OVERDUE
LTCC APPL Start Date
03252014 4062235673 Test name
Total Clients for Worker 1
Total Clients for Owner 1
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Assessment Due Report PSA 01 Start Date 01012017 End Date 08312018 Owner ALL PROVIDERS Worker ALL WORKERS Program Status ACTV and APCL Assessment Type Needed ALL
Overdue and missing assessments are always listed
Summary by PSA
PSA 01 701A Overdue 1
701B Overdue 213
701C Overdue 0
701S Overdue 157
No 701A 0
No 701B 2
No 701C 0
No 701S 0
701A Not Overdue 0
701B Not Overdue 0
701C Not Overdue 0
701S Not Overdue 0
701S Optional 0
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CIC Service Units and Costs Projections County SummaryPSA 99 Program CCE
Start Date 01012017 End Date 12312017
County LEON
Total Total Total Avg Max Projected
StateFederal Projected Reimbursement Provider Unduplicated Provider Service Share Service Units Unit Rate Cost Per Unit Client Count
Report Total
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CIC Service Units and Costs Projections Provider SummaryPSA ALL Provider ALL PROVIDERS Program FEDERALLY FUNDED (0101 TO 1231) Year 2017 From 01012017 To 12312017
PSA County Program Service Total State
Federal Share
Total Projected
Service Units
Avg Reimbursement
Unit Rate
Max Provider
Cost Per Unit
Total Projected Unduplicated Client Count
02 FRANKLIN O3C1 CONGREGATE MEALS $810300 1710 15
Program Total
County Total
$810300
$810300
GULF O3C1 CONGREGATE MEALS $25205 3 5
Program Total $25205
O3C2 HOME DELIVERED MEALS $25205 3 6
Program Total
County Total
$25205
$50411
LEON O3C1 CONGREGATE MEALS $621300 1311 15
CONGREGATE MEALS GUEST
CONGREGATE MEALS VOLUNTEERS
$252055
$277260
25
30
2
5
Program Total $1150615
O3C2 HOME DELIVERED MEAL GUEST $252055 25 3
Program Total $252055
OA3D PEARLS (SESSION 5)
PEARLS (SESSION 6)
PEARLS (SESSION 7)
PEARLS (SESSION 8)
$10247
$10247
$10247
$10247
10
10
10
10
3
3
3
3
Program Total $40988
OA3E RESPITE IN-HOME $200 2 2
Program Total
County Total
$200
$1443858
WAKULLA O3C2 EMERGENCY HOME DELIVERED SHELF MEALS
$8065604 14899 90
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CIC Service Units and Costs Projections - PSA Summary
PSA ALL Program CCE
Strat Date 01012017 End Date 12312017
Total
PSA County Provider Service
Total State Federal
Share
Total Projected
Service Units
Avg Reimbursement
Unit Rate
Max Projected Provider Unduplicated
Cost Per Unit Client Count
02 LEON SOUTHERN SERVICE CASE MANAGEMENT PROVIDER EMERGENCY HOME DELIVERED SHELF MEALS
$2175533
$602000
483
689
32
20
HOME DELIVERED MEALS $530262 993 5
MATERIAL AID $1994536 199
Provider Total $5302331
CountyTotal $5302331
WAKULLA SOUTHERN SERVICE CASE MANAGEMENT PROVIDER EMERGENCY HOME DELIVERED SHELF MEALS
$2175533
$1240200
483
689
32
5
MATERIAL AID $1994536 199
Provider Total $5410269
CountyTotal $5410269
PSA Total $10712599
05 PINELLAS BURSTEIN-APPLEBEE ADULT DAY CARE $000 0 $900 $1000 0
COUNSELING (MENTAL HEALTH COUNSELINGSCREENING) - INDIVIDUAL
Provider Total
$000
$000
0 $6600 $7700 0
CountyTotal $000
PSA Total $000
Report Total $10712599
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CID Service Units and Costs Projections - PSA SummaryPSA ALL Program CCE
Start Date 01012017 End Date 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
PSA County Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
02 LEON CASE MANAGEMENT $2175533 483
EMERGENCY HOME $602000 689DELIVERED SHELF MEALS HOME DELIVERED MEALS $530262 993
MATERIAL AID $1994536 199
County Total $5302331 2364
WAKULLA CASE MANAGEMENT $2175533 483
EMERGENCY HOME $1240200 689DELIVERED SHELF MEALS MATERIAL AID $1994536 199
County Total $5410269 1371
PSA Total $10712599 3735
05 PINELLAS ADULT DAY CARE $000 0
COUNSELING (MENTAL $000 0 HEALTH COUNSELINGSCREENING) - INDIVIDUAL
County Total $000 0
PSA Total $000 0
Report Total $10712599 3735
$900 $900 $900 $1000 $1000 $1000
$6600 $6600 $6600 $7700 $7700 $7700
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CID Service Units and Costs Projections County SummaryPSA 99
Program CCE County LEON
Start Date 01012017 End Date 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
Report Total
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CIE Service Units and Costs Projections - PSA Summary - All Programs
PSA 99 Program FEDERALLY FUNDED (0101 TO 1231) Year 2017 From 01012017 To 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
Program Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
Report Total
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CIE Service Units and Costs Projections - PSA Summary
PSA ALL Program CCE
Start Date 01012017 End Date 12312017
Avg High Low Total Total Avg High Low Provider Provider Provider
StateFederal Projected Reimbursement Reimbursement Reimbursement Cost Cost CostPSA
02
Service
CASE MANAGEMENT
Share
$4351066
Service Units
966
Unit Rate Unit Rate Unit Rate Per Unit Per Unit Per Unit
EMERGENCY HOME DELIVERED SHELF MEALS $1842200 1378
HOME DELIVERED MEALS $530262 993
MATERIAL AID $3989071 398
PSA Total $10712599 3735
05 ADULT DAY CARE $000 0 $900 $900 $900 $1000 $1000 $1000
COUNSELING (MENTAL HEALTH $000 0 $6600 $6600 $6600 $7700 $7700 $7700 COUNSELINGSCREENING) - INDIVIDUAL
PSA Total $000 0
Report Total $10712599 3735
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CAREGIVER SEARCH REPORT
SEARCH RESULTS FOR CONSUMERS
Criteria First Name Last Name SSN PSA ALL
Client Name Client SSN Caregiver Name Caregiver SSN
000000000 000000000 Test Name Test Name
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CARES Referrals in a Time Range PSA ALL
Start Date 01012017 End Date 12312017
Referred to ALL REFERRALS
Referring PSA Employee Name Client Name Client ID
Referral Imminent NH Admit Aging Date Risk Date Referred To Cares Provider Name Received Date
03A 4061561263 Test Name Test Name 09242017 Y 05292017 ARC or ADRC 09252017
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CARES Referrals in a Time Range PSA ALL
Start Date 01012017 End Date 12312017
Referred to ALL REFERRALS
Referring PSA Employee Name Client Name Client ID
Referral Date
Imminent Risk
NH Admit Date Referred To Cares Provider Name
Aging Received Date
04B Test Name Test Name 4061738075 04082017 N ARC or ADRC Test Name 04082017
Total Clients 110
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CARES Referrals not acknowledged by the Aging Network PSA ALL For Referrals after 01012017 Owner ID ALL Owners
Unduplicated Client count Cares Office Total Clients Count
Report Total
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
CIRTS Issue PSA Client ID Client Name Program
Program Status Start Provider Enrollment ID Provider Name
APCL CLIENT WITH DATE OF DEATH 08 4061759417 Test Name OA3B APCL 07232013 1141 WESTERN WORLD RADIO
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
Program Start Provider CIRTS Issue PSA Client ID Client Name Program Status Enrollment ID Provider Name
06 LTCC APCL 01242014 1514 4061713685 Test Name APCL CLIENT WITH DATE OF DEATH CENTRAL THE ORIGINAL HOUSE OF PIES
Count 503
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Civil Rights PSA ALL Provider ALL PROVIDERS Program AC Start Date 01012017 End Date 12312017 The Poverty Level for Single is The Poverty Level for Couple is Sort by County
County Unduplicated Count
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Client Information Report Start Date 01012017 End Date 12312017
Client ID 1001141246
Emergency
Client Name Test Name
Telephone () - Address 78 TEST STREET TALLAHASSEE FL 32399
Most Recent Caregiver Information Date Updated
Doctor
Comments
Client Demographic Information
Birth Date 06041940 Race W
Owner ID Ethnicity O
Most Recent Income Information
Ind Mon Inc Cpl Mon Inc
Ind Assets Couple Assets
Most Recent Assessment Information
Asmt Date Ref Risk Lvl
Asmt Site Spec Shel
AsmtType Spec Reg
Ref Date Primary CG
Ref Source Living Sit
Enrollment Information
Sex
Marital Status
F
S
Medicaid Number
ADL Score
ADL Count
IADL Score
IADL Count
Memory Score
Priority Score
Env Score
Nutr Score
Risk Score
Social Score
Rank
Provider Location Program Program Status Worker Start Date End Date
Care Plan Service Needed
Date Service Units Type Frq End Date
Care Plan Service Planned
Program Service Units Type Frq Start Date End Date
Services Received between 01012017 and 12312017
Service Billed Provider Location Worker Program Service Date Units Unit Type Amount
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Provider N
Client Service Units Report PSA ALL Provider ALL PROVIDERS Location 0000
Program ALL PROGRAMS Service ALL SERVICES Worker ALL WORKERS
City ALL CITIES Include Zero Unit N Include Aggregate N Calculated Amount equals the number of Units Provided times Fixed Cost if it existsService Start Date 01012017 Service End Date 12312017 If Fixed Cost does not exist Calculated
Group by PSA Provider Location Client Name County Worker Amount equals Billed Amount
Unduplicated Client Count 0 Grand Total 000 $000
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Clients In Common PSA All Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 County All Counties Worker All Workers
County JEFFERSON
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
MIAMI-DADE
0 0 0 0 0 0 0 0 0
4061539538 Test NameCounty Count
County
0 01
X
0 1
X
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
4061650856 Test Name X 4061486560 Test Name X 4062452921 Test Name X
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Clients Served Not Enrolled PSA ALL Start Date 01012017 End Date 12312017 Locations 0000 Provider All Providers
Service Service Min Serv Max Serv Program Start End Enrollment PSA Provider Location Program Consumer Name Client ID Service Date Date Status Enrollment Enrollment Provider
Count 0
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
4061472791 04
09
1092
1291
0072
0042
LTCC
LTCC
APCL
APCL
4062714543 06
06
1514
1762
0072
5006
LTCC
LTCC
APCL
APPL
4061802246 11
06
1177
1514
0179
0072
LTCC
LTCC
APCL
APCL
4061563719 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062644312 06
08
1514
1771
0072
0896
LTCC
LTCC
APCL
APCL
1001141670 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
1001141671 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
4062375003 07
05
05
07
1263
1755
1638
1263
0368
0072
0072
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062155124 06
06
1762
1514
0072
0072
LTCC
LTCC
APPL
APCL
4061743886 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0369
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4061499927 06
06
1514
1762
0072
5005
LTCC
LTCC
APCL
APPL
4061583524 08
06
1144
1514
0896
0072
LTCC
LTCC
APCL
APCL
4062694843 06
03
1514
1922
0072
0179
LTCC
LTCC
APCL
APCL
4062744517 07
06
1263
1514
0369
0072
LTCC
LTCC
APCL
APCL
4062005488 10
11
10
11
1929
1177
1164
1177
0072
0073
0179
0179
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
Total Count 15
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CODE DESCRIPTIONS Category ALL STATE TABLES
Code Description Active Available To Code Category
0 UNKNOWN Y CARES SUBJECTIVE_HEALTH_EVALUATION
01 ALACHUA Y COMMON COUNTIES
02 BAKER Y COMMON COUNTIES
03 BAY Y COMMON COUNTIES
04 BRADFORD Y COMMON COUNTIES
05 BREVARD Y COMMON COUNTIES
06 BROWARD Y COMMON COUNTIES
07 CALHOUN Y COMMON COUNTIES
08 CHARLOTTE Y COMMON COUNTIES
09 CITRUS Y COMMON COUNTIES
1 EXCELLENT Y CARES SUBJECTIVE_HEALTH_EVALUATION
10 CLAY Y COMMON COUNTIES
11 COLLIER Y COMMON COUNTIES
12 COLUMBIA Y COMMON COUNTIES
13 MIAMI-DADE Y COMMON COUNTIES
14 DESOTO Y COMMON COUNTIES
15 DIXIE Y COMMON COUNTIES
16 DUVAL Y COMMON COUNTIES
17 ESCAMBIA Y COMMON COUNTIES
18 FLAGLER Y COMMON COUNTIES
19 FRANKLIN Y COMMON COUNTIES
2 GOOD Y CARES SUBJECTIVE_HEALTH_EVALUATION
20 GADSDEN Y COMMON COUNTIES
21 GILCHRIST Y COMMON COUNTIES
22 GLADES Y COMMON COUNTIES
23 GULF Y COMMON COUNTIES
24 HAMILTON Y COMMON COUNTIES
25 HARDEE Y COMMON COUNTIES
26 HENDRY Y COMMON COUNTIES
27 HERNANDO Y COMMON COUNTIES
28 HIGHLANDS Y COMMON COUNTIES
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CONSUMER AGE VERIFICATION REPORT PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Program AC
Age at Start
Enroll or Start Enroll Provider Program Description Consumer Name Client ID DOB Svc date or Svc Date
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Contract Budget Information PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Program Service Provider Location County Served Provider Contract
Projected Service
Units Unit Measure
Projected Unduplicated
State Federal Share Client Count Begin Date End Date
Row Count 0 Amount Total
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Start Enroll Latest Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Date Asmt Date Worker
O3C1 1036 000 4061653427 Test CENTRAL 34982 W M 07091930 09102013 09102013 CIRTS20804 0 Name
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Start Enroll Date
Latest Asmt Date Worker
4061593624 Test Name CENTRAL 34946 B F 11261940 12012011 12312013 CIRTS23407
Count 164
Unduplicated Client Count 163
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Assessments After DOD Report
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Owner 1025
The shaded records indicate clients who have different DOBs andor different names
Assemt Current PSA Owner Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Owner Assessor
Provider Assessor
Assemt Date
Assemt Type
Unduplicated Count Total 0
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Open Enrollments
The Vital Statistics Data for 07192002 - 09112014PSA ALL Provider ALL Program Status ACTV Include MLTC ACTVS N
The shaded records indicate clients who have different DOBs andor different names
Enroll PSA
Enrollment Provider Loc Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Enroll Program Status
Enroll Program
Current Owner ID
02 1065 0072 4062244026 Test Name Test Name 10222004 03231917 03231917 ACTV CCE 1065
Count of enrollments for the Provider 1
Count of enrollments for the PSA 1
Count of enrollments for the Report 1
Unduplicated Count of Individuals with open enrollments and DOD PSA Total Clients Count
02 1
Total 1
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Unduplicated count of individuals with Services after DOD
PSA Total Clients Count
Report Total
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
List of Clients with PSA table entry for SERVICES_AFTER_DOD
Unduplicated Count Total 0
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Age
Provider
Total
Age lt 60 Age 60 - 64 Age 65 - 74 Age 75 - 84 Age 85+ Total Clients Avg Age
Total
Avg Age
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Ethnicity
Provider Hispanic Other Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Race
American Indian Native Hawaiian Other Provider Asian Alaska Native Black Pacific Islander Minority White Multiple Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Gender
Provider Male Female Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Monthly Income
Provider 0 - - Higher than Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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None
Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Total Persons Served 0
Age lt 60 Years 0 0
Age 60 - 64 0 0
Age 65 - 74 0 0
Age 75 - 84 0 0
Age 85+ 0 0
Total Age 0 0
Average 000
Ethnicity Hispanic 0 0
Other Ethnicity 0 0
Unknown Ethnicity 0 0
Total 0 0
Race Asian 0 0
American Indian Alaska Native 0 0
Black 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority 0 0
White 0 0
Multiple 0 0
Unknown 0 0
Total 0 0
Sex Male 0 0
Female 0 0
Unknown Sex 0 0
Total 0 0
Monthly Income 0 - 0 0
- 0 0
Higher than 0 0
Unknown 0 0
Total 0 0
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Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Client ID Date Of Birth Ethnicity Race Sex Individual Monthly Income
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Demographics of Clients OAA Registered Served Only PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 City All Cities Program All Programs Service All Services County ALL COUNTIES Table OAA Registered Services Only Low Income Medium Income
Total Persons Served 0
Agelt 60 Years
Age 60 - 64
Age 65 - 74
Age 75 - 84
Age 85+
0
0
0
0
0
0
0
0
0
0
Monthly Income
0 -
-Higher than
Unknown
0
0
0
0
0
0
0
0
Total
Average
0
000
0 Total 0 0
Ethnicity Hispanic
Other
Unknown
0
0
0
0
0
0
Living Situation
Alone
Null
Policy Change
0
0
0
0
0
0
Total 0 0 Unknown
With Caregiver
0
0
0
0
Race Asian 0 0
With Other
With Other Caregiver
0
0
0
0
American Indian Alaska Native
Black
0
0
0
0Total Living Situation 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority
White
0
0
0
0 Limited English Proficiency
Multiple
Unknown
Total Race
0
0
0
0
0
0
Yes
No
Unknown
0
0
0
0
0
0
Total 0 0
Sex Male
Female
Unknown
0
0
0
0
0
0
Total 0 0
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Disaster Assistance Clients for a Provider PSA ALL Provider All Providers Location 0000 Worker All Workers City All Cities Zip Code All Zip Codes Sort By ZIP
Provider 1036 Provider Name Location 0000 Worker CIRTS18634
Need Care Client Name Address City Zip County Phone Asst Reg Situation Relat Care phone Care Name
34946 N WO DA 000 SAINT JAMES DRIVE CENTRAL (025) 101-0620 Test NameTest Name SAINT LUCIE (005) 100-0369 Y
Client is active and no assessment information is available Special Shelter and Special Registry are unknown
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
Total by PSA 0
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
ALACH BAKER BAY BRADF BREVA BROWA CALHO CHARL CITRUS CLAY COLLIE COLUM DESOT DIXIE DUVAL ESCAM FLAGL FRANK GADSDAssisted Household Report UA ORD RD RD UN OTTE R BIA O BIA ER LIN EN
1 of Household Assisted 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Households AssistedWith Gross Income
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C 100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D 125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
3 Households with at leastOne member
A 60 Years or older 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B Disabled 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C Age 5 years or under 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D Under 60 Years Old 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Undup Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Assisted
Applicant Household Report
of Applicant Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Energy Assisted Household Report
County of Assisted
Households
Households Assisted By Poverty Level
Under 75 75 - 100 101 - 125 126 - 150 Over 150 60 Years or older
At least one member who is
Age 5 years Age 2 years Age 3 years Disabled or younger and younger through 5
Under 60 Years Old
Undup Households
Assisted
Energy Assistance Total
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Unduplicated Total 0 0
County of Assisted
Households Under 75 75 - 100
Households Assisted By Poverty Level
101 - 125 126 - 150 Over 150 60 Years or older Disabled
Age 5 years or younger
Age 2 years and younger
Age 3 years through 5
Under 60 Years Old
At least one member who is
Undup Households
Assisted
Other Assisted Household Report
Other Assistance Total
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Applicant Household Report
County of Applicant
Households Under 75 75 - 100 101 - 125 126 - 150 Over 150 Income data
unavailable
Total 0
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01
Enrollment Active Consumer Count by Program PSA ALL Provider ALL PROVIDERS
County Description Program Count of Clients
BREVARD
ADI
CCE
HCE
LSP
NDP
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
MLTC
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
31
57
44
5
62
123
141
26
9
7
5
40
5
50
67
129
2
19
42
29
1
233
79
63
8
2
14
3
37
14
47
3
3
33
127
10
02
03
04
ALACHUA
BAKER
BAY
BRADFORD
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Enrollment Terminations with Reasons PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 Program All Programs Program Status ALL Program Status Worker ALL WORKERS
Last First Program Medicaid Provider Start End Name Name Client ID Status Description Worker Number Program Location Enrollment Enrollment
Count 0
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Enrollments with Care Plan Report
PSA ALL Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTIVE STATUS Care Plan Service ALL SERVICES Care Plan Start 01012017 Care Plan End 12312017
Care Plan Care Plan Care Plan Client Name
Unduplicated Client Count 0
Client ID Program Status Worker Start Date End Date Service
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PSA CLIENT_ID CLIENT_NAME OWNER PROVIDER_ID ASSESSMENT_DATE ASSESSOR_NAME MEDICAID_NUMBER CAREGIVER_CHANGE ENVIRONMENT_CHANGE HEALTH_CHANGE INCOME_CHANGE SITUATION_CHANGE INITIAL_ASSM ANNUAL_ASSM SSN REFERRAL_SOURCE 1114 N N N N Y N 771771777 SELFFAMILY 812017 JANE CASEWORKER 2 1001141633 TEST TEST N
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Fixed Service Costs List PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Provider Location County Program Service Reimbursement Unit Rate Provider Cost Per Unit Begin Valid End Valid
Count 0
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701S with no Enrollments PSA ALL
Owner All Owners
Assessment Dates between 01012017 12312017
Priority Referral ADL ADL IADL IADL Nutr PSA Client ID Client Name Owner Asmt Date Assessor Name Score Rank Source Count Score Count Score Score
03 4062182441 Test Name 1149 12282017 46 6 16 5 20 9
1001141832
Test AssessorAND FAMILIES
5 OTHER
Count 43
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Active Clients Careplan PSA ALL Provider ALL PROVIDERS Location 0000 Worker SSN All SSNs
Services Needed Services Planned
RecommendedClient ID Client Name Service Date End Date Frequency Program Frequency
4061653427 Test Name CNML 09102013 O3C1
Begin Date End Date
09102013 5 MEL PER WK 5 MEL PER WK
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Active Clients with Contact Information PSA ALL Program AC County All Counties Worker All Workers Zip Code All Zip Codes Provider All Providers Location 0000 Order by Zip Client_Name
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Active AC Consumers Receiving an APS Referral PSA ALL Owner All Owners Risk Level H Program AC Referral Start Date 01012017 Referral End Date 12312017
Start Enroll Risk Referral PSA Client ID Client Name Owner ID Date Prog Provider Workers Level Date
Total Count 0
Total Clients 0
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Active MLTC Clients Who are ACTV APCL or APPL in Another Program
PSA ALL Provider ALL
Program Status ACTV
Include NDP Y
Active MLTC Clients Information
PSA Owner ID Client ID Client Name
02 4061692109 Test NamePSA Count 1
Total Count 1
Unduplicated Client Count 1
MLTC Start Enrollment Date
11012013
Worker
CIRTS15124
Provider
1065
Other Programs Information
Location Program Program Status
0043 O3C1 ACTV
Start Enrollment Date
04042014
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Active or APCL Clients with Caregiver Information PSA ALL Provider ALL PROVIDERS Program AC Program Status ACTV Sort by PROVIDER
Provider Location Program
Program Status Worker Clinet ID Client Name
Most recent Asmt Date Asmt Priority with CaregiverType Score
Risk Score Caregiver Name
HCE Relationship Indicator
1380 0181AC ACTV CIRTS16813 4062414494 Test Name 04232014 701A 40 Test OR N
Count 1
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Active PACE Clients Who are ACTV APCL or APPL in Another Program PSA ALL
Provider ALL
-------- Active PACE Clients Information -------- ------ Other Programs Information ----
PSA Owner ID Client ID Client Name Provider Location Program Program Status
Total Count 0
Unduplicated Client Count 0
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ACTV CCE HCE and ADI Clients with No Care Plan PSA ALL
Program ALL PROGRAMS Provider ALL PROVIDERS
Owner All Owners
Enrollment Information PSA Client ID Name Owner Provider Loc Program Start Date Worker
01 4062521310 Test Name 1911 1911 0932 CCE 03272014 CIRTS29059
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ACTV CCE HCE and ADI Clients with No Care Plan PSA ALL
Program ALL PROGRAMS Provider ALL PROVIDERS
Owner All Owners
PSA Client ID Name Owner Enrollment Information
Provider Loc Program Start Date Worker
4061605936 Test Name 1785 1927 0072 ADI 07202006 CIRTS26739
11
Duplicated Count 72 Unduplicated Counts 70
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ACTV APPL APCL Clients who have moved to another PSA PSA ALL
Provider ALL PROVIDERS
Address Enrollment Client ID Client Name Provider Loc Program Program Start PSA PSA Status Enrollment
01A 02 4062760605 1191 0072 CCE ACTV 11082011 Test Name
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Aging Network Provider Information Report PSA ALL
Address PSA Provider Loc Provider Name Type Provider Address Telephone
01 1147 B
1147
0072 Provider Name
0073 Provider Name B
1147
1147
0100 Provider Name
0179 Provider Name B
1271 B
1271 B
1271
0000 Provider Name
0001 Provider Name
0002 Provider Name B
1271 B
1271
0003 Provider Name
0004 Provider Name B
1271 B
1271
0072 Provider Name
0073 Provider Name B
1271 0100 Provider Name B
1271 B
1271 B
1271 B
1271 B
1271
0101 Provider Name
0138 Provider Name
0179 Provider Name
0286 Provider Name
0287 Provider Name B
123 Provider CALICO DRIVE STAYTON FL 59255
123 Provider TERRA COTTA STREET DARRINGTON
FL 57399
123 Provider LANGTOWN ROAD DARRINGTON FL 57399
123 Provider POINTE LANE Bonum integritas corporis misDARRINGTON FL 58398
123 Provider OAK DRIVE SUNNYVALE MO 83407
123 Provider HOTT STREET DARRINGTON FL 58398
123 Provider GRASSELLI STREET DARRINGTON FL 68396
123 Provider HEAVENS WAY MORRISONS CROSSROADS AL 33165
123 Provider GOOSETOWN DRIVE MIDVILLE
FL 93176
123 Provider PIKE STREET BELLOWS FALLS
FL 48405
123 Provider GLENVIEW DRIVE SUSSEX FL
123 Provider JONES AVENUE BLYTHEVILLE
FL 14027
123 Provider HENERY STREET SUSSEX FL
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Aging Network Provider Information Report PSA ALL
PSA Provider Loc Provider Name Address Type Provider Address Telephone
11 1952 B
1952 B
1952 B
1952 B
1952 B
1952 B
1952 B
123 Test Street ELLSINORE FL 38234 3789 WHITE
123 Test Street OHATCHEE FL 45235 3408 NORMA
123 Test Street WHITE CLOUD FL 46226
123 Test Street NEOSHO FL 06231
123 Test Street WHITE CLOUD FL 16168 3678 OLD
123 Test StreetWHITE CLOUD FL 06231 184 GRANT
123 Test Street WHITE CLOUD FL 93236
1952
1955
1956
B 3123 Test Street Quid censes in Latino fore IaWHITE CLOUD FL 70226
1957
0Provider Name
0Provider Name
0Provider Name
0Provider Name
0Provider Name
0Provider Name
0Provider Name
0Provider Name
0Provider Name
0Provider Name
0Provider Name B 123 Test Street Sed ad rem redeamus ComprehenWHITE CLOUD FL 38227
1957
1958
Count
0474 Provider Name
0072 Provider Name
427
B 123 Test Street BRANCH ROAD Quid ergo hoc loco intellegit WHITE CLOUD FL 25224
Count Total 3117
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Aging Network Providers Report PSA ALL
PSA 01
Provider 1271 Provider Name Provider Name
Location 0000 Location Name Provider Name
Location Business Address 3123 Test Drive DARRINGTON FL 58398
County Served OKALOOSA Phone Fax Location Contact
Provider Director Provider Profit Status Non-Profit
ACCESS_PT CCE_LA N HCE OAA OTHER
ADI EHEAP LSP RELF
CCE Y FOCAL_PT NSIP SR_CTR
Provider 1271 Provider Name Provider Name
Location 0001 Location Name Provider Name
Location Business Address 1234 Test OAK DRIVE SUNNYVALE MO 83407
Phone Fax Location Contact County Served OKALOOSA
Provider Director Provider Profit Status Non-Profit
ACCESS_PT CCE_LA N HCE OAA OTHER
ADI EHEAP LSP RELF
CCE Y FOCAL_PT NSIP SR_CTR
Provider 1271 Provider Name Provider Name
Location 0004 Location Name Provider Name
Location Business Address 1123 Test HEAVENS WAY MORRISONS CROSSROADS AL
33165 Phone County Served OKALOOSA Fax Location Contact
Provider Director Provider Profit Status Non-Profit
ACCESS_PT CCE_LA N HCE Y OAA OTHER
ADI EHEAP LSP RELF
CCE FOCAL_PT NSIP SR_CTR
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Start End Worker Most Recent Nutr Medicaid Program Provider Location Client ID Client Name Status Enrollment Enrollment Worker Active Score Number
O3C1 1036 0000 4061653427 Test Name ACTV 09102013 CIRTS20804 Y 1
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Start End Worker Most Recent Nutr Medicaid Program Provider Location Client ID Client Name Status Enrollment Enrollment Worker Active Score Number
O3C1 1036 0000 4061638016 Test Name ACTV 09122013 CIRTS20804 Y 2
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Start End Worker Most Recent Nutr Medicaid Program Provider Location Client ID Client Name Status Enrollment Enrollment Worker Active Score Number
O3C2 1036 0000 4062000152 Test Name ACTV 02072011 CIRTS23407 N 3
1036 0000 4061594062 ISAACS HATTIE ACTV 11192012 CIRTS20804 Y 5
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Start End Worker Most Recent Nutr Medicaid Program Provider Location Client ID Client Name Status Enrollment Enrollment Worker Active Score Number
O3C2 1036 0000 4062379505 Test Name ACTV 11192012 CIRTS20804 Y 5
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Start End Worker Most Recent Nutr Medicaid Program Provider Location Client ID Client Name Status Enrollment Enrollment Worker Active Score Number
O3C2 1036 0000 4062401063 Test Name ACTV 10162013 CIRTS20804 Y 3
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Provider Location Client ID Client Name Program Status
Start Enrollment
End Enrollment Worker
Worker Active
Most Recent Nutr Score
Medicaid Number
O3C2 1036 0000 4062538939 ACTV 12082000 CIRTS20388 Y Test Name
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All Enrollments Counts During Date Range PSA ALL Start Date 01012017 End Date Location 0000 Provider Program Program Status
12312017 ALL PROVIDERS
ACTV
Group By Program Provider Location
Program Provider Location Client Count O3C1 1036 0000 45
1951 0000 3
O3C2 1036 0000 113
OA3E 1821 0000 2
OA3ES 1821 0000 1
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C1 1036 0000 4061950299 Test Name ACTV 04072011 CIRTS23407 N 11
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C1 1036 4062586019 Test Name ACTV 12292008 CIRTS23407 N 1
Total for Location 45
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C1 1951 0000 4062452921 Test Name ACTV 03301989 CIRTS22695 N 10
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4062786256 Test Name ACTV 09232013 CIRTS20804 Y 4 1
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4062380426 Test Name ACTV 04112012 CIRTS23407 N 55 2
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4061608826 Test Name ACTV 08102011 CIRTS18634 Y 7 3
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4062615533 Test Name ACTV 10032013 CIRTS20804 Y 6 3
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start Enrollment
End Enrollment Worker
Worker Active
Medicaid Number
Most Recent Nutr Score Rank
O3C2 1036 4062466582 Test Name ACTV 10262010 CIRTS23407 N 105 2
Total for Location 113
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PSA
APCL Clients With No Services ALL Owner All Owners Provider ALL PROVIDERS
Start Date 01012017 End Date 12312017
Includes Clients Receiving Only CM INSC SCAS CA REFE Services
PSA Client ID Client Name Owner Provider Program
Count 0
Unduplicated Clients Count 0
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APCL Clients With Services PSA ALL Owner All Owners Provider ALL PROVIDERS Start Date 01012017 End Date 12312017
Exclude CM CA INSC REFE SCAS
PSA Client ID Name Owner Provider Program 10 4062527553 Test Name 1539 1929 CCE
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APCL Clients With Services PSA ALL Owner All Owners Provider ALL PROVIDERS Start Date 01012017 End Date 12312017
Exclude CM CA INSC REFE SCAS
PSA Client ID Name Owner Provider Program 11 4062732638 Test Name 1177 1177 LTCC
Total 21067
Unduplicated clients count 12460
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APS Assessments PSA ALL Risk Level ALL Owner All Owners Referral Date From 01012017 To 12312017
Order by Referral Date and Owner ID
PSA 03
Ref Date Owner ID Client ID Client Name Risk Level Asmt Type Asmt Date
03032017 1390 4062058415 L 701A 03302018 Test Name
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APS Assessments PSA ALL Risk Level ALL Owner All Owners Referral Date From 01012017 To 12312017
Order by Referral Date and Owner ID
12042017 1980 4061617559 H 701B 12072017 Test Name
Assessment Count for the PSA 52
PSA 04A
Ref Date Owner ID Client ID
09102017 4062308458
Client Name
Test Name
Risk Level
H
Asmt Type
O
Asmt Date
09162017
Assessment Count for the PSA 2
Risk Level H
M
L
Count of Assessments 138
23
21
Total Count of Assessments 182
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APS Repeat Referrals in a Time Range
PSA ALL Owner All Owners
Start Date 01012017 End Date 12312017
Current DOEA CIRTS Cirts SSN if Risk Date Created PSA Owner Abuse No different than DCF DCF SSN Name County Level Date of Birth Date Sent by DCF
Count 0
Unduplicated Client Count by PSA
PSA Count SSN
Total
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Assessed Prioritized Consumer List PSA ALL Provider ALL PROVIDERS Program AC County ALL COUNTIES
County Program Consumer Name Client ID
Total Count 0
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Assessment Due Report PSA 01 Start Date 01012017 End Date 08312018 Owner ALL PROVIDERS Worker ALL WORKERS Program Status ACTV and APCL Assessment Type Needed ALL
Overdue and missing assessments are always listed
Owner ID 1065
Client ID Client Name
Owner Assessor ID
Date of Birth
06281928
CIRTS28099
County of Service
GULF
Worker Name HARPER KENNY
Zip Assessment PSA Date
32534 01 01022014
Type
701A
Active Y
Nutr PriorityScore Score
11 58
Rank
5
Due Date
01022015
Status
701S OVERDUE
LTCC APPL Start Date
03252014 4062235673 Test name
Total Clients for Worker 1
Total Clients for Owner 1
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Assessment Due Report PSA 01 Start Date 01012017 End Date 08312018 Owner ALL PROVIDERS Worker ALL WORKERS Program Status ACTV and APCL Assessment Type Needed ALL
Overdue and missing assessments are always listed
Summary by PSA
PSA 01 701A Overdue 1
701B Overdue 213
701C Overdue 0
701S Overdue 157
No 701A 0
No 701B 2
No 701C 0
No 701S 0
701A Not Overdue 0
701B Not Overdue 0
701C Not Overdue 0
701S Not Overdue 0
701S Optional 0
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CIC Service Units and Costs Projections County SummaryPSA 99 Program CCE
Start Date 01012017 End Date 12312017
County LEON
Total Total Total Avg Max Projected
StateFederal Projected Reimbursement Provider Unduplicated Provider Service Share Service Units Unit Rate Cost Per Unit Client Count
Report Total
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CIC Service Units and Costs Projections Provider SummaryPSA ALL Provider ALL PROVIDERS Program FEDERALLY FUNDED (0101 TO 1231) Year 2017 From 01012017 To 12312017
PSA County Program Service Total State
Federal Share
Total Projected
Service Units
Avg Reimbursement
Unit Rate
Max Provider
Cost Per Unit
Total Projected Unduplicated Client Count
02 FRANKLIN O3C1 CONGREGATE MEALS $810300 1710 15
Program Total
County Total
$810300
$810300
GULF O3C1 CONGREGATE MEALS $25205 3 5
Program Total $25205
O3C2 HOME DELIVERED MEALS $25205 3 6
Program Total
County Total
$25205
$50411
LEON O3C1 CONGREGATE MEALS $621300 1311 15
CONGREGATE MEALS GUEST
CONGREGATE MEALS VOLUNTEERS
$252055
$277260
25
30
2
5
Program Total $1150615
O3C2 HOME DELIVERED MEAL GUEST $252055 25 3
Program Total $252055
OA3D PEARLS (SESSION 5)
PEARLS (SESSION 6)
PEARLS (SESSION 7)
PEARLS (SESSION 8)
$10247
$10247
$10247
$10247
10
10
10
10
3
3
3
3
Program Total $40988
OA3E RESPITE IN-HOME $200 2 2
Program Total
County Total
$200
$1443858
WAKULLA O3C2 EMERGENCY HOME DELIVERED SHELF MEALS
$8065604 14899 90
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CIC Service Units and Costs Projections - PSA Summary
PSA ALL Program CCE
Strat Date 01012017 End Date 12312017
Total
PSA County Provider Service
Total State Federal
Share
Total Projected
Service Units
Avg Reimbursement
Unit Rate
Max Projected Provider Unduplicated
Cost Per Unit Client Count
02 LEON SOUTHERN SERVICE CASE MANAGEMENT PROVIDER EMERGENCY HOME DELIVERED SHELF MEALS
$2175533
$602000
483
689
32
20
HOME DELIVERED MEALS $530262 993 5
MATERIAL AID $1994536 199
Provider Total $5302331
CountyTotal $5302331
WAKULLA SOUTHERN SERVICE CASE MANAGEMENT PROVIDER EMERGENCY HOME DELIVERED SHELF MEALS
$2175533
$1240200
483
689
32
5
MATERIAL AID $1994536 199
Provider Total $5410269
CountyTotal $5410269
PSA Total $10712599
05 PINELLAS BURSTEIN-APPLEBEE ADULT DAY CARE $000 0 $900 $1000 0
COUNSELING (MENTAL HEALTH COUNSELINGSCREENING) - INDIVIDUAL
Provider Total
$000
$000
0 $6600 $7700 0
CountyTotal $000
PSA Total $000
Report Total $10712599
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CID Service Units and Costs Projections - PSA SummaryPSA ALL Program CCE
Start Date 01012017 End Date 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
PSA County Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
02 LEON CASE MANAGEMENT $2175533 483
EMERGENCY HOME $602000 689DELIVERED SHELF MEALS HOME DELIVERED MEALS $530262 993
MATERIAL AID $1994536 199
County Total $5302331 2364
WAKULLA CASE MANAGEMENT $2175533 483
EMERGENCY HOME $1240200 689DELIVERED SHELF MEALS MATERIAL AID $1994536 199
County Total $5410269 1371
PSA Total $10712599 3735
05 PINELLAS ADULT DAY CARE $000 0
COUNSELING (MENTAL $000 0 HEALTH COUNSELINGSCREENING) - INDIVIDUAL
County Total $000 0
PSA Total $000 0
Report Total $10712599 3735
$900 $900 $900 $1000 $1000 $1000
$6600 $6600 $6600 $7700 $7700 $7700
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CID Service Units and Costs Projections County SummaryPSA 99
Program CCE County LEON
Start Date 01012017 End Date 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
Report Total
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CIE Service Units and Costs Projections - PSA Summary - All Programs
PSA 99 Program FEDERALLY FUNDED (0101 TO 1231) Year 2017 From 01012017 To 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
Program Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
Report Total
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CIE Service Units and Costs Projections - PSA Summary
PSA ALL Program CCE
Start Date 01012017 End Date 12312017
Avg High Low Total Total Avg High Low Provider Provider Provider
StateFederal Projected Reimbursement Reimbursement Reimbursement Cost Cost CostPSA
02
Service
CASE MANAGEMENT
Share
$4351066
Service Units
966
Unit Rate Unit Rate Unit Rate Per Unit Per Unit Per Unit
EMERGENCY HOME DELIVERED SHELF MEALS $1842200 1378
HOME DELIVERED MEALS $530262 993
MATERIAL AID $3989071 398
PSA Total $10712599 3735
05 ADULT DAY CARE $000 0 $900 $900 $900 $1000 $1000 $1000
COUNSELING (MENTAL HEALTH $000 0 $6600 $6600 $6600 $7700 $7700 $7700 COUNSELINGSCREENING) - INDIVIDUAL
PSA Total $000 0
Report Total $10712599 3735
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CAREGIVER SEARCH REPORT
SEARCH RESULTS FOR CONSUMERS
Criteria First Name Last Name SSN PSA ALL
Client Name Client SSN Caregiver Name Caregiver SSN
000000000 000000000 Test Name Test Name
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CARES Referrals in a Time Range PSA ALL
Start Date 01012017 End Date 12312017
Referred to ALL REFERRALS
Referring PSA Employee Name Client Name Client ID
Referral Imminent NH Admit Aging Date Risk Date Referred To Cares Provider Name Received Date
03A 4061561263 Test Name Test Name 09242017 Y 05292017 ARC or ADRC 09252017
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CARES Referrals in a Time Range PSA ALL
Start Date 01012017 End Date 12312017
Referred to ALL REFERRALS
Referring PSA Employee Name Client Name Client ID
Referral Date
Imminent Risk
NH Admit Date Referred To Cares Provider Name
Aging Received Date
04B Test Name Test Name 4061738075 04082017 N ARC or ADRC Test Name 04082017
Total Clients 110
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CARES Referrals not acknowledged by the Aging Network PSA ALL For Referrals after 01012017 Owner ID ALL Owners
Unduplicated Client count Cares Office Total Clients Count
Report Total
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
CIRTS Issue PSA Client ID Client Name Program
Program Status Start Provider Enrollment ID Provider Name
APCL CLIENT WITH DATE OF DEATH 08 4061759417 Test Name OA3B APCL 07232013 1141 WESTERN WORLD RADIO
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
Program Start Provider CIRTS Issue PSA Client ID Client Name Program Status Enrollment ID Provider Name
06 LTCC APCL 01242014 1514 4061713685 Test Name APCL CLIENT WITH DATE OF DEATH CENTRAL THE ORIGINAL HOUSE OF PIES
Count 503
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Civil Rights PSA ALL Provider ALL PROVIDERS Program AC Start Date 01012017 End Date 12312017 The Poverty Level for Single is The Poverty Level for Couple is Sort by County
County Unduplicated Count
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Client Information Report Start Date 01012017 End Date 12312017
Client ID 1001141246
Emergency
Client Name Test Name
Telephone () - Address 78 TEST STREET TALLAHASSEE FL 32399
Most Recent Caregiver Information Date Updated
Doctor
Comments
Client Demographic Information
Birth Date 06041940 Race W
Owner ID Ethnicity O
Most Recent Income Information
Ind Mon Inc Cpl Mon Inc
Ind Assets Couple Assets
Most Recent Assessment Information
Asmt Date Ref Risk Lvl
Asmt Site Spec Shel
AsmtType Spec Reg
Ref Date Primary CG
Ref Source Living Sit
Enrollment Information
Sex
Marital Status
F
S
Medicaid Number
ADL Score
ADL Count
IADL Score
IADL Count
Memory Score
Priority Score
Env Score
Nutr Score
Risk Score
Social Score
Rank
Provider Location Program Program Status Worker Start Date End Date
Care Plan Service Needed
Date Service Units Type Frq End Date
Care Plan Service Planned
Program Service Units Type Frq Start Date End Date
Services Received between 01012017 and 12312017
Service Billed Provider Location Worker Program Service Date Units Unit Type Amount
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Provider N
Client Service Units Report PSA ALL Provider ALL PROVIDERS Location 0000
Program ALL PROGRAMS Service ALL SERVICES Worker ALL WORKERS
City ALL CITIES Include Zero Unit N Include Aggregate N Calculated Amount equals the number of Units Provided times Fixed Cost if it existsService Start Date 01012017 Service End Date 12312017 If Fixed Cost does not exist Calculated
Group by PSA Provider Location Client Name County Worker Amount equals Billed Amount
Unduplicated Client Count 0 Grand Total 000 $000
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Clients In Common PSA All Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 County All Counties Worker All Workers
County JEFFERSON
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
MIAMI-DADE
0 0 0 0 0 0 0 0 0
4061539538 Test NameCounty Count
County
0 01
X
0 1
X
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
4061650856 Test Name X 4061486560 Test Name X 4062452921 Test Name X
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Clients Served Not Enrolled PSA ALL Start Date 01012017 End Date 12312017 Locations 0000 Provider All Providers
Service Service Min Serv Max Serv Program Start End Enrollment PSA Provider Location Program Consumer Name Client ID Service Date Date Status Enrollment Enrollment Provider
Count 0
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
4061472791 04
09
1092
1291
0072
0042
LTCC
LTCC
APCL
APCL
4062714543 06
06
1514
1762
0072
5006
LTCC
LTCC
APCL
APPL
4061802246 11
06
1177
1514
0179
0072
LTCC
LTCC
APCL
APCL
4061563719 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062644312 06
08
1514
1771
0072
0896
LTCC
LTCC
APCL
APCL
1001141670 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
1001141671 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
4062375003 07
05
05
07
1263
1755
1638
1263
0368
0072
0072
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062155124 06
06
1762
1514
0072
0072
LTCC
LTCC
APPL
APCL
4061743886 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0369
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4061499927 06
06
1514
1762
0072
5005
LTCC
LTCC
APCL
APPL
4061583524 08
06
1144
1514
0896
0072
LTCC
LTCC
APCL
APCL
4062694843 06
03
1514
1922
0072
0179
LTCC
LTCC
APCL
APCL
4062744517 07
06
1263
1514
0369
0072
LTCC
LTCC
APCL
APCL
4062005488 10
11
10
11
1929
1177
1164
1177
0072
0073
0179
0179
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
Total Count 15
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CODE DESCRIPTIONS Category ALL STATE TABLES
Code Description Active Available To Code Category
0 UNKNOWN Y CARES SUBJECTIVE_HEALTH_EVALUATION
01 ALACHUA Y COMMON COUNTIES
02 BAKER Y COMMON COUNTIES
03 BAY Y COMMON COUNTIES
04 BRADFORD Y COMMON COUNTIES
05 BREVARD Y COMMON COUNTIES
06 BROWARD Y COMMON COUNTIES
07 CALHOUN Y COMMON COUNTIES
08 CHARLOTTE Y COMMON COUNTIES
09 CITRUS Y COMMON COUNTIES
1 EXCELLENT Y CARES SUBJECTIVE_HEALTH_EVALUATION
10 CLAY Y COMMON COUNTIES
11 COLLIER Y COMMON COUNTIES
12 COLUMBIA Y COMMON COUNTIES
13 MIAMI-DADE Y COMMON COUNTIES
14 DESOTO Y COMMON COUNTIES
15 DIXIE Y COMMON COUNTIES
16 DUVAL Y COMMON COUNTIES
17 ESCAMBIA Y COMMON COUNTIES
18 FLAGLER Y COMMON COUNTIES
19 FRANKLIN Y COMMON COUNTIES
2 GOOD Y CARES SUBJECTIVE_HEALTH_EVALUATION
20 GADSDEN Y COMMON COUNTIES
21 GILCHRIST Y COMMON COUNTIES
22 GLADES Y COMMON COUNTIES
23 GULF Y COMMON COUNTIES
24 HAMILTON Y COMMON COUNTIES
25 HARDEE Y COMMON COUNTIES
26 HENDRY Y COMMON COUNTIES
27 HERNANDO Y COMMON COUNTIES
28 HIGHLANDS Y COMMON COUNTIES
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CONSUMER AGE VERIFICATION REPORT PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Program AC
Age at Start
Enroll or Start Enroll Provider Program Description Consumer Name Client ID DOB Svc date or Svc Date
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Contract Budget Information PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Program Service Provider Location County Served Provider Contract
Projected Service
Units Unit Measure
Projected Unduplicated
State Federal Share Client Count Begin Date End Date
Row Count 0 Amount Total
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Start Enroll Latest Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Date Asmt Date Worker
O3C1 1036 000 4061653427 Test CENTRAL 34982 W M 07091930 09102013 09102013 CIRTS20804 0 Name
Report run on 08312018 1133 AM Page 1 of 6 actv_by_progrdf
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Start Enroll Date
Latest Asmt Date Worker
4061593624 Test Name CENTRAL 34946 B F 11261940 12012011 12312013 CIRTS23407
Count 164
Unduplicated Client Count 163
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Assessments After DOD Report
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Owner 1025
The shaded records indicate clients who have different DOBs andor different names
Assemt Current PSA Owner Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Owner Assessor
Provider Assessor
Assemt Date
Assemt Type
Unduplicated Count Total 0
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Open Enrollments
The Vital Statistics Data for 07192002 - 09112014PSA ALL Provider ALL Program Status ACTV Include MLTC ACTVS N
The shaded records indicate clients who have different DOBs andor different names
Enroll PSA
Enrollment Provider Loc Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Enroll Program Status
Enroll Program
Current Owner ID
02 1065 0072 4062244026 Test Name Test Name 10222004 03231917 03231917 ACTV CCE 1065
Count of enrollments for the Provider 1
Count of enrollments for the PSA 1
Count of enrollments for the Report 1
Unduplicated Count of Individuals with open enrollments and DOD PSA Total Clients Count
02 1
Total 1
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Unduplicated count of individuals with Services after DOD
PSA Total Clients Count
Report Total
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
List of Clients with PSA table entry for SERVICES_AFTER_DOD
Unduplicated Count Total 0
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Age
Provider
Total
Age lt 60 Age 60 - 64 Age 65 - 74 Age 75 - 84 Age 85+ Total Clients Avg Age
Total
Avg Age
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Ethnicity
Provider Hispanic Other Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Race
American Indian Native Hawaiian Other Provider Asian Alaska Native Black Pacific Islander Minority White Multiple Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Gender
Provider Male Female Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Monthly Income
Provider 0 - - Higher than Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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None
Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Total Persons Served 0
Age lt 60 Years 0 0
Age 60 - 64 0 0
Age 65 - 74 0 0
Age 75 - 84 0 0
Age 85+ 0 0
Total Age 0 0
Average 000
Ethnicity Hispanic 0 0
Other Ethnicity 0 0
Unknown Ethnicity 0 0
Total 0 0
Race Asian 0 0
American Indian Alaska Native 0 0
Black 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority 0 0
White 0 0
Multiple 0 0
Unknown 0 0
Total 0 0
Sex Male 0 0
Female 0 0
Unknown Sex 0 0
Total 0 0
Monthly Income 0 - 0 0
- 0 0
Higher than 0 0
Unknown 0 0
Total 0 0
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Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Client ID Date Of Birth Ethnicity Race Sex Individual Monthly Income
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Demographics of Clients OAA Registered Served Only PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 City All Cities Program All Programs Service All Services County ALL COUNTIES Table OAA Registered Services Only Low Income Medium Income
Total Persons Served 0
Agelt 60 Years
Age 60 - 64
Age 65 - 74
Age 75 - 84
Age 85+
0
0
0
0
0
0
0
0
0
0
Monthly Income
0 -
-Higher than
Unknown
0
0
0
0
0
0
0
0
Total
Average
0
000
0 Total 0 0
Ethnicity Hispanic
Other
Unknown
0
0
0
0
0
0
Living Situation
Alone
Null
Policy Change
0
0
0
0
0
0
Total 0 0 Unknown
With Caregiver
0
0
0
0
Race Asian 0 0
With Other
With Other Caregiver
0
0
0
0
American Indian Alaska Native
Black
0
0
0
0Total Living Situation 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority
White
0
0
0
0 Limited English Proficiency
Multiple
Unknown
Total Race
0
0
0
0
0
0
Yes
No
Unknown
0
0
0
0
0
0
Total 0 0
Sex Male
Female
Unknown
0
0
0
0
0
0
Total 0 0
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Disaster Assistance Clients for a Provider PSA ALL Provider All Providers Location 0000 Worker All Workers City All Cities Zip Code All Zip Codes Sort By ZIP
Provider 1036 Provider Name Location 0000 Worker CIRTS18634
Need Care Client Name Address City Zip County Phone Asst Reg Situation Relat Care phone Care Name
34946 N WO DA 000 SAINT JAMES DRIVE CENTRAL (025) 101-0620 Test NameTest Name SAINT LUCIE (005) 100-0369 Y
Client is active and no assessment information is available Special Shelter and Special Registry are unknown
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
Total by PSA 0
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
ALACH BAKER BAY BRADF BREVA BROWA CALHO CHARL CITRUS CLAY COLLIE COLUM DESOT DIXIE DUVAL ESCAM FLAGL FRANK GADSDAssisted Household Report UA ORD RD RD UN OTTE R BIA O BIA ER LIN EN
1 of Household Assisted 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Households AssistedWith Gross Income
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C 100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D 125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
3 Households with at leastOne member
A 60 Years or older 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B Disabled 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C Age 5 years or under 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D Under 60 Years Old 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Undup Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Assisted
Applicant Household Report
of Applicant Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
Report run on 08312018 1111 AM Page 2 of 5 eheap_exceptionsrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Energy Assisted Household Report
County of Assisted
Households
Households Assisted By Poverty Level
Under 75 75 - 100 101 - 125 126 - 150 Over 150 60 Years or older
At least one member who is
Age 5 years Age 2 years Age 3 years Disabled or younger and younger through 5
Under 60 Years Old
Undup Households
Assisted
Energy Assistance Total
Report run on 08312018 1107 AM Page 1 of 3 eheap_summaryrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Unduplicated Total 0 0
County of Assisted
Households Under 75 75 - 100
Households Assisted By Poverty Level
101 - 125 126 - 150 Over 150 60 Years or older Disabled
Age 5 years or younger
Age 2 years and younger
Age 3 years through 5
Under 60 Years Old
At least one member who is
Undup Households
Assisted
Other Assisted Household Report
Other Assistance Total
Report run on 08312018 1107 AM Page 2 of 3 eheap_summaryrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Applicant Household Report
County of Applicant
Households Under 75 75 - 100 101 - 125 126 - 150 Over 150 Income data
unavailable
Total 0
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01
Enrollment Active Consumer Count by Program PSA ALL Provider ALL PROVIDERS
County Description Program Count of Clients
BREVARD
ADI
CCE
HCE
LSP
NDP
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
MLTC
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
31
57
44
5
62
123
141
26
9
7
5
40
5
50
67
129
2
19
42
29
1
233
79
63
8
2
14
3
37
14
47
3
3
33
127
10
02
03
04
ALACHUA
BAKER
BAY
BRADFORD
Report run on 08312018 1148 AM Page 1 of 18 actv_countrdf
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05
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Enrollment Terminations with Reasons PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 Program All Programs Program Status ALL Program Status Worker ALL WORKERS
Last First Program Medicaid Provider Start End Name Name Client ID Status Description Worker Number Program Location Enrollment Enrollment
Count 0
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Enrollments with Care Plan Report
PSA ALL Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTIVE STATUS Care Plan Service ALL SERVICES Care Plan Start 01012017 Care Plan End 12312017
Care Plan Care Plan Care Plan Client Name
Unduplicated Client Count 0
Client ID Program Status Worker Start Date End Date Service
Report run on 08312018 1054 AM Page 1 of 1 enroll_careplrdf Report run by RSHQALL Dispose of this report so that it cannot be read or reconstructed
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PSA CLIENT_ID CLIENT_NAME OWNER PROVIDER_ID ASSESSMENT_DATE ASSESSOR_NAME MEDICAID_NUMBER CAREGIVER_CHANGE ENVIRONMENT_CHANGE HEALTH_CHANGE INCOME_CHANGE SITUATION_CHANGE INITIAL_ASSM ANNUAL_ASSM SSN REFERRAL_SOURCE 1114 N N N N Y N 771771777 SELFFAMILY 812017 JANE CASEWORKER 2 1001141633 TEST TEST N
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Fixed Service Costs List PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Provider Location County Program Service Reimbursement Unit Rate Provider Cost Per Unit Begin Valid End Valid
Count 0
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Active Clients Careplan PSA ALL Provider ALL PROVIDERS Location 0000 Worker SSN All SSNs
Services Needed Services Planned
RecommendedClient ID Client Name Service Date End Date Frequency Program Frequency
4061653427 Test Name CNML 09102013 O3C1
Begin Date End Date
09102013 5 MEL PER WK 5 MEL PER WK
Report run on 08312018 1054 AM Report run by RSHQALL
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Active Clients with Contact Information PSA ALL Program AC County All Counties Worker All Workers Zip Code All Zip Codes Provider All Providers Location 0000 Order by Zip Client_Name
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Active AC Consumers Receiving an APS Referral PSA ALL Owner All Owners Risk Level H Program AC Referral Start Date 01012017 Referral End Date 12312017
Start Enroll Risk Referral PSA Client ID Client Name Owner ID Date Prog Provider Workers Level Date
Total Count 0
Total Clients 0
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Active MLTC Clients Who are ACTV APCL or APPL in Another Program
PSA ALL Provider ALL
Program Status ACTV
Include NDP Y
Active MLTC Clients Information
PSA Owner ID Client ID Client Name
02 4061692109 Test NamePSA Count 1
Total Count 1
Unduplicated Client Count 1
MLTC Start Enrollment Date
11012013
Worker
CIRTS15124
Provider
1065
Other Programs Information
Location Program Program Status
0043 O3C1 ACTV
Start Enrollment Date
04042014
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Active or APCL Clients with Caregiver Information PSA ALL Provider ALL PROVIDERS Program AC Program Status ACTV Sort by PROVIDER
Provider Location Program
Program Status Worker Clinet ID Client Name
Most recent Asmt Date Asmt Priority with CaregiverType Score
Risk Score Caregiver Name
HCE Relationship Indicator
1380 0181AC ACTV CIRTS16813 4062414494 Test Name 04232014 701A 40 Test OR N
Count 1
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Active PACE Clients Who are ACTV APCL or APPL in Another Program PSA ALL
Provider ALL
-------- Active PACE Clients Information -------- ------ Other Programs Information ----
PSA Owner ID Client ID Client Name Provider Location Program Program Status
Total Count 0
Unduplicated Client Count 0
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ACTV CCE HCE and ADI Clients with No Care Plan PSA ALL
Program ALL PROGRAMS Provider ALL PROVIDERS
Owner All Owners
Enrollment Information PSA Client ID Name Owner Provider Loc Program Start Date Worker
01 4062521310 Test Name 1911 1911 0932 CCE 03272014 CIRTS29059
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ACTV CCE HCE and ADI Clients with No Care Plan PSA ALL
Program ALL PROGRAMS Provider ALL PROVIDERS
Owner All Owners
PSA Client ID Name Owner Enrollment Information
Provider Loc Program Start Date Worker
4061605936 Test Name 1785 1927 0072 ADI 07202006 CIRTS26739
11
Duplicated Count 72 Unduplicated Counts 70
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ACTV APPL APCL Clients who have moved to another PSA PSA ALL
Provider ALL PROVIDERS
Address Enrollment Client ID Client Name Provider Loc Program Program Start PSA PSA Status Enrollment
01A 02 4062760605 1191 0072 CCE ACTV 11082011 Test Name
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Aging Network Provider Information Report PSA ALL
Address PSA Provider Loc Provider Name Type Provider Address Telephone
01 1147 B
1147
0072 Provider Name
0073 Provider Name B
1147
1147
0100 Provider Name
0179 Provider Name B
1271 B
1271 B
1271
0000 Provider Name
0001 Provider Name
0002 Provider Name B
1271 B
1271
0003 Provider Name
0004 Provider Name B
1271 B
1271
0072 Provider Name
0073 Provider Name B
1271 0100 Provider Name B
1271 B
1271 B
1271 B
1271 B
1271
0101 Provider Name
0138 Provider Name
0179 Provider Name
0286 Provider Name
0287 Provider Name B
123 Provider CALICO DRIVE STAYTON FL 59255
123 Provider TERRA COTTA STREET DARRINGTON
FL 57399
123 Provider LANGTOWN ROAD DARRINGTON FL 57399
123 Provider POINTE LANE Bonum integritas corporis misDARRINGTON FL 58398
123 Provider OAK DRIVE SUNNYVALE MO 83407
123 Provider HOTT STREET DARRINGTON FL 58398
123 Provider GRASSELLI STREET DARRINGTON FL 68396
123 Provider HEAVENS WAY MORRISONS CROSSROADS AL 33165
123 Provider GOOSETOWN DRIVE MIDVILLE
FL 93176
123 Provider PIKE STREET BELLOWS FALLS
FL 48405
123 Provider GLENVIEW DRIVE SUSSEX FL
123 Provider JONES AVENUE BLYTHEVILLE
FL 14027
123 Provider HENERY STREET SUSSEX FL
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Aging Network Provider Information Report PSA ALL
PSA Provider Loc Provider Name Address Type Provider Address Telephone
11 1952 B
1952 B
1952 B
1952 B
1952 B
1952 B
1952 B
123 Test Street ELLSINORE FL 38234 3789 WHITE
123 Test Street OHATCHEE FL 45235 3408 NORMA
123 Test Street WHITE CLOUD FL 46226
123 Test Street NEOSHO FL 06231
123 Test Street WHITE CLOUD FL 16168 3678 OLD
123 Test StreetWHITE CLOUD FL 06231 184 GRANT
123 Test Street WHITE CLOUD FL 93236
1952
1955
1956
B 3123 Test Street Quid censes in Latino fore IaWHITE CLOUD FL 70226
1957
0Provider Name
0Provider Name
0Provider Name
0Provider Name
0Provider Name
0Provider Name
0Provider Name
0Provider Name
0Provider Name
0Provider Name
0Provider Name B 123 Test Street Sed ad rem redeamus ComprehenWHITE CLOUD FL 38227
1957
1958
Count
0474 Provider Name
0072 Provider Name
427
B 123 Test Street BRANCH ROAD Quid ergo hoc loco intellegit WHITE CLOUD FL 25224
Count Total 3117
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Aging Network Providers Report PSA ALL
PSA 01
Provider 1271 Provider Name Provider Name
Location 0000 Location Name Provider Name
Location Business Address 3123 Test Drive DARRINGTON FL 58398
County Served OKALOOSA Phone Fax Location Contact
Provider Director Provider Profit Status Non-Profit
ACCESS_PT CCE_LA N HCE OAA OTHER
ADI EHEAP LSP RELF
CCE Y FOCAL_PT NSIP SR_CTR
Provider 1271 Provider Name Provider Name
Location 0001 Location Name Provider Name
Location Business Address 1234 Test OAK DRIVE SUNNYVALE MO 83407
Phone Fax Location Contact County Served OKALOOSA
Provider Director Provider Profit Status Non-Profit
ACCESS_PT CCE_LA N HCE OAA OTHER
ADI EHEAP LSP RELF
CCE Y FOCAL_PT NSIP SR_CTR
Provider 1271 Provider Name Provider Name
Location 0004 Location Name Provider Name
Location Business Address 1123 Test HEAVENS WAY MORRISONS CROSSROADS AL
33165 Phone County Served OKALOOSA Fax Location Contact
Provider Director Provider Profit Status Non-Profit
ACCESS_PT CCE_LA N HCE Y OAA OTHER
ADI EHEAP LSP RELF
CCE FOCAL_PT NSIP SR_CTR
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Start End Worker Most Recent Nutr Medicaid Program Provider Location Client ID Client Name Status Enrollment Enrollment Worker Active Score Number
O3C1 1036 0000 4061653427 Test Name ACTV 09102013 CIRTS20804 Y 1
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Start End Worker Most Recent Nutr Medicaid Program Provider Location Client ID Client Name Status Enrollment Enrollment Worker Active Score Number
O3C1 1036 0000 4061638016 Test Name ACTV 09122013 CIRTS20804 Y 2
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Start End Worker Most Recent Nutr Medicaid Program Provider Location Client ID Client Name Status Enrollment Enrollment Worker Active Score Number
O3C2 1036 0000 4062000152 Test Name ACTV 02072011 CIRTS23407 N 3
1036 0000 4061594062 ISAACS HATTIE ACTV 11192012 CIRTS20804 Y 5
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Start End Worker Most Recent Nutr Medicaid Program Provider Location Client ID Client Name Status Enrollment Enrollment Worker Active Score Number
O3C2 1036 0000 4062379505 Test Name ACTV 11192012 CIRTS20804 Y 5
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Start End Worker Most Recent Nutr Medicaid Program Provider Location Client ID Client Name Status Enrollment Enrollment Worker Active Score Number
O3C2 1036 0000 4062401063 Test Name ACTV 10162013 CIRTS20804 Y 3
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Provider Location Client ID Client Name Program Status
Start Enrollment
End Enrollment Worker
Worker Active
Most Recent Nutr Score
Medicaid Number
O3C2 1036 0000 4062538939 ACTV 12082000 CIRTS20388 Y Test Name
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All Enrollments Counts During Date Range PSA ALL Start Date 01012017 End Date Location 0000 Provider Program Program Status
12312017 ALL PROVIDERS
ACTV
Group By Program Provider Location
Program Provider Location Client Count O3C1 1036 0000 45
1951 0000 3
O3C2 1036 0000 113
OA3E 1821 0000 2
OA3ES 1821 0000 1
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C1 1036 0000 4061950299 Test Name ACTV 04072011 CIRTS23407 N 11
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C1 1036 4062586019 Test Name ACTV 12292008 CIRTS23407 N 1
Total for Location 45
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C1 1951 0000 4062452921 Test Name ACTV 03301989 CIRTS22695 N 10
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4062786256 Test Name ACTV 09232013 CIRTS20804 Y 4 1
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4062380426 Test Name ACTV 04112012 CIRTS23407 N 55 2
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4061608826 Test Name ACTV 08102011 CIRTS18634 Y 7 3
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4062615533 Test Name ACTV 10032013 CIRTS20804 Y 6 3
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start Enrollment
End Enrollment Worker
Worker Active
Medicaid Number
Most Recent Nutr Score Rank
O3C2 1036 4062466582 Test Name ACTV 10262010 CIRTS23407 N 105 2
Total for Location 113
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PSA
APCL Clients With No Services ALL Owner All Owners Provider ALL PROVIDERS
Start Date 01012017 End Date 12312017
Includes Clients Receiving Only CM INSC SCAS CA REFE Services
PSA Client ID Client Name Owner Provider Program
Count 0
Unduplicated Clients Count 0
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APCL Clients With Services PSA ALL Owner All Owners Provider ALL PROVIDERS Start Date 01012017 End Date 12312017
Exclude CM CA INSC REFE SCAS
PSA Client ID Name Owner Provider Program 10 4062527553 Test Name 1539 1929 CCE
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APCL Clients With Services PSA ALL Owner All Owners Provider ALL PROVIDERS Start Date 01012017 End Date 12312017
Exclude CM CA INSC REFE SCAS
PSA Client ID Name Owner Provider Program 11 4062732638 Test Name 1177 1177 LTCC
Total 21067
Unduplicated clients count 12460
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APS Assessments PSA ALL Risk Level ALL Owner All Owners Referral Date From 01012017 To 12312017
Order by Referral Date and Owner ID
PSA 03
Ref Date Owner ID Client ID Client Name Risk Level Asmt Type Asmt Date
03032017 1390 4062058415 L 701A 03302018 Test Name
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APS Assessments PSA ALL Risk Level ALL Owner All Owners Referral Date From 01012017 To 12312017
Order by Referral Date and Owner ID
12042017 1980 4061617559 H 701B 12072017 Test Name
Assessment Count for the PSA 52
PSA 04A
Ref Date Owner ID Client ID
09102017 4062308458
Client Name
Test Name
Risk Level
H
Asmt Type
O
Asmt Date
09162017
Assessment Count for the PSA 2
Risk Level H
M
L
Count of Assessments 138
23
21
Total Count of Assessments 182
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APS Repeat Referrals in a Time Range
PSA ALL Owner All Owners
Start Date 01012017 End Date 12312017
Current DOEA CIRTS Cirts SSN if Risk Date Created PSA Owner Abuse No different than DCF DCF SSN Name County Level Date of Birth Date Sent by DCF
Count 0
Unduplicated Client Count by PSA
PSA Count SSN
Total
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Assessed Prioritized Consumer List PSA ALL Provider ALL PROVIDERS Program AC County ALL COUNTIES
County Program Consumer Name Client ID
Total Count 0
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Assessment Due Report PSA 01 Start Date 01012017 End Date 08312018 Owner ALL PROVIDERS Worker ALL WORKERS Program Status ACTV and APCL Assessment Type Needed ALL
Overdue and missing assessments are always listed
Owner ID 1065
Client ID Client Name
Owner Assessor ID
Date of Birth
06281928
CIRTS28099
County of Service
GULF
Worker Name HARPER KENNY
Zip Assessment PSA Date
32534 01 01022014
Type
701A
Active Y
Nutr PriorityScore Score
11 58
Rank
5
Due Date
01022015
Status
701S OVERDUE
LTCC APPL Start Date
03252014 4062235673 Test name
Total Clients for Worker 1
Total Clients for Owner 1
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Assessment Due Report PSA 01 Start Date 01012017 End Date 08312018 Owner ALL PROVIDERS Worker ALL WORKERS Program Status ACTV and APCL Assessment Type Needed ALL
Overdue and missing assessments are always listed
Summary by PSA
PSA 01 701A Overdue 1
701B Overdue 213
701C Overdue 0
701S Overdue 157
No 701A 0
No 701B 2
No 701C 0
No 701S 0
701A Not Overdue 0
701B Not Overdue 0
701C Not Overdue 0
701S Not Overdue 0
701S Optional 0
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CIC Service Units and Costs Projections County SummaryPSA 99 Program CCE
Start Date 01012017 End Date 12312017
County LEON
Total Total Total Avg Max Projected
StateFederal Projected Reimbursement Provider Unduplicated Provider Service Share Service Units Unit Rate Cost Per Unit Client Count
Report Total
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CIC Service Units and Costs Projections Provider SummaryPSA ALL Provider ALL PROVIDERS Program FEDERALLY FUNDED (0101 TO 1231) Year 2017 From 01012017 To 12312017
PSA County Program Service Total State
Federal Share
Total Projected
Service Units
Avg Reimbursement
Unit Rate
Max Provider
Cost Per Unit
Total Projected Unduplicated Client Count
02 FRANKLIN O3C1 CONGREGATE MEALS $810300 1710 15
Program Total
County Total
$810300
$810300
GULF O3C1 CONGREGATE MEALS $25205 3 5
Program Total $25205
O3C2 HOME DELIVERED MEALS $25205 3 6
Program Total
County Total
$25205
$50411
LEON O3C1 CONGREGATE MEALS $621300 1311 15
CONGREGATE MEALS GUEST
CONGREGATE MEALS VOLUNTEERS
$252055
$277260
25
30
2
5
Program Total $1150615
O3C2 HOME DELIVERED MEAL GUEST $252055 25 3
Program Total $252055
OA3D PEARLS (SESSION 5)
PEARLS (SESSION 6)
PEARLS (SESSION 7)
PEARLS (SESSION 8)
$10247
$10247
$10247
$10247
10
10
10
10
3
3
3
3
Program Total $40988
OA3E RESPITE IN-HOME $200 2 2
Program Total
County Total
$200
$1443858
WAKULLA O3C2 EMERGENCY HOME DELIVERED SHELF MEALS
$8065604 14899 90
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CIC Service Units and Costs Projections - PSA Summary
PSA ALL Program CCE
Strat Date 01012017 End Date 12312017
Total
PSA County Provider Service
Total State Federal
Share
Total Projected
Service Units
Avg Reimbursement
Unit Rate
Max Projected Provider Unduplicated
Cost Per Unit Client Count
02 LEON SOUTHERN SERVICE CASE MANAGEMENT PROVIDER EMERGENCY HOME DELIVERED SHELF MEALS
$2175533
$602000
483
689
32
20
HOME DELIVERED MEALS $530262 993 5
MATERIAL AID $1994536 199
Provider Total $5302331
CountyTotal $5302331
WAKULLA SOUTHERN SERVICE CASE MANAGEMENT PROVIDER EMERGENCY HOME DELIVERED SHELF MEALS
$2175533
$1240200
483
689
32
5
MATERIAL AID $1994536 199
Provider Total $5410269
CountyTotal $5410269
PSA Total $10712599
05 PINELLAS BURSTEIN-APPLEBEE ADULT DAY CARE $000 0 $900 $1000 0
COUNSELING (MENTAL HEALTH COUNSELINGSCREENING) - INDIVIDUAL
Provider Total
$000
$000
0 $6600 $7700 0
CountyTotal $000
PSA Total $000
Report Total $10712599
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CID Service Units and Costs Projections - PSA SummaryPSA ALL Program CCE
Start Date 01012017 End Date 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
PSA County Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
02 LEON CASE MANAGEMENT $2175533 483
EMERGENCY HOME $602000 689DELIVERED SHELF MEALS HOME DELIVERED MEALS $530262 993
MATERIAL AID $1994536 199
County Total $5302331 2364
WAKULLA CASE MANAGEMENT $2175533 483
EMERGENCY HOME $1240200 689DELIVERED SHELF MEALS MATERIAL AID $1994536 199
County Total $5410269 1371
PSA Total $10712599 3735
05 PINELLAS ADULT DAY CARE $000 0
COUNSELING (MENTAL $000 0 HEALTH COUNSELINGSCREENING) - INDIVIDUAL
County Total $000 0
PSA Total $000 0
Report Total $10712599 3735
$900 $900 $900 $1000 $1000 $1000
$6600 $6600 $6600 $7700 $7700 $7700
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CID Service Units and Costs Projections County SummaryPSA 99
Program CCE County LEON
Start Date 01012017 End Date 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
Report Total
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CIE Service Units and Costs Projections - PSA Summary - All Programs
PSA 99 Program FEDERALLY FUNDED (0101 TO 1231) Year 2017 From 01012017 To 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
Program Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
Report Total
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CIE Service Units and Costs Projections - PSA Summary
PSA ALL Program CCE
Start Date 01012017 End Date 12312017
Avg High Low Total Total Avg High Low Provider Provider Provider
StateFederal Projected Reimbursement Reimbursement Reimbursement Cost Cost CostPSA
02
Service
CASE MANAGEMENT
Share
$4351066
Service Units
966
Unit Rate Unit Rate Unit Rate Per Unit Per Unit Per Unit
EMERGENCY HOME DELIVERED SHELF MEALS $1842200 1378
HOME DELIVERED MEALS $530262 993
MATERIAL AID $3989071 398
PSA Total $10712599 3735
05 ADULT DAY CARE $000 0 $900 $900 $900 $1000 $1000 $1000
COUNSELING (MENTAL HEALTH $000 0 $6600 $6600 $6600 $7700 $7700 $7700 COUNSELINGSCREENING) - INDIVIDUAL
PSA Total $000 0
Report Total $10712599 3735
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CAREGIVER SEARCH REPORT
SEARCH RESULTS FOR CONSUMERS
Criteria First Name Last Name SSN PSA ALL
Client Name Client SSN Caregiver Name Caregiver SSN
000000000 000000000 Test Name Test Name
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CARES Referrals in a Time Range PSA ALL
Start Date 01012017 End Date 12312017
Referred to ALL REFERRALS
Referring PSA Employee Name Client Name Client ID
Referral Imminent NH Admit Aging Date Risk Date Referred To Cares Provider Name Received Date
03A 4061561263 Test Name Test Name 09242017 Y 05292017 ARC or ADRC 09252017
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CARES Referrals in a Time Range PSA ALL
Start Date 01012017 End Date 12312017
Referred to ALL REFERRALS
Referring PSA Employee Name Client Name Client ID
Referral Date
Imminent Risk
NH Admit Date Referred To Cares Provider Name
Aging Received Date
04B Test Name Test Name 4061738075 04082017 N ARC or ADRC Test Name 04082017
Total Clients 110
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CARES Referrals not acknowledged by the Aging Network PSA ALL For Referrals after 01012017 Owner ID ALL Owners
Unduplicated Client count Cares Office Total Clients Count
Report Total
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
CIRTS Issue PSA Client ID Client Name Program
Program Status Start Provider Enrollment ID Provider Name
APCL CLIENT WITH DATE OF DEATH 08 4061759417 Test Name OA3B APCL 07232013 1141 WESTERN WORLD RADIO
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
Program Start Provider CIRTS Issue PSA Client ID Client Name Program Status Enrollment ID Provider Name
06 LTCC APCL 01242014 1514 4061713685 Test Name APCL CLIENT WITH DATE OF DEATH CENTRAL THE ORIGINAL HOUSE OF PIES
Count 503
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Civil Rights PSA ALL Provider ALL PROVIDERS Program AC Start Date 01012017 End Date 12312017 The Poverty Level for Single is The Poverty Level for Couple is Sort by County
County Unduplicated Count
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Client Information Report Start Date 01012017 End Date 12312017
Client ID 1001141246
Emergency
Client Name Test Name
Telephone () - Address 78 TEST STREET TALLAHASSEE FL 32399
Most Recent Caregiver Information Date Updated
Doctor
Comments
Client Demographic Information
Birth Date 06041940 Race W
Owner ID Ethnicity O
Most Recent Income Information
Ind Mon Inc Cpl Mon Inc
Ind Assets Couple Assets
Most Recent Assessment Information
Asmt Date Ref Risk Lvl
Asmt Site Spec Shel
AsmtType Spec Reg
Ref Date Primary CG
Ref Source Living Sit
Enrollment Information
Sex
Marital Status
F
S
Medicaid Number
ADL Score
ADL Count
IADL Score
IADL Count
Memory Score
Priority Score
Env Score
Nutr Score
Risk Score
Social Score
Rank
Provider Location Program Program Status Worker Start Date End Date
Care Plan Service Needed
Date Service Units Type Frq End Date
Care Plan Service Planned
Program Service Units Type Frq Start Date End Date
Services Received between 01012017 and 12312017
Service Billed Provider Location Worker Program Service Date Units Unit Type Amount
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Provider N
Client Service Units Report PSA ALL Provider ALL PROVIDERS Location 0000
Program ALL PROGRAMS Service ALL SERVICES Worker ALL WORKERS
City ALL CITIES Include Zero Unit N Include Aggregate N Calculated Amount equals the number of Units Provided times Fixed Cost if it existsService Start Date 01012017 Service End Date 12312017 If Fixed Cost does not exist Calculated
Group by PSA Provider Location Client Name County Worker Amount equals Billed Amount
Unduplicated Client Count 0 Grand Total 000 $000
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Clients In Common PSA All Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 County All Counties Worker All Workers
County JEFFERSON
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
MIAMI-DADE
0 0 0 0 0 0 0 0 0
4061539538 Test NameCounty Count
County
0 01
X
0 1
X
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
4061650856 Test Name X 4061486560 Test Name X 4062452921 Test Name X
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Clients Served Not Enrolled PSA ALL Start Date 01012017 End Date 12312017 Locations 0000 Provider All Providers
Service Service Min Serv Max Serv Program Start End Enrollment PSA Provider Location Program Consumer Name Client ID Service Date Date Status Enrollment Enrollment Provider
Count 0
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
4061472791 04
09
1092
1291
0072
0042
LTCC
LTCC
APCL
APCL
4062714543 06
06
1514
1762
0072
5006
LTCC
LTCC
APCL
APPL
4061802246 11
06
1177
1514
0179
0072
LTCC
LTCC
APCL
APCL
4061563719 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062644312 06
08
1514
1771
0072
0896
LTCC
LTCC
APCL
APCL
1001141670 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
1001141671 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
4062375003 07
05
05
07
1263
1755
1638
1263
0368
0072
0072
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062155124 06
06
1762
1514
0072
0072
LTCC
LTCC
APPL
APCL
4061743886 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0369
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4061499927 06
06
1514
1762
0072
5005
LTCC
LTCC
APCL
APPL
4061583524 08
06
1144
1514
0896
0072
LTCC
LTCC
APCL
APCL
4062694843 06
03
1514
1922
0072
0179
LTCC
LTCC
APCL
APCL
4062744517 07
06
1263
1514
0369
0072
LTCC
LTCC
APCL
APCL
4062005488 10
11
10
11
1929
1177
1164
1177
0072
0073
0179
0179
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
Total Count 15
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CODE DESCRIPTIONS Category ALL STATE TABLES
Code Description Active Available To Code Category
0 UNKNOWN Y CARES SUBJECTIVE_HEALTH_EVALUATION
01 ALACHUA Y COMMON COUNTIES
02 BAKER Y COMMON COUNTIES
03 BAY Y COMMON COUNTIES
04 BRADFORD Y COMMON COUNTIES
05 BREVARD Y COMMON COUNTIES
06 BROWARD Y COMMON COUNTIES
07 CALHOUN Y COMMON COUNTIES
08 CHARLOTTE Y COMMON COUNTIES
09 CITRUS Y COMMON COUNTIES
1 EXCELLENT Y CARES SUBJECTIVE_HEALTH_EVALUATION
10 CLAY Y COMMON COUNTIES
11 COLLIER Y COMMON COUNTIES
12 COLUMBIA Y COMMON COUNTIES
13 MIAMI-DADE Y COMMON COUNTIES
14 DESOTO Y COMMON COUNTIES
15 DIXIE Y COMMON COUNTIES
16 DUVAL Y COMMON COUNTIES
17 ESCAMBIA Y COMMON COUNTIES
18 FLAGLER Y COMMON COUNTIES
19 FRANKLIN Y COMMON COUNTIES
2 GOOD Y CARES SUBJECTIVE_HEALTH_EVALUATION
20 GADSDEN Y COMMON COUNTIES
21 GILCHRIST Y COMMON COUNTIES
22 GLADES Y COMMON COUNTIES
23 GULF Y COMMON COUNTIES
24 HAMILTON Y COMMON COUNTIES
25 HARDEE Y COMMON COUNTIES
26 HENDRY Y COMMON COUNTIES
27 HERNANDO Y COMMON COUNTIES
28 HIGHLANDS Y COMMON COUNTIES
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CONSUMER AGE VERIFICATION REPORT PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Program AC
Age at Start
Enroll or Start Enroll Provider Program Description Consumer Name Client ID DOB Svc date or Svc Date
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Contract Budget Information PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Program Service Provider Location County Served Provider Contract
Projected Service
Units Unit Measure
Projected Unduplicated
State Federal Share Client Count Begin Date End Date
Row Count 0 Amount Total
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Start Enroll Latest Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Date Asmt Date Worker
O3C1 1036 000 4061653427 Test CENTRAL 34982 W M 07091930 09102013 09102013 CIRTS20804 0 Name
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Start Enroll Date
Latest Asmt Date Worker
4061593624 Test Name CENTRAL 34946 B F 11261940 12012011 12312013 CIRTS23407
Count 164
Unduplicated Client Count 163
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Assessments After DOD Report
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Owner 1025
The shaded records indicate clients who have different DOBs andor different names
Assemt Current PSA Owner Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Owner Assessor
Provider Assessor
Assemt Date
Assemt Type
Unduplicated Count Total 0
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Open Enrollments
The Vital Statistics Data for 07192002 - 09112014PSA ALL Provider ALL Program Status ACTV Include MLTC ACTVS N
The shaded records indicate clients who have different DOBs andor different names
Enroll PSA
Enrollment Provider Loc Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Enroll Program Status
Enroll Program
Current Owner ID
02 1065 0072 4062244026 Test Name Test Name 10222004 03231917 03231917 ACTV CCE 1065
Count of enrollments for the Provider 1
Count of enrollments for the PSA 1
Count of enrollments for the Report 1
Unduplicated Count of Individuals with open enrollments and DOD PSA Total Clients Count
02 1
Total 1
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Unduplicated count of individuals with Services after DOD
PSA Total Clients Count
Report Total
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
List of Clients with PSA table entry for SERVICES_AFTER_DOD
Unduplicated Count Total 0
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Age
Provider
Total
Age lt 60 Age 60 - 64 Age 65 - 74 Age 75 - 84 Age 85+ Total Clients Avg Age
Total
Avg Age
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Ethnicity
Provider Hispanic Other Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Race
American Indian Native Hawaiian Other Provider Asian Alaska Native Black Pacific Islander Minority White Multiple Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Gender
Provider Male Female Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Monthly Income
Provider 0 - - Higher than Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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None
Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Total Persons Served 0
Age lt 60 Years 0 0
Age 60 - 64 0 0
Age 65 - 74 0 0
Age 75 - 84 0 0
Age 85+ 0 0
Total Age 0 0
Average 000
Ethnicity Hispanic 0 0
Other Ethnicity 0 0
Unknown Ethnicity 0 0
Total 0 0
Race Asian 0 0
American Indian Alaska Native 0 0
Black 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority 0 0
White 0 0
Multiple 0 0
Unknown 0 0
Total 0 0
Sex Male 0 0
Female 0 0
Unknown Sex 0 0
Total 0 0
Monthly Income 0 - 0 0
- 0 0
Higher than 0 0
Unknown 0 0
Total 0 0
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Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Client ID Date Of Birth Ethnicity Race Sex Individual Monthly Income
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Demographics of Clients OAA Registered Served Only PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 City All Cities Program All Programs Service All Services County ALL COUNTIES Table OAA Registered Services Only Low Income Medium Income
Total Persons Served 0
Agelt 60 Years
Age 60 - 64
Age 65 - 74
Age 75 - 84
Age 85+
0
0
0
0
0
0
0
0
0
0
Monthly Income
0 -
-Higher than
Unknown
0
0
0
0
0
0
0
0
Total
Average
0
000
0 Total 0 0
Ethnicity Hispanic
Other
Unknown
0
0
0
0
0
0
Living Situation
Alone
Null
Policy Change
0
0
0
0
0
0
Total 0 0 Unknown
With Caregiver
0
0
0
0
Race Asian 0 0
With Other
With Other Caregiver
0
0
0
0
American Indian Alaska Native
Black
0
0
0
0Total Living Situation 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority
White
0
0
0
0 Limited English Proficiency
Multiple
Unknown
Total Race
0
0
0
0
0
0
Yes
No
Unknown
0
0
0
0
0
0
Total 0 0
Sex Male
Female
Unknown
0
0
0
0
0
0
Total 0 0
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Disaster Assistance Clients for a Provider PSA ALL Provider All Providers Location 0000 Worker All Workers City All Cities Zip Code All Zip Codes Sort By ZIP
Provider 1036 Provider Name Location 0000 Worker CIRTS18634
Need Care Client Name Address City Zip County Phone Asst Reg Situation Relat Care phone Care Name
34946 N WO DA 000 SAINT JAMES DRIVE CENTRAL (025) 101-0620 Test NameTest Name SAINT LUCIE (005) 100-0369 Y
Client is active and no assessment information is available Special Shelter and Special Registry are unknown
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
Total by PSA 0
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
ALACH BAKER BAY BRADF BREVA BROWA CALHO CHARL CITRUS CLAY COLLIE COLUM DESOT DIXIE DUVAL ESCAM FLAGL FRANK GADSDAssisted Household Report UA ORD RD RD UN OTTE R BIA O BIA ER LIN EN
1 of Household Assisted 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Households AssistedWith Gross Income
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C 100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D 125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
3 Households with at leastOne member
A 60 Years or older 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B Disabled 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C Age 5 years or under 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D Under 60 Years Old 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Undup Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Assisted
Applicant Household Report
of Applicant Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Energy Assisted Household Report
County of Assisted
Households
Households Assisted By Poverty Level
Under 75 75 - 100 101 - 125 126 - 150 Over 150 60 Years or older
At least one member who is
Age 5 years Age 2 years Age 3 years Disabled or younger and younger through 5
Under 60 Years Old
Undup Households
Assisted
Energy Assistance Total
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Unduplicated Total 0 0
County of Assisted
Households Under 75 75 - 100
Households Assisted By Poverty Level
101 - 125 126 - 150 Over 150 60 Years or older Disabled
Age 5 years or younger
Age 2 years and younger
Age 3 years through 5
Under 60 Years Old
At least one member who is
Undup Households
Assisted
Other Assisted Household Report
Other Assistance Total
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Applicant Household Report
County of Applicant
Households Under 75 75 - 100 101 - 125 126 - 150 Over 150 Income data
unavailable
Total 0
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01
Enrollment Active Consumer Count by Program PSA ALL Provider ALL PROVIDERS
County Description Program Count of Clients
BREVARD
ADI
CCE
HCE
LSP
NDP
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
MLTC
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
31
57
44
5
62
123
141
26
9
7
5
40
5
50
67
129
2
19
42
29
1
233
79
63
8
2
14
3
37
14
47
3
3
33
127
10
02
03
04
ALACHUA
BAKER
BAY
BRADFORD
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05
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Enrollment Terminations with Reasons PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 Program All Programs Program Status ALL Program Status Worker ALL WORKERS
Last First Program Medicaid Provider Start End Name Name Client ID Status Description Worker Number Program Location Enrollment Enrollment
Count 0
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Enrollments with Care Plan Report
PSA ALL Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTIVE STATUS Care Plan Service ALL SERVICES Care Plan Start 01012017 Care Plan End 12312017
Care Plan Care Plan Care Plan Client Name
Unduplicated Client Count 0
Client ID Program Status Worker Start Date End Date Service
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PSA CLIENT_ID CLIENT_NAME OWNER PROVIDER_ID ASSESSMENT_DATE ASSESSOR_NAME MEDICAID_NUMBER CAREGIVER_CHANGE ENVIRONMENT_CHANGE HEALTH_CHANGE INCOME_CHANGE SITUATION_CHANGE INITIAL_ASSM ANNUAL_ASSM SSN REFERRAL_SOURCE 1114 N N N N Y N 771771777 SELFFAMILY 812017 JANE CASEWORKER 2 1001141633 TEST TEST N
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Fixed Service Costs List PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Provider Location County Program Service Reimbursement Unit Rate Provider Cost Per Unit Begin Valid End Valid
Count 0
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Active Clients with Contact Information PSA ALL Program AC County All Counties Worker All Workers Zip Code All Zip Codes Provider All Providers Location 0000 Order by Zip Client_Name
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Active AC Consumers Receiving an APS Referral PSA ALL Owner All Owners Risk Level H Program AC Referral Start Date 01012017 Referral End Date 12312017
Start Enroll Risk Referral PSA Client ID Client Name Owner ID Date Prog Provider Workers Level Date
Total Count 0
Total Clients 0
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Active MLTC Clients Who are ACTV APCL or APPL in Another Program
PSA ALL Provider ALL
Program Status ACTV
Include NDP Y
Active MLTC Clients Information
PSA Owner ID Client ID Client Name
02 4061692109 Test NamePSA Count 1
Total Count 1
Unduplicated Client Count 1
MLTC Start Enrollment Date
11012013
Worker
CIRTS15124
Provider
1065
Other Programs Information
Location Program Program Status
0043 O3C1 ACTV
Start Enrollment Date
04042014
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Active or APCL Clients with Caregiver Information PSA ALL Provider ALL PROVIDERS Program AC Program Status ACTV Sort by PROVIDER
Provider Location Program
Program Status Worker Clinet ID Client Name
Most recent Asmt Date Asmt Priority with CaregiverType Score
Risk Score Caregiver Name
HCE Relationship Indicator
1380 0181AC ACTV CIRTS16813 4062414494 Test Name 04232014 701A 40 Test OR N
Count 1
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Active PACE Clients Who are ACTV APCL or APPL in Another Program PSA ALL
Provider ALL
-------- Active PACE Clients Information -------- ------ Other Programs Information ----
PSA Owner ID Client ID Client Name Provider Location Program Program Status
Total Count 0
Unduplicated Client Count 0
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ACTV CCE HCE and ADI Clients with No Care Plan PSA ALL
Program ALL PROGRAMS Provider ALL PROVIDERS
Owner All Owners
Enrollment Information PSA Client ID Name Owner Provider Loc Program Start Date Worker
01 4062521310 Test Name 1911 1911 0932 CCE 03272014 CIRTS29059
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ACTV CCE HCE and ADI Clients with No Care Plan PSA ALL
Program ALL PROGRAMS Provider ALL PROVIDERS
Owner All Owners
PSA Client ID Name Owner Enrollment Information
Provider Loc Program Start Date Worker
4061605936 Test Name 1785 1927 0072 ADI 07202006 CIRTS26739
11
Duplicated Count 72 Unduplicated Counts 70
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ACTV APPL APCL Clients who have moved to another PSA PSA ALL
Provider ALL PROVIDERS
Address Enrollment Client ID Client Name Provider Loc Program Program Start PSA PSA Status Enrollment
01A 02 4062760605 1191 0072 CCE ACTV 11082011 Test Name
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Aging Network Provider Information Report PSA ALL
Address PSA Provider Loc Provider Name Type Provider Address Telephone
01 1147 B
1147
0072 Provider Name
0073 Provider Name B
1147
1147
0100 Provider Name
0179 Provider Name B
1271 B
1271 B
1271
0000 Provider Name
0001 Provider Name
0002 Provider Name B
1271 B
1271
0003 Provider Name
0004 Provider Name B
1271 B
1271
0072 Provider Name
0073 Provider Name B
1271 0100 Provider Name B
1271 B
1271 B
1271 B
1271 B
1271
0101 Provider Name
0138 Provider Name
0179 Provider Name
0286 Provider Name
0287 Provider Name B
123 Provider CALICO DRIVE STAYTON FL 59255
123 Provider TERRA COTTA STREET DARRINGTON
FL 57399
123 Provider LANGTOWN ROAD DARRINGTON FL 57399
123 Provider POINTE LANE Bonum integritas corporis misDARRINGTON FL 58398
123 Provider OAK DRIVE SUNNYVALE MO 83407
123 Provider HOTT STREET DARRINGTON FL 58398
123 Provider GRASSELLI STREET DARRINGTON FL 68396
123 Provider HEAVENS WAY MORRISONS CROSSROADS AL 33165
123 Provider GOOSETOWN DRIVE MIDVILLE
FL 93176
123 Provider PIKE STREET BELLOWS FALLS
FL 48405
123 Provider GLENVIEW DRIVE SUSSEX FL
123 Provider JONES AVENUE BLYTHEVILLE
FL 14027
123 Provider HENERY STREET SUSSEX FL
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Aging Network Provider Information Report PSA ALL
PSA Provider Loc Provider Name Address Type Provider Address Telephone
11 1952 B
1952 B
1952 B
1952 B
1952 B
1952 B
1952 B
123 Test Street ELLSINORE FL 38234 3789 WHITE
123 Test Street OHATCHEE FL 45235 3408 NORMA
123 Test Street WHITE CLOUD FL 46226
123 Test Street NEOSHO FL 06231
123 Test Street WHITE CLOUD FL 16168 3678 OLD
123 Test StreetWHITE CLOUD FL 06231 184 GRANT
123 Test Street WHITE CLOUD FL 93236
1952
1955
1956
B 3123 Test Street Quid censes in Latino fore IaWHITE CLOUD FL 70226
1957
0Provider Name
0Provider Name
0Provider Name
0Provider Name
0Provider Name
0Provider Name
0Provider Name
0Provider Name
0Provider Name
0Provider Name
0Provider Name B 123 Test Street Sed ad rem redeamus ComprehenWHITE CLOUD FL 38227
1957
1958
Count
0474 Provider Name
0072 Provider Name
427
B 123 Test Street BRANCH ROAD Quid ergo hoc loco intellegit WHITE CLOUD FL 25224
Count Total 3117
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Aging Network Providers Report PSA ALL
PSA 01
Provider 1271 Provider Name Provider Name
Location 0000 Location Name Provider Name
Location Business Address 3123 Test Drive DARRINGTON FL 58398
County Served OKALOOSA Phone Fax Location Contact
Provider Director Provider Profit Status Non-Profit
ACCESS_PT CCE_LA N HCE OAA OTHER
ADI EHEAP LSP RELF
CCE Y FOCAL_PT NSIP SR_CTR
Provider 1271 Provider Name Provider Name
Location 0001 Location Name Provider Name
Location Business Address 1234 Test OAK DRIVE SUNNYVALE MO 83407
Phone Fax Location Contact County Served OKALOOSA
Provider Director Provider Profit Status Non-Profit
ACCESS_PT CCE_LA N HCE OAA OTHER
ADI EHEAP LSP RELF
CCE Y FOCAL_PT NSIP SR_CTR
Provider 1271 Provider Name Provider Name
Location 0004 Location Name Provider Name
Location Business Address 1123 Test HEAVENS WAY MORRISONS CROSSROADS AL
33165 Phone County Served OKALOOSA Fax Location Contact
Provider Director Provider Profit Status Non-Profit
ACCESS_PT CCE_LA N HCE Y OAA OTHER
ADI EHEAP LSP RELF
CCE FOCAL_PT NSIP SR_CTR
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Start End Worker Most Recent Nutr Medicaid Program Provider Location Client ID Client Name Status Enrollment Enrollment Worker Active Score Number
O3C1 1036 0000 4061653427 Test Name ACTV 09102013 CIRTS20804 Y 1
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Start End Worker Most Recent Nutr Medicaid Program Provider Location Client ID Client Name Status Enrollment Enrollment Worker Active Score Number
O3C1 1036 0000 4061638016 Test Name ACTV 09122013 CIRTS20804 Y 2
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Start End Worker Most Recent Nutr Medicaid Program Provider Location Client ID Client Name Status Enrollment Enrollment Worker Active Score Number
O3C2 1036 0000 4062000152 Test Name ACTV 02072011 CIRTS23407 N 3
1036 0000 4061594062 ISAACS HATTIE ACTV 11192012 CIRTS20804 Y 5
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Start End Worker Most Recent Nutr Medicaid Program Provider Location Client ID Client Name Status Enrollment Enrollment Worker Active Score Number
O3C2 1036 0000 4062379505 Test Name ACTV 11192012 CIRTS20804 Y 5
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Start End Worker Most Recent Nutr Medicaid Program Provider Location Client ID Client Name Status Enrollment Enrollment Worker Active Score Number
O3C2 1036 0000 4062401063 Test Name ACTV 10162013 CIRTS20804 Y 3
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Provider Location Client ID Client Name Program Status
Start Enrollment
End Enrollment Worker
Worker Active
Most Recent Nutr Score
Medicaid Number
O3C2 1036 0000 4062538939 ACTV 12082000 CIRTS20388 Y Test Name
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All Enrollments Counts During Date Range PSA ALL Start Date 01012017 End Date Location 0000 Provider Program Program Status
12312017 ALL PROVIDERS
ACTV
Group By Program Provider Location
Program Provider Location Client Count O3C1 1036 0000 45
1951 0000 3
O3C2 1036 0000 113
OA3E 1821 0000 2
OA3ES 1821 0000 1
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C1 1036 0000 4061950299 Test Name ACTV 04072011 CIRTS23407 N 11
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C1 1036 4062586019 Test Name ACTV 12292008 CIRTS23407 N 1
Total for Location 45
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C1 1951 0000 4062452921 Test Name ACTV 03301989 CIRTS22695 N 10
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4062786256 Test Name ACTV 09232013 CIRTS20804 Y 4 1
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4062380426 Test Name ACTV 04112012 CIRTS23407 N 55 2
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4061608826 Test Name ACTV 08102011 CIRTS18634 Y 7 3
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4062615533 Test Name ACTV 10032013 CIRTS20804 Y 6 3
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start Enrollment
End Enrollment Worker
Worker Active
Medicaid Number
Most Recent Nutr Score Rank
O3C2 1036 4062466582 Test Name ACTV 10262010 CIRTS23407 N 105 2
Total for Location 113
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PSA
APCL Clients With No Services ALL Owner All Owners Provider ALL PROVIDERS
Start Date 01012017 End Date 12312017
Includes Clients Receiving Only CM INSC SCAS CA REFE Services
PSA Client ID Client Name Owner Provider Program
Count 0
Unduplicated Clients Count 0
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APCL Clients With Services PSA ALL Owner All Owners Provider ALL PROVIDERS Start Date 01012017 End Date 12312017
Exclude CM CA INSC REFE SCAS
PSA Client ID Name Owner Provider Program 10 4062527553 Test Name 1539 1929 CCE
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APCL Clients With Services PSA ALL Owner All Owners Provider ALL PROVIDERS Start Date 01012017 End Date 12312017
Exclude CM CA INSC REFE SCAS
PSA Client ID Name Owner Provider Program 11 4062732638 Test Name 1177 1177 LTCC
Total 21067
Unduplicated clients count 12460
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APS Assessments PSA ALL Risk Level ALL Owner All Owners Referral Date From 01012017 To 12312017
Order by Referral Date and Owner ID
PSA 03
Ref Date Owner ID Client ID Client Name Risk Level Asmt Type Asmt Date
03032017 1390 4062058415 L 701A 03302018 Test Name
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APS Assessments PSA ALL Risk Level ALL Owner All Owners Referral Date From 01012017 To 12312017
Order by Referral Date and Owner ID
12042017 1980 4061617559 H 701B 12072017 Test Name
Assessment Count for the PSA 52
PSA 04A
Ref Date Owner ID Client ID
09102017 4062308458
Client Name
Test Name
Risk Level
H
Asmt Type
O
Asmt Date
09162017
Assessment Count for the PSA 2
Risk Level H
M
L
Count of Assessments 138
23
21
Total Count of Assessments 182
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APS Repeat Referrals in a Time Range
PSA ALL Owner All Owners
Start Date 01012017 End Date 12312017
Current DOEA CIRTS Cirts SSN if Risk Date Created PSA Owner Abuse No different than DCF DCF SSN Name County Level Date of Birth Date Sent by DCF
Count 0
Unduplicated Client Count by PSA
PSA Count SSN
Total
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Assessed Prioritized Consumer List PSA ALL Provider ALL PROVIDERS Program AC County ALL COUNTIES
County Program Consumer Name Client ID
Total Count 0
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Assessment Due Report PSA 01 Start Date 01012017 End Date 08312018 Owner ALL PROVIDERS Worker ALL WORKERS Program Status ACTV and APCL Assessment Type Needed ALL
Overdue and missing assessments are always listed
Owner ID 1065
Client ID Client Name
Owner Assessor ID
Date of Birth
06281928
CIRTS28099
County of Service
GULF
Worker Name HARPER KENNY
Zip Assessment PSA Date
32534 01 01022014
Type
701A
Active Y
Nutr PriorityScore Score
11 58
Rank
5
Due Date
01022015
Status
701S OVERDUE
LTCC APPL Start Date
03252014 4062235673 Test name
Total Clients for Worker 1
Total Clients for Owner 1
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Assessment Due Report PSA 01 Start Date 01012017 End Date 08312018 Owner ALL PROVIDERS Worker ALL WORKERS Program Status ACTV and APCL Assessment Type Needed ALL
Overdue and missing assessments are always listed
Summary by PSA
PSA 01 701A Overdue 1
701B Overdue 213
701C Overdue 0
701S Overdue 157
No 701A 0
No 701B 2
No 701C 0
No 701S 0
701A Not Overdue 0
701B Not Overdue 0
701C Not Overdue 0
701S Not Overdue 0
701S Optional 0
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CIC Service Units and Costs Projections County SummaryPSA 99 Program CCE
Start Date 01012017 End Date 12312017
County LEON
Total Total Total Avg Max Projected
StateFederal Projected Reimbursement Provider Unduplicated Provider Service Share Service Units Unit Rate Cost Per Unit Client Count
Report Total
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CIC Service Units and Costs Projections Provider SummaryPSA ALL Provider ALL PROVIDERS Program FEDERALLY FUNDED (0101 TO 1231) Year 2017 From 01012017 To 12312017
PSA County Program Service Total State
Federal Share
Total Projected
Service Units
Avg Reimbursement
Unit Rate
Max Provider
Cost Per Unit
Total Projected Unduplicated Client Count
02 FRANKLIN O3C1 CONGREGATE MEALS $810300 1710 15
Program Total
County Total
$810300
$810300
GULF O3C1 CONGREGATE MEALS $25205 3 5
Program Total $25205
O3C2 HOME DELIVERED MEALS $25205 3 6
Program Total
County Total
$25205
$50411
LEON O3C1 CONGREGATE MEALS $621300 1311 15
CONGREGATE MEALS GUEST
CONGREGATE MEALS VOLUNTEERS
$252055
$277260
25
30
2
5
Program Total $1150615
O3C2 HOME DELIVERED MEAL GUEST $252055 25 3
Program Total $252055
OA3D PEARLS (SESSION 5)
PEARLS (SESSION 6)
PEARLS (SESSION 7)
PEARLS (SESSION 8)
$10247
$10247
$10247
$10247
10
10
10
10
3
3
3
3
Program Total $40988
OA3E RESPITE IN-HOME $200 2 2
Program Total
County Total
$200
$1443858
WAKULLA O3C2 EMERGENCY HOME DELIVERED SHELF MEALS
$8065604 14899 90
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CIC Service Units and Costs Projections - PSA Summary
PSA ALL Program CCE
Strat Date 01012017 End Date 12312017
Total
PSA County Provider Service
Total State Federal
Share
Total Projected
Service Units
Avg Reimbursement
Unit Rate
Max Projected Provider Unduplicated
Cost Per Unit Client Count
02 LEON SOUTHERN SERVICE CASE MANAGEMENT PROVIDER EMERGENCY HOME DELIVERED SHELF MEALS
$2175533
$602000
483
689
32
20
HOME DELIVERED MEALS $530262 993 5
MATERIAL AID $1994536 199
Provider Total $5302331
CountyTotal $5302331
WAKULLA SOUTHERN SERVICE CASE MANAGEMENT PROVIDER EMERGENCY HOME DELIVERED SHELF MEALS
$2175533
$1240200
483
689
32
5
MATERIAL AID $1994536 199
Provider Total $5410269
CountyTotal $5410269
PSA Total $10712599
05 PINELLAS BURSTEIN-APPLEBEE ADULT DAY CARE $000 0 $900 $1000 0
COUNSELING (MENTAL HEALTH COUNSELINGSCREENING) - INDIVIDUAL
Provider Total
$000
$000
0 $6600 $7700 0
CountyTotal $000
PSA Total $000
Report Total $10712599
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CID Service Units and Costs Projections - PSA SummaryPSA ALL Program CCE
Start Date 01012017 End Date 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
PSA County Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
02 LEON CASE MANAGEMENT $2175533 483
EMERGENCY HOME $602000 689DELIVERED SHELF MEALS HOME DELIVERED MEALS $530262 993
MATERIAL AID $1994536 199
County Total $5302331 2364
WAKULLA CASE MANAGEMENT $2175533 483
EMERGENCY HOME $1240200 689DELIVERED SHELF MEALS MATERIAL AID $1994536 199
County Total $5410269 1371
PSA Total $10712599 3735
05 PINELLAS ADULT DAY CARE $000 0
COUNSELING (MENTAL $000 0 HEALTH COUNSELINGSCREENING) - INDIVIDUAL
County Total $000 0
PSA Total $000 0
Report Total $10712599 3735
$900 $900 $900 $1000 $1000 $1000
$6600 $6600 $6600 $7700 $7700 $7700
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CID Service Units and Costs Projections County SummaryPSA 99
Program CCE County LEON
Start Date 01012017 End Date 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
Report Total
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CIE Service Units and Costs Projections - PSA Summary - All Programs
PSA 99 Program FEDERALLY FUNDED (0101 TO 1231) Year 2017 From 01012017 To 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
Program Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
Report Total
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CIE Service Units and Costs Projections - PSA Summary
PSA ALL Program CCE
Start Date 01012017 End Date 12312017
Avg High Low Total Total Avg High Low Provider Provider Provider
StateFederal Projected Reimbursement Reimbursement Reimbursement Cost Cost CostPSA
02
Service
CASE MANAGEMENT
Share
$4351066
Service Units
966
Unit Rate Unit Rate Unit Rate Per Unit Per Unit Per Unit
EMERGENCY HOME DELIVERED SHELF MEALS $1842200 1378
HOME DELIVERED MEALS $530262 993
MATERIAL AID $3989071 398
PSA Total $10712599 3735
05 ADULT DAY CARE $000 0 $900 $900 $900 $1000 $1000 $1000
COUNSELING (MENTAL HEALTH $000 0 $6600 $6600 $6600 $7700 $7700 $7700 COUNSELINGSCREENING) - INDIVIDUAL
PSA Total $000 0
Report Total $10712599 3735
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CAREGIVER SEARCH REPORT
SEARCH RESULTS FOR CONSUMERS
Criteria First Name Last Name SSN PSA ALL
Client Name Client SSN Caregiver Name Caregiver SSN
000000000 000000000 Test Name Test Name
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CARES Referrals in a Time Range PSA ALL
Start Date 01012017 End Date 12312017
Referred to ALL REFERRALS
Referring PSA Employee Name Client Name Client ID
Referral Imminent NH Admit Aging Date Risk Date Referred To Cares Provider Name Received Date
03A 4061561263 Test Name Test Name 09242017 Y 05292017 ARC or ADRC 09252017
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CARES Referrals in a Time Range PSA ALL
Start Date 01012017 End Date 12312017
Referred to ALL REFERRALS
Referring PSA Employee Name Client Name Client ID
Referral Date
Imminent Risk
NH Admit Date Referred To Cares Provider Name
Aging Received Date
04B Test Name Test Name 4061738075 04082017 N ARC or ADRC Test Name 04082017
Total Clients 110
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CARES Referrals not acknowledged by the Aging Network PSA ALL For Referrals after 01012017 Owner ID ALL Owners
Unduplicated Client count Cares Office Total Clients Count
Report Total
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
CIRTS Issue PSA Client ID Client Name Program
Program Status Start Provider Enrollment ID Provider Name
APCL CLIENT WITH DATE OF DEATH 08 4061759417 Test Name OA3B APCL 07232013 1141 WESTERN WORLD RADIO
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
Program Start Provider CIRTS Issue PSA Client ID Client Name Program Status Enrollment ID Provider Name
06 LTCC APCL 01242014 1514 4061713685 Test Name APCL CLIENT WITH DATE OF DEATH CENTRAL THE ORIGINAL HOUSE OF PIES
Count 503
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Civil Rights PSA ALL Provider ALL PROVIDERS Program AC Start Date 01012017 End Date 12312017 The Poverty Level for Single is The Poverty Level for Couple is Sort by County
County Unduplicated Count
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Client Information Report Start Date 01012017 End Date 12312017
Client ID 1001141246
Emergency
Client Name Test Name
Telephone () - Address 78 TEST STREET TALLAHASSEE FL 32399
Most Recent Caregiver Information Date Updated
Doctor
Comments
Client Demographic Information
Birth Date 06041940 Race W
Owner ID Ethnicity O
Most Recent Income Information
Ind Mon Inc Cpl Mon Inc
Ind Assets Couple Assets
Most Recent Assessment Information
Asmt Date Ref Risk Lvl
Asmt Site Spec Shel
AsmtType Spec Reg
Ref Date Primary CG
Ref Source Living Sit
Enrollment Information
Sex
Marital Status
F
S
Medicaid Number
ADL Score
ADL Count
IADL Score
IADL Count
Memory Score
Priority Score
Env Score
Nutr Score
Risk Score
Social Score
Rank
Provider Location Program Program Status Worker Start Date End Date
Care Plan Service Needed
Date Service Units Type Frq End Date
Care Plan Service Planned
Program Service Units Type Frq Start Date End Date
Services Received between 01012017 and 12312017
Service Billed Provider Location Worker Program Service Date Units Unit Type Amount
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Provider N
Client Service Units Report PSA ALL Provider ALL PROVIDERS Location 0000
Program ALL PROGRAMS Service ALL SERVICES Worker ALL WORKERS
City ALL CITIES Include Zero Unit N Include Aggregate N Calculated Amount equals the number of Units Provided times Fixed Cost if it existsService Start Date 01012017 Service End Date 12312017 If Fixed Cost does not exist Calculated
Group by PSA Provider Location Client Name County Worker Amount equals Billed Amount
Unduplicated Client Count 0 Grand Total 000 $000
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Clients In Common PSA All Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 County All Counties Worker All Workers
County JEFFERSON
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
MIAMI-DADE
0 0 0 0 0 0 0 0 0
4061539538 Test NameCounty Count
County
0 01
X
0 1
X
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
4061650856 Test Name X 4061486560 Test Name X 4062452921 Test Name X
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Clients Served Not Enrolled PSA ALL Start Date 01012017 End Date 12312017 Locations 0000 Provider All Providers
Service Service Min Serv Max Serv Program Start End Enrollment PSA Provider Location Program Consumer Name Client ID Service Date Date Status Enrollment Enrollment Provider
Count 0
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
4061472791 04
09
1092
1291
0072
0042
LTCC
LTCC
APCL
APCL
4062714543 06
06
1514
1762
0072
5006
LTCC
LTCC
APCL
APPL
4061802246 11
06
1177
1514
0179
0072
LTCC
LTCC
APCL
APCL
4061563719 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062644312 06
08
1514
1771
0072
0896
LTCC
LTCC
APCL
APCL
1001141670 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
1001141671 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
4062375003 07
05
05
07
1263
1755
1638
1263
0368
0072
0072
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062155124 06
06
1762
1514
0072
0072
LTCC
LTCC
APPL
APCL
4061743886 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0369
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4061499927 06
06
1514
1762
0072
5005
LTCC
LTCC
APCL
APPL
4061583524 08
06
1144
1514
0896
0072
LTCC
LTCC
APCL
APCL
4062694843 06
03
1514
1922
0072
0179
LTCC
LTCC
APCL
APCL
4062744517 07
06
1263
1514
0369
0072
LTCC
LTCC
APCL
APCL
4062005488 10
11
10
11
1929
1177
1164
1177
0072
0073
0179
0179
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
Total Count 15
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CODE DESCRIPTIONS Category ALL STATE TABLES
Code Description Active Available To Code Category
0 UNKNOWN Y CARES SUBJECTIVE_HEALTH_EVALUATION
01 ALACHUA Y COMMON COUNTIES
02 BAKER Y COMMON COUNTIES
03 BAY Y COMMON COUNTIES
04 BRADFORD Y COMMON COUNTIES
05 BREVARD Y COMMON COUNTIES
06 BROWARD Y COMMON COUNTIES
07 CALHOUN Y COMMON COUNTIES
08 CHARLOTTE Y COMMON COUNTIES
09 CITRUS Y COMMON COUNTIES
1 EXCELLENT Y CARES SUBJECTIVE_HEALTH_EVALUATION
10 CLAY Y COMMON COUNTIES
11 COLLIER Y COMMON COUNTIES
12 COLUMBIA Y COMMON COUNTIES
13 MIAMI-DADE Y COMMON COUNTIES
14 DESOTO Y COMMON COUNTIES
15 DIXIE Y COMMON COUNTIES
16 DUVAL Y COMMON COUNTIES
17 ESCAMBIA Y COMMON COUNTIES
18 FLAGLER Y COMMON COUNTIES
19 FRANKLIN Y COMMON COUNTIES
2 GOOD Y CARES SUBJECTIVE_HEALTH_EVALUATION
20 GADSDEN Y COMMON COUNTIES
21 GILCHRIST Y COMMON COUNTIES
22 GLADES Y COMMON COUNTIES
23 GULF Y COMMON COUNTIES
24 HAMILTON Y COMMON COUNTIES
25 HARDEE Y COMMON COUNTIES
26 HENDRY Y COMMON COUNTIES
27 HERNANDO Y COMMON COUNTIES
28 HIGHLANDS Y COMMON COUNTIES
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CONSUMER AGE VERIFICATION REPORT PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Program AC
Age at Start
Enroll or Start Enroll Provider Program Description Consumer Name Client ID DOB Svc date or Svc Date
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Contract Budget Information PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Program Service Provider Location County Served Provider Contract
Projected Service
Units Unit Measure
Projected Unduplicated
State Federal Share Client Count Begin Date End Date
Row Count 0 Amount Total
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Start Enroll Latest Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Date Asmt Date Worker
O3C1 1036 000 4061653427 Test CENTRAL 34982 W M 07091930 09102013 09102013 CIRTS20804 0 Name
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Start Enroll Date
Latest Asmt Date Worker
4061593624 Test Name CENTRAL 34946 B F 11261940 12012011 12312013 CIRTS23407
Count 164
Unduplicated Client Count 163
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Assessments After DOD Report
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Owner 1025
The shaded records indicate clients who have different DOBs andor different names
Assemt Current PSA Owner Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Owner Assessor
Provider Assessor
Assemt Date
Assemt Type
Unduplicated Count Total 0
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Open Enrollments
The Vital Statistics Data for 07192002 - 09112014PSA ALL Provider ALL Program Status ACTV Include MLTC ACTVS N
The shaded records indicate clients who have different DOBs andor different names
Enroll PSA
Enrollment Provider Loc Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Enroll Program Status
Enroll Program
Current Owner ID
02 1065 0072 4062244026 Test Name Test Name 10222004 03231917 03231917 ACTV CCE 1065
Count of enrollments for the Provider 1
Count of enrollments for the PSA 1
Count of enrollments for the Report 1
Unduplicated Count of Individuals with open enrollments and DOD PSA Total Clients Count
02 1
Total 1
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Unduplicated count of individuals with Services after DOD
PSA Total Clients Count
Report Total
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
List of Clients with PSA table entry for SERVICES_AFTER_DOD
Unduplicated Count Total 0
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Age
Provider
Total
Age lt 60 Age 60 - 64 Age 65 - 74 Age 75 - 84 Age 85+ Total Clients Avg Age
Total
Avg Age
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Ethnicity
Provider Hispanic Other Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Race
American Indian Native Hawaiian Other Provider Asian Alaska Native Black Pacific Islander Minority White Multiple Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Gender
Provider Male Female Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 4 of 5 demo_all_prvrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Monthly Income
Provider 0 - - Higher than Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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None
Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Total Persons Served 0
Age lt 60 Years 0 0
Age 60 - 64 0 0
Age 65 - 74 0 0
Age 75 - 84 0 0
Age 85+ 0 0
Total Age 0 0
Average 000
Ethnicity Hispanic 0 0
Other Ethnicity 0 0
Unknown Ethnicity 0 0
Total 0 0
Race Asian 0 0
American Indian Alaska Native 0 0
Black 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority 0 0
White 0 0
Multiple 0 0
Unknown 0 0
Total 0 0
Sex Male 0 0
Female 0 0
Unknown Sex 0 0
Total 0 0
Monthly Income 0 - 0 0
- 0 0
Higher than 0 0
Unknown 0 0
Total 0 0
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Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Client ID Date Of Birth Ethnicity Race Sex Individual Monthly Income
Report run on 08312018 1058 AM Page 2 of 2 demo_by_prov_detrdf Report run byRSHQALL Dispose of this report so that it can not be read or reconstructed
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Demographics of Clients OAA Registered Served Only PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 City All Cities Program All Programs Service All Services County ALL COUNTIES Table OAA Registered Services Only Low Income Medium Income
Total Persons Served 0
Agelt 60 Years
Age 60 - 64
Age 65 - 74
Age 75 - 84
Age 85+
0
0
0
0
0
0
0
0
0
0
Monthly Income
0 -
-Higher than
Unknown
0
0
0
0
0
0
0
0
Total
Average
0
000
0 Total 0 0
Ethnicity Hispanic
Other
Unknown
0
0
0
0
0
0
Living Situation
Alone
Null
Policy Change
0
0
0
0
0
0
Total 0 0 Unknown
With Caregiver
0
0
0
0
Race Asian 0 0
With Other
With Other Caregiver
0
0
0
0
American Indian Alaska Native
Black
0
0
0
0Total Living Situation 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority
White
0
0
0
0 Limited English Proficiency
Multiple
Unknown
Total Race
0
0
0
0
0
0
Yes
No
Unknown
0
0
0
0
0
0
Total 0 0
Sex Male
Female
Unknown
0
0
0
0
0
0
Total 0 0
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Disaster Assistance Clients for a Provider PSA ALL Provider All Providers Location 0000 Worker All Workers City All Cities Zip Code All Zip Codes Sort By ZIP
Provider 1036 Provider Name Location 0000 Worker CIRTS18634
Need Care Client Name Address City Zip County Phone Asst Reg Situation Relat Care phone Care Name
34946 N WO DA 000 SAINT JAMES DRIVE CENTRAL (025) 101-0620 Test NameTest Name SAINT LUCIE (005) 100-0369 Y
Client is active and no assessment information is available Special Shelter and Special Registry are unknown
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
Total by PSA 0
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
ALACH BAKER BAY BRADF BREVA BROWA CALHO CHARL CITRUS CLAY COLLIE COLUM DESOT DIXIE DUVAL ESCAM FLAGL FRANK GADSDAssisted Household Report UA ORD RD RD UN OTTE R BIA O BIA ER LIN EN
1 of Household Assisted 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Households AssistedWith Gross Income
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C 100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D 125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
3 Households with at leastOne member
A 60 Years or older 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B Disabled 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C Age 5 years or under 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D Under 60 Years Old 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Undup Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Assisted
Applicant Household Report
of Applicant Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Energy Assisted Household Report
County of Assisted
Households
Households Assisted By Poverty Level
Under 75 75 - 100 101 - 125 126 - 150 Over 150 60 Years or older
At least one member who is
Age 5 years Age 2 years Age 3 years Disabled or younger and younger through 5
Under 60 Years Old
Undup Households
Assisted
Energy Assistance Total
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Unduplicated Total 0 0
County of Assisted
Households Under 75 75 - 100
Households Assisted By Poverty Level
101 - 125 126 - 150 Over 150 60 Years or older Disabled
Age 5 years or younger
Age 2 years and younger
Age 3 years through 5
Under 60 Years Old
At least one member who is
Undup Households
Assisted
Other Assisted Household Report
Other Assistance Total
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Applicant Household Report
County of Applicant
Households Under 75 75 - 100 101 - 125 126 - 150 Over 150 Income data
unavailable
Total 0
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01
Enrollment Active Consumer Count by Program PSA ALL Provider ALL PROVIDERS
County Description Program Count of Clients
BREVARD
ADI
CCE
HCE
LSP
NDP
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
MLTC
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
31
57
44
5
62
123
141
26
9
7
5
40
5
50
67
129
2
19
42
29
1
233
79
63
8
2
14
3
37
14
47
3
3
33
127
10
02
03
04
ALACHUA
BAKER
BAY
BRADFORD
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05
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Enrollment Terminations with Reasons PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 Program All Programs Program Status ALL Program Status Worker ALL WORKERS
Last First Program Medicaid Provider Start End Name Name Client ID Status Description Worker Number Program Location Enrollment Enrollment
Count 0
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Enrollments with Care Plan Report
PSA ALL Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTIVE STATUS Care Plan Service ALL SERVICES Care Plan Start 01012017 Care Plan End 12312017
Care Plan Care Plan Care Plan Client Name
Unduplicated Client Count 0
Client ID Program Status Worker Start Date End Date Service
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PSA CLIENT_ID CLIENT_NAME OWNER PROVIDER_ID ASSESSMENT_DATE ASSESSOR_NAME MEDICAID_NUMBER CAREGIVER_CHANGE ENVIRONMENT_CHANGE HEALTH_CHANGE INCOME_CHANGE SITUATION_CHANGE INITIAL_ASSM ANNUAL_ASSM SSN REFERRAL_SOURCE 1114 N N N N Y N 771771777 SELFFAMILY 812017 JANE CASEWORKER 2 1001141633 TEST TEST N
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Fixed Service Costs List PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Provider Location County Program Service Reimbursement Unit Rate Provider Cost Per Unit Begin Valid End Valid
Count 0
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Active AC Consumers Receiving an APS Referral PSA ALL Owner All Owners Risk Level H Program AC Referral Start Date 01012017 Referral End Date 12312017
Start Enroll Risk Referral PSA Client ID Client Name Owner ID Date Prog Provider Workers Level Date
Total Count 0
Total Clients 0
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Active MLTC Clients Who are ACTV APCL or APPL in Another Program
PSA ALL Provider ALL
Program Status ACTV
Include NDP Y
Active MLTC Clients Information
PSA Owner ID Client ID Client Name
02 4061692109 Test NamePSA Count 1
Total Count 1
Unduplicated Client Count 1
MLTC Start Enrollment Date
11012013
Worker
CIRTS15124
Provider
1065
Other Programs Information
Location Program Program Status
0043 O3C1 ACTV
Start Enrollment Date
04042014
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Active or APCL Clients with Caregiver Information PSA ALL Provider ALL PROVIDERS Program AC Program Status ACTV Sort by PROVIDER
Provider Location Program
Program Status Worker Clinet ID Client Name
Most recent Asmt Date Asmt Priority with CaregiverType Score
Risk Score Caregiver Name
HCE Relationship Indicator
1380 0181AC ACTV CIRTS16813 4062414494 Test Name 04232014 701A 40 Test OR N
Count 1
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Active PACE Clients Who are ACTV APCL or APPL in Another Program PSA ALL
Provider ALL
-------- Active PACE Clients Information -------- ------ Other Programs Information ----
PSA Owner ID Client ID Client Name Provider Location Program Program Status
Total Count 0
Unduplicated Client Count 0
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ACTV CCE HCE and ADI Clients with No Care Plan PSA ALL
Program ALL PROGRAMS Provider ALL PROVIDERS
Owner All Owners
Enrollment Information PSA Client ID Name Owner Provider Loc Program Start Date Worker
01 4062521310 Test Name 1911 1911 0932 CCE 03272014 CIRTS29059
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ACTV CCE HCE and ADI Clients with No Care Plan PSA ALL
Program ALL PROGRAMS Provider ALL PROVIDERS
Owner All Owners
PSA Client ID Name Owner Enrollment Information
Provider Loc Program Start Date Worker
4061605936 Test Name 1785 1927 0072 ADI 07202006 CIRTS26739
11
Duplicated Count 72 Unduplicated Counts 70
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ACTV APPL APCL Clients who have moved to another PSA PSA ALL
Provider ALL PROVIDERS
Address Enrollment Client ID Client Name Provider Loc Program Program Start PSA PSA Status Enrollment
01A 02 4062760605 1191 0072 CCE ACTV 11082011 Test Name
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Aging Network Provider Information Report PSA ALL
Address PSA Provider Loc Provider Name Type Provider Address Telephone
01 1147 B
1147
0072 Provider Name
0073 Provider Name B
1147
1147
0100 Provider Name
0179 Provider Name B
1271 B
1271 B
1271
0000 Provider Name
0001 Provider Name
0002 Provider Name B
1271 B
1271
0003 Provider Name
0004 Provider Name B
1271 B
1271
0072 Provider Name
0073 Provider Name B
1271 0100 Provider Name B
1271 B
1271 B
1271 B
1271 B
1271
0101 Provider Name
0138 Provider Name
0179 Provider Name
0286 Provider Name
0287 Provider Name B
123 Provider CALICO DRIVE STAYTON FL 59255
123 Provider TERRA COTTA STREET DARRINGTON
FL 57399
123 Provider LANGTOWN ROAD DARRINGTON FL 57399
123 Provider POINTE LANE Bonum integritas corporis misDARRINGTON FL 58398
123 Provider OAK DRIVE SUNNYVALE MO 83407
123 Provider HOTT STREET DARRINGTON FL 58398
123 Provider GRASSELLI STREET DARRINGTON FL 68396
123 Provider HEAVENS WAY MORRISONS CROSSROADS AL 33165
123 Provider GOOSETOWN DRIVE MIDVILLE
FL 93176
123 Provider PIKE STREET BELLOWS FALLS
FL 48405
123 Provider GLENVIEW DRIVE SUSSEX FL
123 Provider JONES AVENUE BLYTHEVILLE
FL 14027
123 Provider HENERY STREET SUSSEX FL
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Aging Network Provider Information Report PSA ALL
PSA Provider Loc Provider Name Address Type Provider Address Telephone
11 1952 B
1952 B
1952 B
1952 B
1952 B
1952 B
1952 B
123 Test Street ELLSINORE FL 38234 3789 WHITE
123 Test Street OHATCHEE FL 45235 3408 NORMA
123 Test Street WHITE CLOUD FL 46226
123 Test Street NEOSHO FL 06231
123 Test Street WHITE CLOUD FL 16168 3678 OLD
123 Test StreetWHITE CLOUD FL 06231 184 GRANT
123 Test Street WHITE CLOUD FL 93236
1952
1955
1956
B 3123 Test Street Quid censes in Latino fore IaWHITE CLOUD FL 70226
1957
0Provider Name
0Provider Name
0Provider Name
0Provider Name
0Provider Name
0Provider Name
0Provider Name
0Provider Name
0Provider Name
0Provider Name
0Provider Name B 123 Test Street Sed ad rem redeamus ComprehenWHITE CLOUD FL 38227
1957
1958
Count
0474 Provider Name
0072 Provider Name
427
B 123 Test Street BRANCH ROAD Quid ergo hoc loco intellegit WHITE CLOUD FL 25224
Count Total 3117
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Aging Network Providers Report PSA ALL
PSA 01
Provider 1271 Provider Name Provider Name
Location 0000 Location Name Provider Name
Location Business Address 3123 Test Drive DARRINGTON FL 58398
County Served OKALOOSA Phone Fax Location Contact
Provider Director Provider Profit Status Non-Profit
ACCESS_PT CCE_LA N HCE OAA OTHER
ADI EHEAP LSP RELF
CCE Y FOCAL_PT NSIP SR_CTR
Provider 1271 Provider Name Provider Name
Location 0001 Location Name Provider Name
Location Business Address 1234 Test OAK DRIVE SUNNYVALE MO 83407
Phone Fax Location Contact County Served OKALOOSA
Provider Director Provider Profit Status Non-Profit
ACCESS_PT CCE_LA N HCE OAA OTHER
ADI EHEAP LSP RELF
CCE Y FOCAL_PT NSIP SR_CTR
Provider 1271 Provider Name Provider Name
Location 0004 Location Name Provider Name
Location Business Address 1123 Test HEAVENS WAY MORRISONS CROSSROADS AL
33165 Phone County Served OKALOOSA Fax Location Contact
Provider Director Provider Profit Status Non-Profit
ACCESS_PT CCE_LA N HCE Y OAA OTHER
ADI EHEAP LSP RELF
CCE FOCAL_PT NSIP SR_CTR
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Start End Worker Most Recent Nutr Medicaid Program Provider Location Client ID Client Name Status Enrollment Enrollment Worker Active Score Number
O3C1 1036 0000 4061653427 Test Name ACTV 09102013 CIRTS20804 Y 1
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Start End Worker Most Recent Nutr Medicaid Program Provider Location Client ID Client Name Status Enrollment Enrollment Worker Active Score Number
O3C1 1036 0000 4061638016 Test Name ACTV 09122013 CIRTS20804 Y 2
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Start End Worker Most Recent Nutr Medicaid Program Provider Location Client ID Client Name Status Enrollment Enrollment Worker Active Score Number
O3C2 1036 0000 4062000152 Test Name ACTV 02072011 CIRTS23407 N 3
1036 0000 4061594062 ISAACS HATTIE ACTV 11192012 CIRTS20804 Y 5
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Start End Worker Most Recent Nutr Medicaid Program Provider Location Client ID Client Name Status Enrollment Enrollment Worker Active Score Number
O3C2 1036 0000 4062379505 Test Name ACTV 11192012 CIRTS20804 Y 5
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Start End Worker Most Recent Nutr Medicaid Program Provider Location Client ID Client Name Status Enrollment Enrollment Worker Active Score Number
O3C2 1036 0000 4062401063 Test Name ACTV 10162013 CIRTS20804 Y 3
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Provider Location Client ID Client Name Program Status
Start Enrollment
End Enrollment Worker
Worker Active
Most Recent Nutr Score
Medicaid Number
O3C2 1036 0000 4062538939 ACTV 12082000 CIRTS20388 Y Test Name
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All Enrollments Counts During Date Range PSA ALL Start Date 01012017 End Date Location 0000 Provider Program Program Status
12312017 ALL PROVIDERS
ACTV
Group By Program Provider Location
Program Provider Location Client Count O3C1 1036 0000 45
1951 0000 3
O3C2 1036 0000 113
OA3E 1821 0000 2
OA3ES 1821 0000 1
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C1 1036 0000 4061950299 Test Name ACTV 04072011 CIRTS23407 N 11
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C1 1036 4062586019 Test Name ACTV 12292008 CIRTS23407 N 1
Total for Location 45
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C1 1951 0000 4062452921 Test Name ACTV 03301989 CIRTS22695 N 10
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4062786256 Test Name ACTV 09232013 CIRTS20804 Y 4 1
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4062380426 Test Name ACTV 04112012 CIRTS23407 N 55 2
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4061608826 Test Name ACTV 08102011 CIRTS18634 Y 7 3
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4062615533 Test Name ACTV 10032013 CIRTS20804 Y 6 3
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start Enrollment
End Enrollment Worker
Worker Active
Medicaid Number
Most Recent Nutr Score Rank
O3C2 1036 4062466582 Test Name ACTV 10262010 CIRTS23407 N 105 2
Total for Location 113
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PSA
APCL Clients With No Services ALL Owner All Owners Provider ALL PROVIDERS
Start Date 01012017 End Date 12312017
Includes Clients Receiving Only CM INSC SCAS CA REFE Services
PSA Client ID Client Name Owner Provider Program
Count 0
Unduplicated Clients Count 0
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APCL Clients With Services PSA ALL Owner All Owners Provider ALL PROVIDERS Start Date 01012017 End Date 12312017
Exclude CM CA INSC REFE SCAS
PSA Client ID Name Owner Provider Program 10 4062527553 Test Name 1539 1929 CCE
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APCL Clients With Services PSA ALL Owner All Owners Provider ALL PROVIDERS Start Date 01012017 End Date 12312017
Exclude CM CA INSC REFE SCAS
PSA Client ID Name Owner Provider Program 11 4062732638 Test Name 1177 1177 LTCC
Total 21067
Unduplicated clients count 12460
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APS Assessments PSA ALL Risk Level ALL Owner All Owners Referral Date From 01012017 To 12312017
Order by Referral Date and Owner ID
PSA 03
Ref Date Owner ID Client ID Client Name Risk Level Asmt Type Asmt Date
03032017 1390 4062058415 L 701A 03302018 Test Name
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APS Assessments PSA ALL Risk Level ALL Owner All Owners Referral Date From 01012017 To 12312017
Order by Referral Date and Owner ID
12042017 1980 4061617559 H 701B 12072017 Test Name
Assessment Count for the PSA 52
PSA 04A
Ref Date Owner ID Client ID
09102017 4062308458
Client Name
Test Name
Risk Level
H
Asmt Type
O
Asmt Date
09162017
Assessment Count for the PSA 2
Risk Level H
M
L
Count of Assessments 138
23
21
Total Count of Assessments 182
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APS Repeat Referrals in a Time Range
PSA ALL Owner All Owners
Start Date 01012017 End Date 12312017
Current DOEA CIRTS Cirts SSN if Risk Date Created PSA Owner Abuse No different than DCF DCF SSN Name County Level Date of Birth Date Sent by DCF
Count 0
Unduplicated Client Count by PSA
PSA Count SSN
Total
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Assessed Prioritized Consumer List PSA ALL Provider ALL PROVIDERS Program AC County ALL COUNTIES
County Program Consumer Name Client ID
Total Count 0
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Assessment Due Report PSA 01 Start Date 01012017 End Date 08312018 Owner ALL PROVIDERS Worker ALL WORKERS Program Status ACTV and APCL Assessment Type Needed ALL
Overdue and missing assessments are always listed
Owner ID 1065
Client ID Client Name
Owner Assessor ID
Date of Birth
06281928
CIRTS28099
County of Service
GULF
Worker Name HARPER KENNY
Zip Assessment PSA Date
32534 01 01022014
Type
701A
Active Y
Nutr PriorityScore Score
11 58
Rank
5
Due Date
01022015
Status
701S OVERDUE
LTCC APPL Start Date
03252014 4062235673 Test name
Total Clients for Worker 1
Total Clients for Owner 1
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Assessment Due Report PSA 01 Start Date 01012017 End Date 08312018 Owner ALL PROVIDERS Worker ALL WORKERS Program Status ACTV and APCL Assessment Type Needed ALL
Overdue and missing assessments are always listed
Summary by PSA
PSA 01 701A Overdue 1
701B Overdue 213
701C Overdue 0
701S Overdue 157
No 701A 0
No 701B 2
No 701C 0
No 701S 0
701A Not Overdue 0
701B Not Overdue 0
701C Not Overdue 0
701S Not Overdue 0
701S Optional 0
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CIC Service Units and Costs Projections County SummaryPSA 99 Program CCE
Start Date 01012017 End Date 12312017
County LEON
Total Total Total Avg Max Projected
StateFederal Projected Reimbursement Provider Unduplicated Provider Service Share Service Units Unit Rate Cost Per Unit Client Count
Report Total
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CIC Service Units and Costs Projections Provider SummaryPSA ALL Provider ALL PROVIDERS Program FEDERALLY FUNDED (0101 TO 1231) Year 2017 From 01012017 To 12312017
PSA County Program Service Total State
Federal Share
Total Projected
Service Units
Avg Reimbursement
Unit Rate
Max Provider
Cost Per Unit
Total Projected Unduplicated Client Count
02 FRANKLIN O3C1 CONGREGATE MEALS $810300 1710 15
Program Total
County Total
$810300
$810300
GULF O3C1 CONGREGATE MEALS $25205 3 5
Program Total $25205
O3C2 HOME DELIVERED MEALS $25205 3 6
Program Total
County Total
$25205
$50411
LEON O3C1 CONGREGATE MEALS $621300 1311 15
CONGREGATE MEALS GUEST
CONGREGATE MEALS VOLUNTEERS
$252055
$277260
25
30
2
5
Program Total $1150615
O3C2 HOME DELIVERED MEAL GUEST $252055 25 3
Program Total $252055
OA3D PEARLS (SESSION 5)
PEARLS (SESSION 6)
PEARLS (SESSION 7)
PEARLS (SESSION 8)
$10247
$10247
$10247
$10247
10
10
10
10
3
3
3
3
Program Total $40988
OA3E RESPITE IN-HOME $200 2 2
Program Total
County Total
$200
$1443858
WAKULLA O3C2 EMERGENCY HOME DELIVERED SHELF MEALS
$8065604 14899 90
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CIC Service Units and Costs Projections - PSA Summary
PSA ALL Program CCE
Strat Date 01012017 End Date 12312017
Total
PSA County Provider Service
Total State Federal
Share
Total Projected
Service Units
Avg Reimbursement
Unit Rate
Max Projected Provider Unduplicated
Cost Per Unit Client Count
02 LEON SOUTHERN SERVICE CASE MANAGEMENT PROVIDER EMERGENCY HOME DELIVERED SHELF MEALS
$2175533
$602000
483
689
32
20
HOME DELIVERED MEALS $530262 993 5
MATERIAL AID $1994536 199
Provider Total $5302331
CountyTotal $5302331
WAKULLA SOUTHERN SERVICE CASE MANAGEMENT PROVIDER EMERGENCY HOME DELIVERED SHELF MEALS
$2175533
$1240200
483
689
32
5
MATERIAL AID $1994536 199
Provider Total $5410269
CountyTotal $5410269
PSA Total $10712599
05 PINELLAS BURSTEIN-APPLEBEE ADULT DAY CARE $000 0 $900 $1000 0
COUNSELING (MENTAL HEALTH COUNSELINGSCREENING) - INDIVIDUAL
Provider Total
$000
$000
0 $6600 $7700 0
CountyTotal $000
PSA Total $000
Report Total $10712599
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CID Service Units and Costs Projections - PSA SummaryPSA ALL Program CCE
Start Date 01012017 End Date 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
PSA County Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
02 LEON CASE MANAGEMENT $2175533 483
EMERGENCY HOME $602000 689DELIVERED SHELF MEALS HOME DELIVERED MEALS $530262 993
MATERIAL AID $1994536 199
County Total $5302331 2364
WAKULLA CASE MANAGEMENT $2175533 483
EMERGENCY HOME $1240200 689DELIVERED SHELF MEALS MATERIAL AID $1994536 199
County Total $5410269 1371
PSA Total $10712599 3735
05 PINELLAS ADULT DAY CARE $000 0
COUNSELING (MENTAL $000 0 HEALTH COUNSELINGSCREENING) - INDIVIDUAL
County Total $000 0
PSA Total $000 0
Report Total $10712599 3735
$900 $900 $900 $1000 $1000 $1000
$6600 $6600 $6600 $7700 $7700 $7700
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CID Service Units and Costs Projections County SummaryPSA 99
Program CCE County LEON
Start Date 01012017 End Date 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
Report Total
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CIE Service Units and Costs Projections - PSA Summary - All Programs
PSA 99 Program FEDERALLY FUNDED (0101 TO 1231) Year 2017 From 01012017 To 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
Program Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
Report Total
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CIE Service Units and Costs Projections - PSA Summary
PSA ALL Program CCE
Start Date 01012017 End Date 12312017
Avg High Low Total Total Avg High Low Provider Provider Provider
StateFederal Projected Reimbursement Reimbursement Reimbursement Cost Cost CostPSA
02
Service
CASE MANAGEMENT
Share
$4351066
Service Units
966
Unit Rate Unit Rate Unit Rate Per Unit Per Unit Per Unit
EMERGENCY HOME DELIVERED SHELF MEALS $1842200 1378
HOME DELIVERED MEALS $530262 993
MATERIAL AID $3989071 398
PSA Total $10712599 3735
05 ADULT DAY CARE $000 0 $900 $900 $900 $1000 $1000 $1000
COUNSELING (MENTAL HEALTH $000 0 $6600 $6600 $6600 $7700 $7700 $7700 COUNSELINGSCREENING) - INDIVIDUAL
PSA Total $000 0
Report Total $10712599 3735
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CAREGIVER SEARCH REPORT
SEARCH RESULTS FOR CONSUMERS
Criteria First Name Last Name SSN PSA ALL
Client Name Client SSN Caregiver Name Caregiver SSN
000000000 000000000 Test Name Test Name
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CARES Referrals in a Time Range PSA ALL
Start Date 01012017 End Date 12312017
Referred to ALL REFERRALS
Referring PSA Employee Name Client Name Client ID
Referral Imminent NH Admit Aging Date Risk Date Referred To Cares Provider Name Received Date
03A 4061561263 Test Name Test Name 09242017 Y 05292017 ARC or ADRC 09252017
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CARES Referrals in a Time Range PSA ALL
Start Date 01012017 End Date 12312017
Referred to ALL REFERRALS
Referring PSA Employee Name Client Name Client ID
Referral Date
Imminent Risk
NH Admit Date Referred To Cares Provider Name
Aging Received Date
04B Test Name Test Name 4061738075 04082017 N ARC or ADRC Test Name 04082017
Total Clients 110
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CARES Referrals not acknowledged by the Aging Network PSA ALL For Referrals after 01012017 Owner ID ALL Owners
Unduplicated Client count Cares Office Total Clients Count
Report Total
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
CIRTS Issue PSA Client ID Client Name Program
Program Status Start Provider Enrollment ID Provider Name
APCL CLIENT WITH DATE OF DEATH 08 4061759417 Test Name OA3B APCL 07232013 1141 WESTERN WORLD RADIO
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
Program Start Provider CIRTS Issue PSA Client ID Client Name Program Status Enrollment ID Provider Name
06 LTCC APCL 01242014 1514 4061713685 Test Name APCL CLIENT WITH DATE OF DEATH CENTRAL THE ORIGINAL HOUSE OF PIES
Count 503
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Civil Rights PSA ALL Provider ALL PROVIDERS Program AC Start Date 01012017 End Date 12312017 The Poverty Level for Single is The Poverty Level for Couple is Sort by County
County Unduplicated Count
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Client Information Report Start Date 01012017 End Date 12312017
Client ID 1001141246
Emergency
Client Name Test Name
Telephone () - Address 78 TEST STREET TALLAHASSEE FL 32399
Most Recent Caregiver Information Date Updated
Doctor
Comments
Client Demographic Information
Birth Date 06041940 Race W
Owner ID Ethnicity O
Most Recent Income Information
Ind Mon Inc Cpl Mon Inc
Ind Assets Couple Assets
Most Recent Assessment Information
Asmt Date Ref Risk Lvl
Asmt Site Spec Shel
AsmtType Spec Reg
Ref Date Primary CG
Ref Source Living Sit
Enrollment Information
Sex
Marital Status
F
S
Medicaid Number
ADL Score
ADL Count
IADL Score
IADL Count
Memory Score
Priority Score
Env Score
Nutr Score
Risk Score
Social Score
Rank
Provider Location Program Program Status Worker Start Date End Date
Care Plan Service Needed
Date Service Units Type Frq End Date
Care Plan Service Planned
Program Service Units Type Frq Start Date End Date
Services Received between 01012017 and 12312017
Service Billed Provider Location Worker Program Service Date Units Unit Type Amount
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Provider N
Client Service Units Report PSA ALL Provider ALL PROVIDERS Location 0000
Program ALL PROGRAMS Service ALL SERVICES Worker ALL WORKERS
City ALL CITIES Include Zero Unit N Include Aggregate N Calculated Amount equals the number of Units Provided times Fixed Cost if it existsService Start Date 01012017 Service End Date 12312017 If Fixed Cost does not exist Calculated
Group by PSA Provider Location Client Name County Worker Amount equals Billed Amount
Unduplicated Client Count 0 Grand Total 000 $000
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Clients In Common PSA All Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 County All Counties Worker All Workers
County JEFFERSON
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
MIAMI-DADE
0 0 0 0 0 0 0 0 0
4061539538 Test NameCounty Count
County
0 01
X
0 1
X
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
4061650856 Test Name X 4061486560 Test Name X 4062452921 Test Name X
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Clients Served Not Enrolled PSA ALL Start Date 01012017 End Date 12312017 Locations 0000 Provider All Providers
Service Service Min Serv Max Serv Program Start End Enrollment PSA Provider Location Program Consumer Name Client ID Service Date Date Status Enrollment Enrollment Provider
Count 0
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
4061472791 04
09
1092
1291
0072
0042
LTCC
LTCC
APCL
APCL
4062714543 06
06
1514
1762
0072
5006
LTCC
LTCC
APCL
APPL
4061802246 11
06
1177
1514
0179
0072
LTCC
LTCC
APCL
APCL
4061563719 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062644312 06
08
1514
1771
0072
0896
LTCC
LTCC
APCL
APCL
1001141670 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
1001141671 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
4062375003 07
05
05
07
1263
1755
1638
1263
0368
0072
0072
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062155124 06
06
1762
1514
0072
0072
LTCC
LTCC
APPL
APCL
4061743886 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0369
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4061499927 06
06
1514
1762
0072
5005
LTCC
LTCC
APCL
APPL
4061583524 08
06
1144
1514
0896
0072
LTCC
LTCC
APCL
APCL
4062694843 06
03
1514
1922
0072
0179
LTCC
LTCC
APCL
APCL
4062744517 07
06
1263
1514
0369
0072
LTCC
LTCC
APCL
APCL
4062005488 10
11
10
11
1929
1177
1164
1177
0072
0073
0179
0179
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
Total Count 15
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CODE DESCRIPTIONS Category ALL STATE TABLES
Code Description Active Available To Code Category
0 UNKNOWN Y CARES SUBJECTIVE_HEALTH_EVALUATION
01 ALACHUA Y COMMON COUNTIES
02 BAKER Y COMMON COUNTIES
03 BAY Y COMMON COUNTIES
04 BRADFORD Y COMMON COUNTIES
05 BREVARD Y COMMON COUNTIES
06 BROWARD Y COMMON COUNTIES
07 CALHOUN Y COMMON COUNTIES
08 CHARLOTTE Y COMMON COUNTIES
09 CITRUS Y COMMON COUNTIES
1 EXCELLENT Y CARES SUBJECTIVE_HEALTH_EVALUATION
10 CLAY Y COMMON COUNTIES
11 COLLIER Y COMMON COUNTIES
12 COLUMBIA Y COMMON COUNTIES
13 MIAMI-DADE Y COMMON COUNTIES
14 DESOTO Y COMMON COUNTIES
15 DIXIE Y COMMON COUNTIES
16 DUVAL Y COMMON COUNTIES
17 ESCAMBIA Y COMMON COUNTIES
18 FLAGLER Y COMMON COUNTIES
19 FRANKLIN Y COMMON COUNTIES
2 GOOD Y CARES SUBJECTIVE_HEALTH_EVALUATION
20 GADSDEN Y COMMON COUNTIES
21 GILCHRIST Y COMMON COUNTIES
22 GLADES Y COMMON COUNTIES
23 GULF Y COMMON COUNTIES
24 HAMILTON Y COMMON COUNTIES
25 HARDEE Y COMMON COUNTIES
26 HENDRY Y COMMON COUNTIES
27 HERNANDO Y COMMON COUNTIES
28 HIGHLANDS Y COMMON COUNTIES
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CONSUMER AGE VERIFICATION REPORT PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Program AC
Age at Start
Enroll or Start Enroll Provider Program Description Consumer Name Client ID DOB Svc date or Svc Date
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Contract Budget Information PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Program Service Provider Location County Served Provider Contract
Projected Service
Units Unit Measure
Projected Unduplicated
State Federal Share Client Count Begin Date End Date
Row Count 0 Amount Total
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Start Enroll Latest Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Date Asmt Date Worker
O3C1 1036 000 4061653427 Test CENTRAL 34982 W M 07091930 09102013 09102013 CIRTS20804 0 Name
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Start Enroll Date
Latest Asmt Date Worker
4061593624 Test Name CENTRAL 34946 B F 11261940 12012011 12312013 CIRTS23407
Count 164
Unduplicated Client Count 163
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Assessments After DOD Report
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Owner 1025
The shaded records indicate clients who have different DOBs andor different names
Assemt Current PSA Owner Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Owner Assessor
Provider Assessor
Assemt Date
Assemt Type
Unduplicated Count Total 0
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Open Enrollments
The Vital Statistics Data for 07192002 - 09112014PSA ALL Provider ALL Program Status ACTV Include MLTC ACTVS N
The shaded records indicate clients who have different DOBs andor different names
Enroll PSA
Enrollment Provider Loc Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Enroll Program Status
Enroll Program
Current Owner ID
02 1065 0072 4062244026 Test Name Test Name 10222004 03231917 03231917 ACTV CCE 1065
Count of enrollments for the Provider 1
Count of enrollments for the PSA 1
Count of enrollments for the Report 1
Unduplicated Count of Individuals with open enrollments and DOD PSA Total Clients Count
02 1
Total 1
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Unduplicated count of individuals with Services after DOD
PSA Total Clients Count
Report Total
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
List of Clients with PSA table entry for SERVICES_AFTER_DOD
Unduplicated Count Total 0
Report run on 08312018 0207 PM Page 3 of 3 vs_servicesrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Age
Provider
Total
Age lt 60 Age 60 - 64 Age 65 - 74 Age 75 - 84 Age 85+ Total Clients Avg Age
Total
Avg Age
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 1 of 5 demo_all_prvrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Ethnicity
Provider Hispanic Other Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Race
American Indian Native Hawaiian Other Provider Asian Alaska Native Black Pacific Islander Minority White Multiple Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Gender
Provider Male Female Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 4 of 5 demo_all_prvrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Monthly Income
Provider 0 - - Higher than Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 5 of 5 demo_all_prvrdf
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None
Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Total Persons Served 0
Age lt 60 Years 0 0
Age 60 - 64 0 0
Age 65 - 74 0 0
Age 75 - 84 0 0
Age 85+ 0 0
Total Age 0 0
Average 000
Ethnicity Hispanic 0 0
Other Ethnicity 0 0
Unknown Ethnicity 0 0
Total 0 0
Race Asian 0 0
American Indian Alaska Native 0 0
Black 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority 0 0
White 0 0
Multiple 0 0
Unknown 0 0
Total 0 0
Sex Male 0 0
Female 0 0
Unknown Sex 0 0
Total 0 0
Monthly Income 0 - 0 0
- 0 0
Higher than 0 0
Unknown 0 0
Total 0 0
Report run on 08312018 1058 AM Page 1 of 2 demo_by_prov_detrdf Report run byRSHQALL Dispose of this report so that it can not be read or reconstructed
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Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Client ID Date Of Birth Ethnicity Race Sex Individual Monthly Income
Report run on 08312018 1058 AM Page 2 of 2 demo_by_prov_detrdf Report run byRSHQALL Dispose of this report so that it can not be read or reconstructed
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Demographics of Clients OAA Registered Served Only PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 City All Cities Program All Programs Service All Services County ALL COUNTIES Table OAA Registered Services Only Low Income Medium Income
Total Persons Served 0
Agelt 60 Years
Age 60 - 64
Age 65 - 74
Age 75 - 84
Age 85+
0
0
0
0
0
0
0
0
0
0
Monthly Income
0 -
-Higher than
Unknown
0
0
0
0
0
0
0
0
Total
Average
0
000
0 Total 0 0
Ethnicity Hispanic
Other
Unknown
0
0
0
0
0
0
Living Situation
Alone
Null
Policy Change
0
0
0
0
0
0
Total 0 0 Unknown
With Caregiver
0
0
0
0
Race Asian 0 0
With Other
With Other Caregiver
0
0
0
0
American Indian Alaska Native
Black
0
0
0
0Total Living Situation 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority
White
0
0
0
0 Limited English Proficiency
Multiple
Unknown
Total Race
0
0
0
0
0
0
Yes
No
Unknown
0
0
0
0
0
0
Total 0 0
Sex Male
Female
Unknown
0
0
0
0
0
0
Total 0 0
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Disaster Assistance Clients for a Provider PSA ALL Provider All Providers Location 0000 Worker All Workers City All Cities Zip Code All Zip Codes Sort By ZIP
Provider 1036 Provider Name Location 0000 Worker CIRTS18634
Need Care Client Name Address City Zip County Phone Asst Reg Situation Relat Care phone Care Name
34946 N WO DA 000 SAINT JAMES DRIVE CENTRAL (025) 101-0620 Test NameTest Name SAINT LUCIE (005) 100-0369 Y
Client is active and no assessment information is available Special Shelter and Special Registry are unknown
Report run on 08312018 1102 AM Page 1 of 8 disaster_by_provrdf
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
Total by PSA 0
Report run on 08312018 1111 AM Page 1 of 5 eheap_exceptionsrdf
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
ALACH BAKER BAY BRADF BREVA BROWA CALHO CHARL CITRUS CLAY COLLIE COLUM DESOT DIXIE DUVAL ESCAM FLAGL FRANK GADSDAssisted Household Report UA ORD RD RD UN OTTE R BIA O BIA ER LIN EN
1 of Household Assisted 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Households AssistedWith Gross Income
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C 100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D 125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
3 Households with at leastOne member
A 60 Years or older 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B Disabled 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C Age 5 years or under 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D Under 60 Years Old 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Undup Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Assisted
Applicant Household Report
of Applicant Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
Report run on 08312018 1111 AM Page 2 of 5 eheap_exceptionsrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Energy Assisted Household Report
County of Assisted
Households
Households Assisted By Poverty Level
Under 75 75 - 100 101 - 125 126 - 150 Over 150 60 Years or older
At least one member who is
Age 5 years Age 2 years Age 3 years Disabled or younger and younger through 5
Under 60 Years Old
Undup Households
Assisted
Energy Assistance Total
Report run on 08312018 1107 AM Page 1 of 3 eheap_summaryrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Unduplicated Total 0 0
County of Assisted
Households Under 75 75 - 100
Households Assisted By Poverty Level
101 - 125 126 - 150 Over 150 60 Years or older Disabled
Age 5 years or younger
Age 2 years and younger
Age 3 years through 5
Under 60 Years Old
At least one member who is
Undup Households
Assisted
Other Assisted Household Report
Other Assistance Total
Report run on 08312018 1107 AM Page 2 of 3 eheap_summaryrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Applicant Household Report
County of Applicant
Households Under 75 75 - 100 101 - 125 126 - 150 Over 150 Income data
unavailable
Total 0
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01
Enrollment Active Consumer Count by Program PSA ALL Provider ALL PROVIDERS
County Description Program Count of Clients
BREVARD
ADI
CCE
HCE
LSP
NDP
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
MLTC
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
31
57
44
5
62
123
141
26
9
7
5
40
5
50
67
129
2
19
42
29
1
233
79
63
8
2
14
3
37
14
47
3
3
33
127
10
02
03
04
ALACHUA
BAKER
BAY
BRADFORD
Report run on 08312018 1148 AM Page 1 of 18 actv_countrdf
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05
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Enrollment Terminations with Reasons PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 Program All Programs Program Status ALL Program Status Worker ALL WORKERS
Last First Program Medicaid Provider Start End Name Name Client ID Status Description Worker Number Program Location Enrollment Enrollment
Count 0
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Enrollments with Care Plan Report
PSA ALL Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTIVE STATUS Care Plan Service ALL SERVICES Care Plan Start 01012017 Care Plan End 12312017
Care Plan Care Plan Care Plan Client Name
Unduplicated Client Count 0
Client ID Program Status Worker Start Date End Date Service
Report run on 08312018 1054 AM Page 1 of 1 enroll_careplrdf Report run by RSHQALL Dispose of this report so that it cannot be read or reconstructed
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PSA CLIENT_ID CLIENT_NAME OWNER PROVIDER_ID ASSESSMENT_DATE ASSESSOR_NAME MEDICAID_NUMBER CAREGIVER_CHANGE ENVIRONMENT_CHANGE HEALTH_CHANGE INCOME_CHANGE SITUATION_CHANGE INITIAL_ASSM ANNUAL_ASSM SSN REFERRAL_SOURCE 1114 N N N N Y N 771771777 SELFFAMILY 812017 JANE CASEWORKER 2 1001141633 TEST TEST N
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Fixed Service Costs List PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Provider Location County Program Service Reimbursement Unit Rate Provider Cost Per Unit Begin Valid End Valid
Count 0
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Active MLTC Clients Who are ACTV APCL or APPL in Another Program
PSA ALL Provider ALL
Program Status ACTV
Include NDP Y
Active MLTC Clients Information
PSA Owner ID Client ID Client Name
02 4061692109 Test NamePSA Count 1
Total Count 1
Unduplicated Client Count 1
MLTC Start Enrollment Date
11012013
Worker
CIRTS15124
Provider
1065
Other Programs Information
Location Program Program Status
0043 O3C1 ACTV
Start Enrollment Date
04042014
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Active or APCL Clients with Caregiver Information PSA ALL Provider ALL PROVIDERS Program AC Program Status ACTV Sort by PROVIDER
Provider Location Program
Program Status Worker Clinet ID Client Name
Most recent Asmt Date Asmt Priority with CaregiverType Score
Risk Score Caregiver Name
HCE Relationship Indicator
1380 0181AC ACTV CIRTS16813 4062414494 Test Name 04232014 701A 40 Test OR N
Count 1
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Active PACE Clients Who are ACTV APCL or APPL in Another Program PSA ALL
Provider ALL
-------- Active PACE Clients Information -------- ------ Other Programs Information ----
PSA Owner ID Client ID Client Name Provider Location Program Program Status
Total Count 0
Unduplicated Client Count 0
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ACTV CCE HCE and ADI Clients with No Care Plan PSA ALL
Program ALL PROGRAMS Provider ALL PROVIDERS
Owner All Owners
Enrollment Information PSA Client ID Name Owner Provider Loc Program Start Date Worker
01 4062521310 Test Name 1911 1911 0932 CCE 03272014 CIRTS29059
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ACTV CCE HCE and ADI Clients with No Care Plan PSA ALL
Program ALL PROGRAMS Provider ALL PROVIDERS
Owner All Owners
PSA Client ID Name Owner Enrollment Information
Provider Loc Program Start Date Worker
4061605936 Test Name 1785 1927 0072 ADI 07202006 CIRTS26739
11
Duplicated Count 72 Unduplicated Counts 70
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ACTV APPL APCL Clients who have moved to another PSA PSA ALL
Provider ALL PROVIDERS
Address Enrollment Client ID Client Name Provider Loc Program Program Start PSA PSA Status Enrollment
01A 02 4062760605 1191 0072 CCE ACTV 11082011 Test Name
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Aging Network Provider Information Report PSA ALL
Address PSA Provider Loc Provider Name Type Provider Address Telephone
01 1147 B
1147
0072 Provider Name
0073 Provider Name B
1147
1147
0100 Provider Name
0179 Provider Name B
1271 B
1271 B
1271
0000 Provider Name
0001 Provider Name
0002 Provider Name B
1271 B
1271
0003 Provider Name
0004 Provider Name B
1271 B
1271
0072 Provider Name
0073 Provider Name B
1271 0100 Provider Name B
1271 B
1271 B
1271 B
1271 B
1271
0101 Provider Name
0138 Provider Name
0179 Provider Name
0286 Provider Name
0287 Provider Name B
123 Provider CALICO DRIVE STAYTON FL 59255
123 Provider TERRA COTTA STREET DARRINGTON
FL 57399
123 Provider LANGTOWN ROAD DARRINGTON FL 57399
123 Provider POINTE LANE Bonum integritas corporis misDARRINGTON FL 58398
123 Provider OAK DRIVE SUNNYVALE MO 83407
123 Provider HOTT STREET DARRINGTON FL 58398
123 Provider GRASSELLI STREET DARRINGTON FL 68396
123 Provider HEAVENS WAY MORRISONS CROSSROADS AL 33165
123 Provider GOOSETOWN DRIVE MIDVILLE
FL 93176
123 Provider PIKE STREET BELLOWS FALLS
FL 48405
123 Provider GLENVIEW DRIVE SUSSEX FL
123 Provider JONES AVENUE BLYTHEVILLE
FL 14027
123 Provider HENERY STREET SUSSEX FL
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Aging Network Provider Information Report PSA ALL
PSA Provider Loc Provider Name Address Type Provider Address Telephone
11 1952 B
1952 B
1952 B
1952 B
1952 B
1952 B
1952 B
123 Test Street ELLSINORE FL 38234 3789 WHITE
123 Test Street OHATCHEE FL 45235 3408 NORMA
123 Test Street WHITE CLOUD FL 46226
123 Test Street NEOSHO FL 06231
123 Test Street WHITE CLOUD FL 16168 3678 OLD
123 Test StreetWHITE CLOUD FL 06231 184 GRANT
123 Test Street WHITE CLOUD FL 93236
1952
1955
1956
B 3123 Test Street Quid censes in Latino fore IaWHITE CLOUD FL 70226
1957
0Provider Name
0Provider Name
0Provider Name
0Provider Name
0Provider Name
0Provider Name
0Provider Name
0Provider Name
0Provider Name
0Provider Name
0Provider Name B 123 Test Street Sed ad rem redeamus ComprehenWHITE CLOUD FL 38227
1957
1958
Count
0474 Provider Name
0072 Provider Name
427
B 123 Test Street BRANCH ROAD Quid ergo hoc loco intellegit WHITE CLOUD FL 25224
Count Total 3117
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Aging Network Providers Report PSA ALL
PSA 01
Provider 1271 Provider Name Provider Name
Location 0000 Location Name Provider Name
Location Business Address 3123 Test Drive DARRINGTON FL 58398
County Served OKALOOSA Phone Fax Location Contact
Provider Director Provider Profit Status Non-Profit
ACCESS_PT CCE_LA N HCE OAA OTHER
ADI EHEAP LSP RELF
CCE Y FOCAL_PT NSIP SR_CTR
Provider 1271 Provider Name Provider Name
Location 0001 Location Name Provider Name
Location Business Address 1234 Test OAK DRIVE SUNNYVALE MO 83407
Phone Fax Location Contact County Served OKALOOSA
Provider Director Provider Profit Status Non-Profit
ACCESS_PT CCE_LA N HCE OAA OTHER
ADI EHEAP LSP RELF
CCE Y FOCAL_PT NSIP SR_CTR
Provider 1271 Provider Name Provider Name
Location 0004 Location Name Provider Name
Location Business Address 1123 Test HEAVENS WAY MORRISONS CROSSROADS AL
33165 Phone County Served OKALOOSA Fax Location Contact
Provider Director Provider Profit Status Non-Profit
ACCESS_PT CCE_LA N HCE Y OAA OTHER
ADI EHEAP LSP RELF
CCE FOCAL_PT NSIP SR_CTR
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Start End Worker Most Recent Nutr Medicaid Program Provider Location Client ID Client Name Status Enrollment Enrollment Worker Active Score Number
O3C1 1036 0000 4061653427 Test Name ACTV 09102013 CIRTS20804 Y 1
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Start End Worker Most Recent Nutr Medicaid Program Provider Location Client ID Client Name Status Enrollment Enrollment Worker Active Score Number
O3C1 1036 0000 4061638016 Test Name ACTV 09122013 CIRTS20804 Y 2
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Start End Worker Most Recent Nutr Medicaid Program Provider Location Client ID Client Name Status Enrollment Enrollment Worker Active Score Number
O3C2 1036 0000 4062000152 Test Name ACTV 02072011 CIRTS23407 N 3
1036 0000 4061594062 ISAACS HATTIE ACTV 11192012 CIRTS20804 Y 5
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Start End Worker Most Recent Nutr Medicaid Program Provider Location Client ID Client Name Status Enrollment Enrollment Worker Active Score Number
O3C2 1036 0000 4062379505 Test Name ACTV 11192012 CIRTS20804 Y 5
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Start End Worker Most Recent Nutr Medicaid Program Provider Location Client ID Client Name Status Enrollment Enrollment Worker Active Score Number
O3C2 1036 0000 4062401063 Test Name ACTV 10162013 CIRTS20804 Y 3
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Provider Location Client ID Client Name Program Status
Start Enrollment
End Enrollment Worker
Worker Active
Most Recent Nutr Score
Medicaid Number
O3C2 1036 0000 4062538939 ACTV 12082000 CIRTS20388 Y Test Name
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All Enrollments Counts During Date Range PSA ALL Start Date 01012017 End Date Location 0000 Provider Program Program Status
12312017 ALL PROVIDERS
ACTV
Group By Program Provider Location
Program Provider Location Client Count O3C1 1036 0000 45
1951 0000 3
O3C2 1036 0000 113
OA3E 1821 0000 2
OA3ES 1821 0000 1
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C1 1036 0000 4061950299 Test Name ACTV 04072011 CIRTS23407 N 11
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C1 1036 4062586019 Test Name ACTV 12292008 CIRTS23407 N 1
Total for Location 45
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C1 1951 0000 4062452921 Test Name ACTV 03301989 CIRTS22695 N 10
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4062786256 Test Name ACTV 09232013 CIRTS20804 Y 4 1
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4062380426 Test Name ACTV 04112012 CIRTS23407 N 55 2
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4061608826 Test Name ACTV 08102011 CIRTS18634 Y 7 3
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4062615533 Test Name ACTV 10032013 CIRTS20804 Y 6 3
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start Enrollment
End Enrollment Worker
Worker Active
Medicaid Number
Most Recent Nutr Score Rank
O3C2 1036 4062466582 Test Name ACTV 10262010 CIRTS23407 N 105 2
Total for Location 113
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PSA
APCL Clients With No Services ALL Owner All Owners Provider ALL PROVIDERS
Start Date 01012017 End Date 12312017
Includes Clients Receiving Only CM INSC SCAS CA REFE Services
PSA Client ID Client Name Owner Provider Program
Count 0
Unduplicated Clients Count 0
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APCL Clients With Services PSA ALL Owner All Owners Provider ALL PROVIDERS Start Date 01012017 End Date 12312017
Exclude CM CA INSC REFE SCAS
PSA Client ID Name Owner Provider Program 10 4062527553 Test Name 1539 1929 CCE
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APCL Clients With Services PSA ALL Owner All Owners Provider ALL PROVIDERS Start Date 01012017 End Date 12312017
Exclude CM CA INSC REFE SCAS
PSA Client ID Name Owner Provider Program 11 4062732638 Test Name 1177 1177 LTCC
Total 21067
Unduplicated clients count 12460
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APS Assessments PSA ALL Risk Level ALL Owner All Owners Referral Date From 01012017 To 12312017
Order by Referral Date and Owner ID
PSA 03
Ref Date Owner ID Client ID Client Name Risk Level Asmt Type Asmt Date
03032017 1390 4062058415 L 701A 03302018 Test Name
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APS Assessments PSA ALL Risk Level ALL Owner All Owners Referral Date From 01012017 To 12312017
Order by Referral Date and Owner ID
12042017 1980 4061617559 H 701B 12072017 Test Name
Assessment Count for the PSA 52
PSA 04A
Ref Date Owner ID Client ID
09102017 4062308458
Client Name
Test Name
Risk Level
H
Asmt Type
O
Asmt Date
09162017
Assessment Count for the PSA 2
Risk Level H
M
L
Count of Assessments 138
23
21
Total Count of Assessments 182
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APS Repeat Referrals in a Time Range
PSA ALL Owner All Owners
Start Date 01012017 End Date 12312017
Current DOEA CIRTS Cirts SSN if Risk Date Created PSA Owner Abuse No different than DCF DCF SSN Name County Level Date of Birth Date Sent by DCF
Count 0
Unduplicated Client Count by PSA
PSA Count SSN
Total
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Assessed Prioritized Consumer List PSA ALL Provider ALL PROVIDERS Program AC County ALL COUNTIES
County Program Consumer Name Client ID
Total Count 0
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Assessment Due Report PSA 01 Start Date 01012017 End Date 08312018 Owner ALL PROVIDERS Worker ALL WORKERS Program Status ACTV and APCL Assessment Type Needed ALL
Overdue and missing assessments are always listed
Owner ID 1065
Client ID Client Name
Owner Assessor ID
Date of Birth
06281928
CIRTS28099
County of Service
GULF
Worker Name HARPER KENNY
Zip Assessment PSA Date
32534 01 01022014
Type
701A
Active Y
Nutr PriorityScore Score
11 58
Rank
5
Due Date
01022015
Status
701S OVERDUE
LTCC APPL Start Date
03252014 4062235673 Test name
Total Clients for Worker 1
Total Clients for Owner 1
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Assessment Due Report PSA 01 Start Date 01012017 End Date 08312018 Owner ALL PROVIDERS Worker ALL WORKERS Program Status ACTV and APCL Assessment Type Needed ALL
Overdue and missing assessments are always listed
Summary by PSA
PSA 01 701A Overdue 1
701B Overdue 213
701C Overdue 0
701S Overdue 157
No 701A 0
No 701B 2
No 701C 0
No 701S 0
701A Not Overdue 0
701B Not Overdue 0
701C Not Overdue 0
701S Not Overdue 0
701S Optional 0
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CIC Service Units and Costs Projections County SummaryPSA 99 Program CCE
Start Date 01012017 End Date 12312017
County LEON
Total Total Total Avg Max Projected
StateFederal Projected Reimbursement Provider Unduplicated Provider Service Share Service Units Unit Rate Cost Per Unit Client Count
Report Total
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CIC Service Units and Costs Projections Provider SummaryPSA ALL Provider ALL PROVIDERS Program FEDERALLY FUNDED (0101 TO 1231) Year 2017 From 01012017 To 12312017
PSA County Program Service Total State
Federal Share
Total Projected
Service Units
Avg Reimbursement
Unit Rate
Max Provider
Cost Per Unit
Total Projected Unduplicated Client Count
02 FRANKLIN O3C1 CONGREGATE MEALS $810300 1710 15
Program Total
County Total
$810300
$810300
GULF O3C1 CONGREGATE MEALS $25205 3 5
Program Total $25205
O3C2 HOME DELIVERED MEALS $25205 3 6
Program Total
County Total
$25205
$50411
LEON O3C1 CONGREGATE MEALS $621300 1311 15
CONGREGATE MEALS GUEST
CONGREGATE MEALS VOLUNTEERS
$252055
$277260
25
30
2
5
Program Total $1150615
O3C2 HOME DELIVERED MEAL GUEST $252055 25 3
Program Total $252055
OA3D PEARLS (SESSION 5)
PEARLS (SESSION 6)
PEARLS (SESSION 7)
PEARLS (SESSION 8)
$10247
$10247
$10247
$10247
10
10
10
10
3
3
3
3
Program Total $40988
OA3E RESPITE IN-HOME $200 2 2
Program Total
County Total
$200
$1443858
WAKULLA O3C2 EMERGENCY HOME DELIVERED SHELF MEALS
$8065604 14899 90
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CIC Service Units and Costs Projections - PSA Summary
PSA ALL Program CCE
Strat Date 01012017 End Date 12312017
Total
PSA County Provider Service
Total State Federal
Share
Total Projected
Service Units
Avg Reimbursement
Unit Rate
Max Projected Provider Unduplicated
Cost Per Unit Client Count
02 LEON SOUTHERN SERVICE CASE MANAGEMENT PROVIDER EMERGENCY HOME DELIVERED SHELF MEALS
$2175533
$602000
483
689
32
20
HOME DELIVERED MEALS $530262 993 5
MATERIAL AID $1994536 199
Provider Total $5302331
CountyTotal $5302331
WAKULLA SOUTHERN SERVICE CASE MANAGEMENT PROVIDER EMERGENCY HOME DELIVERED SHELF MEALS
$2175533
$1240200
483
689
32
5
MATERIAL AID $1994536 199
Provider Total $5410269
CountyTotal $5410269
PSA Total $10712599
05 PINELLAS BURSTEIN-APPLEBEE ADULT DAY CARE $000 0 $900 $1000 0
COUNSELING (MENTAL HEALTH COUNSELINGSCREENING) - INDIVIDUAL
Provider Total
$000
$000
0 $6600 $7700 0
CountyTotal $000
PSA Total $000
Report Total $10712599
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CID Service Units and Costs Projections - PSA SummaryPSA ALL Program CCE
Start Date 01012017 End Date 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
PSA County Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
02 LEON CASE MANAGEMENT $2175533 483
EMERGENCY HOME $602000 689DELIVERED SHELF MEALS HOME DELIVERED MEALS $530262 993
MATERIAL AID $1994536 199
County Total $5302331 2364
WAKULLA CASE MANAGEMENT $2175533 483
EMERGENCY HOME $1240200 689DELIVERED SHELF MEALS MATERIAL AID $1994536 199
County Total $5410269 1371
PSA Total $10712599 3735
05 PINELLAS ADULT DAY CARE $000 0
COUNSELING (MENTAL $000 0 HEALTH COUNSELINGSCREENING) - INDIVIDUAL
County Total $000 0
PSA Total $000 0
Report Total $10712599 3735
$900 $900 $900 $1000 $1000 $1000
$6600 $6600 $6600 $7700 $7700 $7700
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CID Service Units and Costs Projections County SummaryPSA 99
Program CCE County LEON
Start Date 01012017 End Date 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
Report Total
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CIE Service Units and Costs Projections - PSA Summary - All Programs
PSA 99 Program FEDERALLY FUNDED (0101 TO 1231) Year 2017 From 01012017 To 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
Program Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
Report Total
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CIE Service Units and Costs Projections - PSA Summary
PSA ALL Program CCE
Start Date 01012017 End Date 12312017
Avg High Low Total Total Avg High Low Provider Provider Provider
StateFederal Projected Reimbursement Reimbursement Reimbursement Cost Cost CostPSA
02
Service
CASE MANAGEMENT
Share
$4351066
Service Units
966
Unit Rate Unit Rate Unit Rate Per Unit Per Unit Per Unit
EMERGENCY HOME DELIVERED SHELF MEALS $1842200 1378
HOME DELIVERED MEALS $530262 993
MATERIAL AID $3989071 398
PSA Total $10712599 3735
05 ADULT DAY CARE $000 0 $900 $900 $900 $1000 $1000 $1000
COUNSELING (MENTAL HEALTH $000 0 $6600 $6600 $6600 $7700 $7700 $7700 COUNSELINGSCREENING) - INDIVIDUAL
PSA Total $000 0
Report Total $10712599 3735
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CAREGIVER SEARCH REPORT
SEARCH RESULTS FOR CONSUMERS
Criteria First Name Last Name SSN PSA ALL
Client Name Client SSN Caregiver Name Caregiver SSN
000000000 000000000 Test Name Test Name
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CARES Referrals in a Time Range PSA ALL
Start Date 01012017 End Date 12312017
Referred to ALL REFERRALS
Referring PSA Employee Name Client Name Client ID
Referral Imminent NH Admit Aging Date Risk Date Referred To Cares Provider Name Received Date
03A 4061561263 Test Name Test Name 09242017 Y 05292017 ARC or ADRC 09252017
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CARES Referrals in a Time Range PSA ALL
Start Date 01012017 End Date 12312017
Referred to ALL REFERRALS
Referring PSA Employee Name Client Name Client ID
Referral Date
Imminent Risk
NH Admit Date Referred To Cares Provider Name
Aging Received Date
04B Test Name Test Name 4061738075 04082017 N ARC or ADRC Test Name 04082017
Total Clients 110
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CARES Referrals not acknowledged by the Aging Network PSA ALL For Referrals after 01012017 Owner ID ALL Owners
Unduplicated Client count Cares Office Total Clients Count
Report Total
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
CIRTS Issue PSA Client ID Client Name Program
Program Status Start Provider Enrollment ID Provider Name
APCL CLIENT WITH DATE OF DEATH 08 4061759417 Test Name OA3B APCL 07232013 1141 WESTERN WORLD RADIO
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
Program Start Provider CIRTS Issue PSA Client ID Client Name Program Status Enrollment ID Provider Name
06 LTCC APCL 01242014 1514 4061713685 Test Name APCL CLIENT WITH DATE OF DEATH CENTRAL THE ORIGINAL HOUSE OF PIES
Count 503
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Civil Rights PSA ALL Provider ALL PROVIDERS Program AC Start Date 01012017 End Date 12312017 The Poverty Level for Single is The Poverty Level for Couple is Sort by County
County Unduplicated Count
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Client Information Report Start Date 01012017 End Date 12312017
Client ID 1001141246
Emergency
Client Name Test Name
Telephone () - Address 78 TEST STREET TALLAHASSEE FL 32399
Most Recent Caregiver Information Date Updated
Doctor
Comments
Client Demographic Information
Birth Date 06041940 Race W
Owner ID Ethnicity O
Most Recent Income Information
Ind Mon Inc Cpl Mon Inc
Ind Assets Couple Assets
Most Recent Assessment Information
Asmt Date Ref Risk Lvl
Asmt Site Spec Shel
AsmtType Spec Reg
Ref Date Primary CG
Ref Source Living Sit
Enrollment Information
Sex
Marital Status
F
S
Medicaid Number
ADL Score
ADL Count
IADL Score
IADL Count
Memory Score
Priority Score
Env Score
Nutr Score
Risk Score
Social Score
Rank
Provider Location Program Program Status Worker Start Date End Date
Care Plan Service Needed
Date Service Units Type Frq End Date
Care Plan Service Planned
Program Service Units Type Frq Start Date End Date
Services Received between 01012017 and 12312017
Service Billed Provider Location Worker Program Service Date Units Unit Type Amount
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Provider N
Client Service Units Report PSA ALL Provider ALL PROVIDERS Location 0000
Program ALL PROGRAMS Service ALL SERVICES Worker ALL WORKERS
City ALL CITIES Include Zero Unit N Include Aggregate N Calculated Amount equals the number of Units Provided times Fixed Cost if it existsService Start Date 01012017 Service End Date 12312017 If Fixed Cost does not exist Calculated
Group by PSA Provider Location Client Name County Worker Amount equals Billed Amount
Unduplicated Client Count 0 Grand Total 000 $000
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Clients In Common PSA All Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 County All Counties Worker All Workers
County JEFFERSON
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
MIAMI-DADE
0 0 0 0 0 0 0 0 0
4061539538 Test NameCounty Count
County
0 01
X
0 1
X
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
4061650856 Test Name X 4061486560 Test Name X 4062452921 Test Name X
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Clients Served Not Enrolled PSA ALL Start Date 01012017 End Date 12312017 Locations 0000 Provider All Providers
Service Service Min Serv Max Serv Program Start End Enrollment PSA Provider Location Program Consumer Name Client ID Service Date Date Status Enrollment Enrollment Provider
Count 0
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
4061472791 04
09
1092
1291
0072
0042
LTCC
LTCC
APCL
APCL
4062714543 06
06
1514
1762
0072
5006
LTCC
LTCC
APCL
APPL
4061802246 11
06
1177
1514
0179
0072
LTCC
LTCC
APCL
APCL
4061563719 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062644312 06
08
1514
1771
0072
0896
LTCC
LTCC
APCL
APCL
1001141670 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
1001141671 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
4062375003 07
05
05
07
1263
1755
1638
1263
0368
0072
0072
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062155124 06
06
1762
1514
0072
0072
LTCC
LTCC
APPL
APCL
4061743886 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0369
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4061499927 06
06
1514
1762
0072
5005
LTCC
LTCC
APCL
APPL
4061583524 08
06
1144
1514
0896
0072
LTCC
LTCC
APCL
APCL
4062694843 06
03
1514
1922
0072
0179
LTCC
LTCC
APCL
APCL
4062744517 07
06
1263
1514
0369
0072
LTCC
LTCC
APCL
APCL
4062005488 10
11
10
11
1929
1177
1164
1177
0072
0073
0179
0179
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
Total Count 15
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CODE DESCRIPTIONS Category ALL STATE TABLES
Code Description Active Available To Code Category
0 UNKNOWN Y CARES SUBJECTIVE_HEALTH_EVALUATION
01 ALACHUA Y COMMON COUNTIES
02 BAKER Y COMMON COUNTIES
03 BAY Y COMMON COUNTIES
04 BRADFORD Y COMMON COUNTIES
05 BREVARD Y COMMON COUNTIES
06 BROWARD Y COMMON COUNTIES
07 CALHOUN Y COMMON COUNTIES
08 CHARLOTTE Y COMMON COUNTIES
09 CITRUS Y COMMON COUNTIES
1 EXCELLENT Y CARES SUBJECTIVE_HEALTH_EVALUATION
10 CLAY Y COMMON COUNTIES
11 COLLIER Y COMMON COUNTIES
12 COLUMBIA Y COMMON COUNTIES
13 MIAMI-DADE Y COMMON COUNTIES
14 DESOTO Y COMMON COUNTIES
15 DIXIE Y COMMON COUNTIES
16 DUVAL Y COMMON COUNTIES
17 ESCAMBIA Y COMMON COUNTIES
18 FLAGLER Y COMMON COUNTIES
19 FRANKLIN Y COMMON COUNTIES
2 GOOD Y CARES SUBJECTIVE_HEALTH_EVALUATION
20 GADSDEN Y COMMON COUNTIES
21 GILCHRIST Y COMMON COUNTIES
22 GLADES Y COMMON COUNTIES
23 GULF Y COMMON COUNTIES
24 HAMILTON Y COMMON COUNTIES
25 HARDEE Y COMMON COUNTIES
26 HENDRY Y COMMON COUNTIES
27 HERNANDO Y COMMON COUNTIES
28 HIGHLANDS Y COMMON COUNTIES
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CONSUMER AGE VERIFICATION REPORT PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Program AC
Age at Start
Enroll or Start Enroll Provider Program Description Consumer Name Client ID DOB Svc date or Svc Date
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Contract Budget Information PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Program Service Provider Location County Served Provider Contract
Projected Service
Units Unit Measure
Projected Unduplicated
State Federal Share Client Count Begin Date End Date
Row Count 0 Amount Total
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Start Enroll Latest Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Date Asmt Date Worker
O3C1 1036 000 4061653427 Test CENTRAL 34982 W M 07091930 09102013 09102013 CIRTS20804 0 Name
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Start Enroll Date
Latest Asmt Date Worker
4061593624 Test Name CENTRAL 34946 B F 11261940 12012011 12312013 CIRTS23407
Count 164
Unduplicated Client Count 163
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Assessments After DOD Report
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Owner 1025
The shaded records indicate clients who have different DOBs andor different names
Assemt Current PSA Owner Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Owner Assessor
Provider Assessor
Assemt Date
Assemt Type
Unduplicated Count Total 0
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Open Enrollments
The Vital Statistics Data for 07192002 - 09112014PSA ALL Provider ALL Program Status ACTV Include MLTC ACTVS N
The shaded records indicate clients who have different DOBs andor different names
Enroll PSA
Enrollment Provider Loc Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Enroll Program Status
Enroll Program
Current Owner ID
02 1065 0072 4062244026 Test Name Test Name 10222004 03231917 03231917 ACTV CCE 1065
Count of enrollments for the Provider 1
Count of enrollments for the PSA 1
Count of enrollments for the Report 1
Unduplicated Count of Individuals with open enrollments and DOD PSA Total Clients Count
02 1
Total 1
Report run on 08312018 0205 PM Page 1 of 1 vs_open_enrollrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Report run on 08312018 0207 PM Page 1 of 3 vs_servicesrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Unduplicated count of individuals with Services after DOD
PSA Total Clients Count
Report Total
Report run on 08312018 0207 PM Page 2 of 3 vs_servicesrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
List of Clients with PSA table entry for SERVICES_AFTER_DOD
Unduplicated Count Total 0
Report run on 08312018 0207 PM Page 3 of 3 vs_servicesrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Age
Provider
Total
Age lt 60 Age 60 - 64 Age 65 - 74 Age 75 - 84 Age 85+ Total Clients Avg Age
Total
Avg Age
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 1 of 5 demo_all_prvrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Ethnicity
Provider Hispanic Other Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Race
American Indian Native Hawaiian Other Provider Asian Alaska Native Black Pacific Islander Minority White Multiple Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Gender
Provider Male Female Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 4 of 5 demo_all_prvrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Monthly Income
Provider 0 - - Higher than Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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None
Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Total Persons Served 0
Age lt 60 Years 0 0
Age 60 - 64 0 0
Age 65 - 74 0 0
Age 75 - 84 0 0
Age 85+ 0 0
Total Age 0 0
Average 000
Ethnicity Hispanic 0 0
Other Ethnicity 0 0
Unknown Ethnicity 0 0
Total 0 0
Race Asian 0 0
American Indian Alaska Native 0 0
Black 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority 0 0
White 0 0
Multiple 0 0
Unknown 0 0
Total 0 0
Sex Male 0 0
Female 0 0
Unknown Sex 0 0
Total 0 0
Monthly Income 0 - 0 0
- 0 0
Higher than 0 0
Unknown 0 0
Total 0 0
Report run on 08312018 1058 AM Page 1 of 2 demo_by_prov_detrdf Report run byRSHQALL Dispose of this report so that it can not be read or reconstructed
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Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Client ID Date Of Birth Ethnicity Race Sex Individual Monthly Income
Report run on 08312018 1058 AM Page 2 of 2 demo_by_prov_detrdf Report run byRSHQALL Dispose of this report so that it can not be read or reconstructed
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Demographics of Clients OAA Registered Served Only PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 City All Cities Program All Programs Service All Services County ALL COUNTIES Table OAA Registered Services Only Low Income Medium Income
Total Persons Served 0
Agelt 60 Years
Age 60 - 64
Age 65 - 74
Age 75 - 84
Age 85+
0
0
0
0
0
0
0
0
0
0
Monthly Income
0 -
-Higher than
Unknown
0
0
0
0
0
0
0
0
Total
Average
0
000
0 Total 0 0
Ethnicity Hispanic
Other
Unknown
0
0
0
0
0
0
Living Situation
Alone
Null
Policy Change
0
0
0
0
0
0
Total 0 0 Unknown
With Caregiver
0
0
0
0
Race Asian 0 0
With Other
With Other Caregiver
0
0
0
0
American Indian Alaska Native
Black
0
0
0
0Total Living Situation 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority
White
0
0
0
0 Limited English Proficiency
Multiple
Unknown
Total Race
0
0
0
0
0
0
Yes
No
Unknown
0
0
0
0
0
0
Total 0 0
Sex Male
Female
Unknown
0
0
0
0
0
0
Total 0 0
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Disaster Assistance Clients for a Provider PSA ALL Provider All Providers Location 0000 Worker All Workers City All Cities Zip Code All Zip Codes Sort By ZIP
Provider 1036 Provider Name Location 0000 Worker CIRTS18634
Need Care Client Name Address City Zip County Phone Asst Reg Situation Relat Care phone Care Name
34946 N WO DA 000 SAINT JAMES DRIVE CENTRAL (025) 101-0620 Test NameTest Name SAINT LUCIE (005) 100-0369 Y
Client is active and no assessment information is available Special Shelter and Special Registry are unknown
Report run on 08312018 1102 AM Page 1 of 8 disaster_by_provrdf
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
Total by PSA 0
Report run on 08312018 1111 AM Page 1 of 5 eheap_exceptionsrdf
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
ALACH BAKER BAY BRADF BREVA BROWA CALHO CHARL CITRUS CLAY COLLIE COLUM DESOT DIXIE DUVAL ESCAM FLAGL FRANK GADSDAssisted Household Report UA ORD RD RD UN OTTE R BIA O BIA ER LIN EN
1 of Household Assisted 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Households AssistedWith Gross Income
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C 100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D 125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
3 Households with at leastOne member
A 60 Years or older 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B Disabled 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C Age 5 years or under 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D Under 60 Years Old 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Undup Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Assisted
Applicant Household Report
of Applicant Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Energy Assisted Household Report
County of Assisted
Households
Households Assisted By Poverty Level
Under 75 75 - 100 101 - 125 126 - 150 Over 150 60 Years or older
At least one member who is
Age 5 years Age 2 years Age 3 years Disabled or younger and younger through 5
Under 60 Years Old
Undup Households
Assisted
Energy Assistance Total
Report run on 08312018 1107 AM Page 1 of 3 eheap_summaryrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Unduplicated Total 0 0
County of Assisted
Households Under 75 75 - 100
Households Assisted By Poverty Level
101 - 125 126 - 150 Over 150 60 Years or older Disabled
Age 5 years or younger
Age 2 years and younger
Age 3 years through 5
Under 60 Years Old
At least one member who is
Undup Households
Assisted
Other Assisted Household Report
Other Assistance Total
Report run on 08312018 1107 AM Page 2 of 3 eheap_summaryrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Applicant Household Report
County of Applicant
Households Under 75 75 - 100 101 - 125 126 - 150 Over 150 Income data
unavailable
Total 0
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01
Enrollment Active Consumer Count by Program PSA ALL Provider ALL PROVIDERS
County Description Program Count of Clients
BREVARD
ADI
CCE
HCE
LSP
NDP
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
MLTC
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
31
57
44
5
62
123
141
26
9
7
5
40
5
50
67
129
2
19
42
29
1
233
79
63
8
2
14
3
37
14
47
3
3
33
127
10
02
03
04
ALACHUA
BAKER
BAY
BRADFORD
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05
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Enrollment Terminations with Reasons PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 Program All Programs Program Status ALL Program Status Worker ALL WORKERS
Last First Program Medicaid Provider Start End Name Name Client ID Status Description Worker Number Program Location Enrollment Enrollment
Count 0
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Enrollments with Care Plan Report
PSA ALL Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTIVE STATUS Care Plan Service ALL SERVICES Care Plan Start 01012017 Care Plan End 12312017
Care Plan Care Plan Care Plan Client Name
Unduplicated Client Count 0
Client ID Program Status Worker Start Date End Date Service
Report run on 08312018 1054 AM Page 1 of 1 enroll_careplrdf Report run by RSHQALL Dispose of this report so that it cannot be read or reconstructed
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PSA CLIENT_ID CLIENT_NAME OWNER PROVIDER_ID ASSESSMENT_DATE ASSESSOR_NAME MEDICAID_NUMBER CAREGIVER_CHANGE ENVIRONMENT_CHANGE HEALTH_CHANGE INCOME_CHANGE SITUATION_CHANGE INITIAL_ASSM ANNUAL_ASSM SSN REFERRAL_SOURCE 1114 N N N N Y N 771771777 SELFFAMILY 812017 JANE CASEWORKER 2 1001141633 TEST TEST N
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Fixed Service Costs List PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Provider Location County Program Service Reimbursement Unit Rate Provider Cost Per Unit Begin Valid End Valid
Count 0
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Active or APCL Clients with Caregiver Information PSA ALL Provider ALL PROVIDERS Program AC Program Status ACTV Sort by PROVIDER
Provider Location Program
Program Status Worker Clinet ID Client Name
Most recent Asmt Date Asmt Priority with CaregiverType Score
Risk Score Caregiver Name
HCE Relationship Indicator
1380 0181AC ACTV CIRTS16813 4062414494 Test Name 04232014 701A 40 Test OR N
Count 1
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Active PACE Clients Who are ACTV APCL or APPL in Another Program PSA ALL
Provider ALL
-------- Active PACE Clients Information -------- ------ Other Programs Information ----
PSA Owner ID Client ID Client Name Provider Location Program Program Status
Total Count 0
Unduplicated Client Count 0
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ACTV CCE HCE and ADI Clients with No Care Plan PSA ALL
Program ALL PROGRAMS Provider ALL PROVIDERS
Owner All Owners
Enrollment Information PSA Client ID Name Owner Provider Loc Program Start Date Worker
01 4062521310 Test Name 1911 1911 0932 CCE 03272014 CIRTS29059
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ACTV CCE HCE and ADI Clients with No Care Plan PSA ALL
Program ALL PROGRAMS Provider ALL PROVIDERS
Owner All Owners
PSA Client ID Name Owner Enrollment Information
Provider Loc Program Start Date Worker
4061605936 Test Name 1785 1927 0072 ADI 07202006 CIRTS26739
11
Duplicated Count 72 Unduplicated Counts 70
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ACTV APPL APCL Clients who have moved to another PSA PSA ALL
Provider ALL PROVIDERS
Address Enrollment Client ID Client Name Provider Loc Program Program Start PSA PSA Status Enrollment
01A 02 4062760605 1191 0072 CCE ACTV 11082011 Test Name
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Aging Network Provider Information Report PSA ALL
Address PSA Provider Loc Provider Name Type Provider Address Telephone
01 1147 B
1147
0072 Provider Name
0073 Provider Name B
1147
1147
0100 Provider Name
0179 Provider Name B
1271 B
1271 B
1271
0000 Provider Name
0001 Provider Name
0002 Provider Name B
1271 B
1271
0003 Provider Name
0004 Provider Name B
1271 B
1271
0072 Provider Name
0073 Provider Name B
1271 0100 Provider Name B
1271 B
1271 B
1271 B
1271 B
1271
0101 Provider Name
0138 Provider Name
0179 Provider Name
0286 Provider Name
0287 Provider Name B
123 Provider CALICO DRIVE STAYTON FL 59255
123 Provider TERRA COTTA STREET DARRINGTON
FL 57399
123 Provider LANGTOWN ROAD DARRINGTON FL 57399
123 Provider POINTE LANE Bonum integritas corporis misDARRINGTON FL 58398
123 Provider OAK DRIVE SUNNYVALE MO 83407
123 Provider HOTT STREET DARRINGTON FL 58398
123 Provider GRASSELLI STREET DARRINGTON FL 68396
123 Provider HEAVENS WAY MORRISONS CROSSROADS AL 33165
123 Provider GOOSETOWN DRIVE MIDVILLE
FL 93176
123 Provider PIKE STREET BELLOWS FALLS
FL 48405
123 Provider GLENVIEW DRIVE SUSSEX FL
123 Provider JONES AVENUE BLYTHEVILLE
FL 14027
123 Provider HENERY STREET SUSSEX FL
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Aging Network Provider Information Report PSA ALL
PSA Provider Loc Provider Name Address Type Provider Address Telephone
11 1952 B
1952 B
1952 B
1952 B
1952 B
1952 B
1952 B
123 Test Street ELLSINORE FL 38234 3789 WHITE
123 Test Street OHATCHEE FL 45235 3408 NORMA
123 Test Street WHITE CLOUD FL 46226
123 Test Street NEOSHO FL 06231
123 Test Street WHITE CLOUD FL 16168 3678 OLD
123 Test StreetWHITE CLOUD FL 06231 184 GRANT
123 Test Street WHITE CLOUD FL 93236
1952
1955
1956
B 3123 Test Street Quid censes in Latino fore IaWHITE CLOUD FL 70226
1957
0Provider Name
0Provider Name
0Provider Name
0Provider Name
0Provider Name
0Provider Name
0Provider Name
0Provider Name
0Provider Name
0Provider Name
0Provider Name B 123 Test Street Sed ad rem redeamus ComprehenWHITE CLOUD FL 38227
1957
1958
Count
0474 Provider Name
0072 Provider Name
427
B 123 Test Street BRANCH ROAD Quid ergo hoc loco intellegit WHITE CLOUD FL 25224
Count Total 3117
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Aging Network Providers Report PSA ALL
PSA 01
Provider 1271 Provider Name Provider Name
Location 0000 Location Name Provider Name
Location Business Address 3123 Test Drive DARRINGTON FL 58398
County Served OKALOOSA Phone Fax Location Contact
Provider Director Provider Profit Status Non-Profit
ACCESS_PT CCE_LA N HCE OAA OTHER
ADI EHEAP LSP RELF
CCE Y FOCAL_PT NSIP SR_CTR
Provider 1271 Provider Name Provider Name
Location 0001 Location Name Provider Name
Location Business Address 1234 Test OAK DRIVE SUNNYVALE MO 83407
Phone Fax Location Contact County Served OKALOOSA
Provider Director Provider Profit Status Non-Profit
ACCESS_PT CCE_LA N HCE OAA OTHER
ADI EHEAP LSP RELF
CCE Y FOCAL_PT NSIP SR_CTR
Provider 1271 Provider Name Provider Name
Location 0004 Location Name Provider Name
Location Business Address 1123 Test HEAVENS WAY MORRISONS CROSSROADS AL
33165 Phone County Served OKALOOSA Fax Location Contact
Provider Director Provider Profit Status Non-Profit
ACCESS_PT CCE_LA N HCE Y OAA OTHER
ADI EHEAP LSP RELF
CCE FOCAL_PT NSIP SR_CTR
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Start End Worker Most Recent Nutr Medicaid Program Provider Location Client ID Client Name Status Enrollment Enrollment Worker Active Score Number
O3C1 1036 0000 4061653427 Test Name ACTV 09102013 CIRTS20804 Y 1
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Start End Worker Most Recent Nutr Medicaid Program Provider Location Client ID Client Name Status Enrollment Enrollment Worker Active Score Number
O3C1 1036 0000 4061638016 Test Name ACTV 09122013 CIRTS20804 Y 2
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Start End Worker Most Recent Nutr Medicaid Program Provider Location Client ID Client Name Status Enrollment Enrollment Worker Active Score Number
O3C2 1036 0000 4062000152 Test Name ACTV 02072011 CIRTS23407 N 3
1036 0000 4061594062 ISAACS HATTIE ACTV 11192012 CIRTS20804 Y 5
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Start End Worker Most Recent Nutr Medicaid Program Provider Location Client ID Client Name Status Enrollment Enrollment Worker Active Score Number
O3C2 1036 0000 4062379505 Test Name ACTV 11192012 CIRTS20804 Y 5
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Start End Worker Most Recent Nutr Medicaid Program Provider Location Client ID Client Name Status Enrollment Enrollment Worker Active Score Number
O3C2 1036 0000 4062401063 Test Name ACTV 10162013 CIRTS20804 Y 3
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Provider Location Client ID Client Name Program Status
Start Enrollment
End Enrollment Worker
Worker Active
Most Recent Nutr Score
Medicaid Number
O3C2 1036 0000 4062538939 ACTV 12082000 CIRTS20388 Y Test Name
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All Enrollments Counts During Date Range PSA ALL Start Date 01012017 End Date Location 0000 Provider Program Program Status
12312017 ALL PROVIDERS
ACTV
Group By Program Provider Location
Program Provider Location Client Count O3C1 1036 0000 45
1951 0000 3
O3C2 1036 0000 113
OA3E 1821 0000 2
OA3ES 1821 0000 1
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C1 1036 0000 4061950299 Test Name ACTV 04072011 CIRTS23407 N 11
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C1 1036 4062586019 Test Name ACTV 12292008 CIRTS23407 N 1
Total for Location 45
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C1 1951 0000 4062452921 Test Name ACTV 03301989 CIRTS22695 N 10
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4062786256 Test Name ACTV 09232013 CIRTS20804 Y 4 1
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4062380426 Test Name ACTV 04112012 CIRTS23407 N 55 2
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4061608826 Test Name ACTV 08102011 CIRTS18634 Y 7 3
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4062615533 Test Name ACTV 10032013 CIRTS20804 Y 6 3
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start Enrollment
End Enrollment Worker
Worker Active
Medicaid Number
Most Recent Nutr Score Rank
O3C2 1036 4062466582 Test Name ACTV 10262010 CIRTS23407 N 105 2
Total for Location 113
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PSA
APCL Clients With No Services ALL Owner All Owners Provider ALL PROVIDERS
Start Date 01012017 End Date 12312017
Includes Clients Receiving Only CM INSC SCAS CA REFE Services
PSA Client ID Client Name Owner Provider Program
Count 0
Unduplicated Clients Count 0
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APCL Clients With Services PSA ALL Owner All Owners Provider ALL PROVIDERS Start Date 01012017 End Date 12312017
Exclude CM CA INSC REFE SCAS
PSA Client ID Name Owner Provider Program 10 4062527553 Test Name 1539 1929 CCE
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APCL Clients With Services PSA ALL Owner All Owners Provider ALL PROVIDERS Start Date 01012017 End Date 12312017
Exclude CM CA INSC REFE SCAS
PSA Client ID Name Owner Provider Program 11 4062732638 Test Name 1177 1177 LTCC
Total 21067
Unduplicated clients count 12460
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APS Assessments PSA ALL Risk Level ALL Owner All Owners Referral Date From 01012017 To 12312017
Order by Referral Date and Owner ID
PSA 03
Ref Date Owner ID Client ID Client Name Risk Level Asmt Type Asmt Date
03032017 1390 4062058415 L 701A 03302018 Test Name
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APS Assessments PSA ALL Risk Level ALL Owner All Owners Referral Date From 01012017 To 12312017
Order by Referral Date and Owner ID
12042017 1980 4061617559 H 701B 12072017 Test Name
Assessment Count for the PSA 52
PSA 04A
Ref Date Owner ID Client ID
09102017 4062308458
Client Name
Test Name
Risk Level
H
Asmt Type
O
Asmt Date
09162017
Assessment Count for the PSA 2
Risk Level H
M
L
Count of Assessments 138
23
21
Total Count of Assessments 182
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APS Repeat Referrals in a Time Range
PSA ALL Owner All Owners
Start Date 01012017 End Date 12312017
Current DOEA CIRTS Cirts SSN if Risk Date Created PSA Owner Abuse No different than DCF DCF SSN Name County Level Date of Birth Date Sent by DCF
Count 0
Unduplicated Client Count by PSA
PSA Count SSN
Total
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Assessed Prioritized Consumer List PSA ALL Provider ALL PROVIDERS Program AC County ALL COUNTIES
County Program Consumer Name Client ID
Total Count 0
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Assessment Due Report PSA 01 Start Date 01012017 End Date 08312018 Owner ALL PROVIDERS Worker ALL WORKERS Program Status ACTV and APCL Assessment Type Needed ALL
Overdue and missing assessments are always listed
Owner ID 1065
Client ID Client Name
Owner Assessor ID
Date of Birth
06281928
CIRTS28099
County of Service
GULF
Worker Name HARPER KENNY
Zip Assessment PSA Date
32534 01 01022014
Type
701A
Active Y
Nutr PriorityScore Score
11 58
Rank
5
Due Date
01022015
Status
701S OVERDUE
LTCC APPL Start Date
03252014 4062235673 Test name
Total Clients for Worker 1
Total Clients for Owner 1
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Assessment Due Report PSA 01 Start Date 01012017 End Date 08312018 Owner ALL PROVIDERS Worker ALL WORKERS Program Status ACTV and APCL Assessment Type Needed ALL
Overdue and missing assessments are always listed
Summary by PSA
PSA 01 701A Overdue 1
701B Overdue 213
701C Overdue 0
701S Overdue 157
No 701A 0
No 701B 2
No 701C 0
No 701S 0
701A Not Overdue 0
701B Not Overdue 0
701C Not Overdue 0
701S Not Overdue 0
701S Optional 0
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CIC Service Units and Costs Projections County SummaryPSA 99 Program CCE
Start Date 01012017 End Date 12312017
County LEON
Total Total Total Avg Max Projected
StateFederal Projected Reimbursement Provider Unduplicated Provider Service Share Service Units Unit Rate Cost Per Unit Client Count
Report Total
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CIC Service Units and Costs Projections Provider SummaryPSA ALL Provider ALL PROVIDERS Program FEDERALLY FUNDED (0101 TO 1231) Year 2017 From 01012017 To 12312017
PSA County Program Service Total State
Federal Share
Total Projected
Service Units
Avg Reimbursement
Unit Rate
Max Provider
Cost Per Unit
Total Projected Unduplicated Client Count
02 FRANKLIN O3C1 CONGREGATE MEALS $810300 1710 15
Program Total
County Total
$810300
$810300
GULF O3C1 CONGREGATE MEALS $25205 3 5
Program Total $25205
O3C2 HOME DELIVERED MEALS $25205 3 6
Program Total
County Total
$25205
$50411
LEON O3C1 CONGREGATE MEALS $621300 1311 15
CONGREGATE MEALS GUEST
CONGREGATE MEALS VOLUNTEERS
$252055
$277260
25
30
2
5
Program Total $1150615
O3C2 HOME DELIVERED MEAL GUEST $252055 25 3
Program Total $252055
OA3D PEARLS (SESSION 5)
PEARLS (SESSION 6)
PEARLS (SESSION 7)
PEARLS (SESSION 8)
$10247
$10247
$10247
$10247
10
10
10
10
3
3
3
3
Program Total $40988
OA3E RESPITE IN-HOME $200 2 2
Program Total
County Total
$200
$1443858
WAKULLA O3C2 EMERGENCY HOME DELIVERED SHELF MEALS
$8065604 14899 90
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CIC Service Units and Costs Projections - PSA Summary
PSA ALL Program CCE
Strat Date 01012017 End Date 12312017
Total
PSA County Provider Service
Total State Federal
Share
Total Projected
Service Units
Avg Reimbursement
Unit Rate
Max Projected Provider Unduplicated
Cost Per Unit Client Count
02 LEON SOUTHERN SERVICE CASE MANAGEMENT PROVIDER EMERGENCY HOME DELIVERED SHELF MEALS
$2175533
$602000
483
689
32
20
HOME DELIVERED MEALS $530262 993 5
MATERIAL AID $1994536 199
Provider Total $5302331
CountyTotal $5302331
WAKULLA SOUTHERN SERVICE CASE MANAGEMENT PROVIDER EMERGENCY HOME DELIVERED SHELF MEALS
$2175533
$1240200
483
689
32
5
MATERIAL AID $1994536 199
Provider Total $5410269
CountyTotal $5410269
PSA Total $10712599
05 PINELLAS BURSTEIN-APPLEBEE ADULT DAY CARE $000 0 $900 $1000 0
COUNSELING (MENTAL HEALTH COUNSELINGSCREENING) - INDIVIDUAL
Provider Total
$000
$000
0 $6600 $7700 0
CountyTotal $000
PSA Total $000
Report Total $10712599
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CID Service Units and Costs Projections - PSA SummaryPSA ALL Program CCE
Start Date 01012017 End Date 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
PSA County Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
02 LEON CASE MANAGEMENT $2175533 483
EMERGENCY HOME $602000 689DELIVERED SHELF MEALS HOME DELIVERED MEALS $530262 993
MATERIAL AID $1994536 199
County Total $5302331 2364
WAKULLA CASE MANAGEMENT $2175533 483
EMERGENCY HOME $1240200 689DELIVERED SHELF MEALS MATERIAL AID $1994536 199
County Total $5410269 1371
PSA Total $10712599 3735
05 PINELLAS ADULT DAY CARE $000 0
COUNSELING (MENTAL $000 0 HEALTH COUNSELINGSCREENING) - INDIVIDUAL
County Total $000 0
PSA Total $000 0
Report Total $10712599 3735
$900 $900 $900 $1000 $1000 $1000
$6600 $6600 $6600 $7700 $7700 $7700
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CID Service Units and Costs Projections County SummaryPSA 99
Program CCE County LEON
Start Date 01012017 End Date 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
Report Total
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CIE Service Units and Costs Projections - PSA Summary - All Programs
PSA 99 Program FEDERALLY FUNDED (0101 TO 1231) Year 2017 From 01012017 To 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
Program Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
Report Total
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CIE Service Units and Costs Projections - PSA Summary
PSA ALL Program CCE
Start Date 01012017 End Date 12312017
Avg High Low Total Total Avg High Low Provider Provider Provider
StateFederal Projected Reimbursement Reimbursement Reimbursement Cost Cost CostPSA
02
Service
CASE MANAGEMENT
Share
$4351066
Service Units
966
Unit Rate Unit Rate Unit Rate Per Unit Per Unit Per Unit
EMERGENCY HOME DELIVERED SHELF MEALS $1842200 1378
HOME DELIVERED MEALS $530262 993
MATERIAL AID $3989071 398
PSA Total $10712599 3735
05 ADULT DAY CARE $000 0 $900 $900 $900 $1000 $1000 $1000
COUNSELING (MENTAL HEALTH $000 0 $6600 $6600 $6600 $7700 $7700 $7700 COUNSELINGSCREENING) - INDIVIDUAL
PSA Total $000 0
Report Total $10712599 3735
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CAREGIVER SEARCH REPORT
SEARCH RESULTS FOR CONSUMERS
Criteria First Name Last Name SSN PSA ALL
Client Name Client SSN Caregiver Name Caregiver SSN
000000000 000000000 Test Name Test Name
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CARES Referrals in a Time Range PSA ALL
Start Date 01012017 End Date 12312017
Referred to ALL REFERRALS
Referring PSA Employee Name Client Name Client ID
Referral Imminent NH Admit Aging Date Risk Date Referred To Cares Provider Name Received Date
03A 4061561263 Test Name Test Name 09242017 Y 05292017 ARC or ADRC 09252017
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CARES Referrals in a Time Range PSA ALL
Start Date 01012017 End Date 12312017
Referred to ALL REFERRALS
Referring PSA Employee Name Client Name Client ID
Referral Date
Imminent Risk
NH Admit Date Referred To Cares Provider Name
Aging Received Date
04B Test Name Test Name 4061738075 04082017 N ARC or ADRC Test Name 04082017
Total Clients 110
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CARES Referrals not acknowledged by the Aging Network PSA ALL For Referrals after 01012017 Owner ID ALL Owners
Unduplicated Client count Cares Office Total Clients Count
Report Total
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
CIRTS Issue PSA Client ID Client Name Program
Program Status Start Provider Enrollment ID Provider Name
APCL CLIENT WITH DATE OF DEATH 08 4061759417 Test Name OA3B APCL 07232013 1141 WESTERN WORLD RADIO
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
Program Start Provider CIRTS Issue PSA Client ID Client Name Program Status Enrollment ID Provider Name
06 LTCC APCL 01242014 1514 4061713685 Test Name APCL CLIENT WITH DATE OF DEATH CENTRAL THE ORIGINAL HOUSE OF PIES
Count 503
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Civil Rights PSA ALL Provider ALL PROVIDERS Program AC Start Date 01012017 End Date 12312017 The Poverty Level for Single is The Poverty Level for Couple is Sort by County
County Unduplicated Count
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Client Information Report Start Date 01012017 End Date 12312017
Client ID 1001141246
Emergency
Client Name Test Name
Telephone () - Address 78 TEST STREET TALLAHASSEE FL 32399
Most Recent Caregiver Information Date Updated
Doctor
Comments
Client Demographic Information
Birth Date 06041940 Race W
Owner ID Ethnicity O
Most Recent Income Information
Ind Mon Inc Cpl Mon Inc
Ind Assets Couple Assets
Most Recent Assessment Information
Asmt Date Ref Risk Lvl
Asmt Site Spec Shel
AsmtType Spec Reg
Ref Date Primary CG
Ref Source Living Sit
Enrollment Information
Sex
Marital Status
F
S
Medicaid Number
ADL Score
ADL Count
IADL Score
IADL Count
Memory Score
Priority Score
Env Score
Nutr Score
Risk Score
Social Score
Rank
Provider Location Program Program Status Worker Start Date End Date
Care Plan Service Needed
Date Service Units Type Frq End Date
Care Plan Service Planned
Program Service Units Type Frq Start Date End Date
Services Received between 01012017 and 12312017
Service Billed Provider Location Worker Program Service Date Units Unit Type Amount
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Provider N
Client Service Units Report PSA ALL Provider ALL PROVIDERS Location 0000
Program ALL PROGRAMS Service ALL SERVICES Worker ALL WORKERS
City ALL CITIES Include Zero Unit N Include Aggregate N Calculated Amount equals the number of Units Provided times Fixed Cost if it existsService Start Date 01012017 Service End Date 12312017 If Fixed Cost does not exist Calculated
Group by PSA Provider Location Client Name County Worker Amount equals Billed Amount
Unduplicated Client Count 0 Grand Total 000 $000
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Clients In Common PSA All Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 County All Counties Worker All Workers
County JEFFERSON
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
MIAMI-DADE
0 0 0 0 0 0 0 0 0
4061539538 Test NameCounty Count
County
0 01
X
0 1
X
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
4061650856 Test Name X 4061486560 Test Name X 4062452921 Test Name X
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Clients Served Not Enrolled PSA ALL Start Date 01012017 End Date 12312017 Locations 0000 Provider All Providers
Service Service Min Serv Max Serv Program Start End Enrollment PSA Provider Location Program Consumer Name Client ID Service Date Date Status Enrollment Enrollment Provider
Count 0
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
4061472791 04
09
1092
1291
0072
0042
LTCC
LTCC
APCL
APCL
4062714543 06
06
1514
1762
0072
5006
LTCC
LTCC
APCL
APPL
4061802246 11
06
1177
1514
0179
0072
LTCC
LTCC
APCL
APCL
4061563719 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062644312 06
08
1514
1771
0072
0896
LTCC
LTCC
APCL
APCL
1001141670 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
1001141671 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
4062375003 07
05
05
07
1263
1755
1638
1263
0368
0072
0072
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062155124 06
06
1762
1514
0072
0072
LTCC
LTCC
APPL
APCL
4061743886 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0369
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4061499927 06
06
1514
1762
0072
5005
LTCC
LTCC
APCL
APPL
4061583524 08
06
1144
1514
0896
0072
LTCC
LTCC
APCL
APCL
4062694843 06
03
1514
1922
0072
0179
LTCC
LTCC
APCL
APCL
4062744517 07
06
1263
1514
0369
0072
LTCC
LTCC
APCL
APCL
4062005488 10
11
10
11
1929
1177
1164
1177
0072
0073
0179
0179
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
Total Count 15
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CODE DESCRIPTIONS Category ALL STATE TABLES
Code Description Active Available To Code Category
0 UNKNOWN Y CARES SUBJECTIVE_HEALTH_EVALUATION
01 ALACHUA Y COMMON COUNTIES
02 BAKER Y COMMON COUNTIES
03 BAY Y COMMON COUNTIES
04 BRADFORD Y COMMON COUNTIES
05 BREVARD Y COMMON COUNTIES
06 BROWARD Y COMMON COUNTIES
07 CALHOUN Y COMMON COUNTIES
08 CHARLOTTE Y COMMON COUNTIES
09 CITRUS Y COMMON COUNTIES
1 EXCELLENT Y CARES SUBJECTIVE_HEALTH_EVALUATION
10 CLAY Y COMMON COUNTIES
11 COLLIER Y COMMON COUNTIES
12 COLUMBIA Y COMMON COUNTIES
13 MIAMI-DADE Y COMMON COUNTIES
14 DESOTO Y COMMON COUNTIES
15 DIXIE Y COMMON COUNTIES
16 DUVAL Y COMMON COUNTIES
17 ESCAMBIA Y COMMON COUNTIES
18 FLAGLER Y COMMON COUNTIES
19 FRANKLIN Y COMMON COUNTIES
2 GOOD Y CARES SUBJECTIVE_HEALTH_EVALUATION
20 GADSDEN Y COMMON COUNTIES
21 GILCHRIST Y COMMON COUNTIES
22 GLADES Y COMMON COUNTIES
23 GULF Y COMMON COUNTIES
24 HAMILTON Y COMMON COUNTIES
25 HARDEE Y COMMON COUNTIES
26 HENDRY Y COMMON COUNTIES
27 HERNANDO Y COMMON COUNTIES
28 HIGHLANDS Y COMMON COUNTIES
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CONSUMER AGE VERIFICATION REPORT PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Program AC
Age at Start
Enroll or Start Enroll Provider Program Description Consumer Name Client ID DOB Svc date or Svc Date
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Contract Budget Information PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Program Service Provider Location County Served Provider Contract
Projected Service
Units Unit Measure
Projected Unduplicated
State Federal Share Client Count Begin Date End Date
Row Count 0 Amount Total
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Start Enroll Latest Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Date Asmt Date Worker
O3C1 1036 000 4061653427 Test CENTRAL 34982 W M 07091930 09102013 09102013 CIRTS20804 0 Name
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Start Enroll Date
Latest Asmt Date Worker
4061593624 Test Name CENTRAL 34946 B F 11261940 12012011 12312013 CIRTS23407
Count 164
Unduplicated Client Count 163
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Assessments After DOD Report
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Owner 1025
The shaded records indicate clients who have different DOBs andor different names
Assemt Current PSA Owner Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Owner Assessor
Provider Assessor
Assemt Date
Assemt Type
Unduplicated Count Total 0
Report run on 08312018 0206 PM Page 1 of 1 vs_assmrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Open Enrollments
The Vital Statistics Data for 07192002 - 09112014PSA ALL Provider ALL Program Status ACTV Include MLTC ACTVS N
The shaded records indicate clients who have different DOBs andor different names
Enroll PSA
Enrollment Provider Loc Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Enroll Program Status
Enroll Program
Current Owner ID
02 1065 0072 4062244026 Test Name Test Name 10222004 03231917 03231917 ACTV CCE 1065
Count of enrollments for the Provider 1
Count of enrollments for the PSA 1
Count of enrollments for the Report 1
Unduplicated Count of Individuals with open enrollments and DOD PSA Total Clients Count
02 1
Total 1
Report run on 08312018 0205 PM Page 1 of 1 vs_open_enrollrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Report run on 08312018 0207 PM Page 1 of 3 vs_servicesrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Unduplicated count of individuals with Services after DOD
PSA Total Clients Count
Report Total
Report run on 08312018 0207 PM Page 2 of 3 vs_servicesrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
List of Clients with PSA table entry for SERVICES_AFTER_DOD
Unduplicated Count Total 0
Report run on 08312018 0207 PM Page 3 of 3 vs_servicesrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Age
Provider
Total
Age lt 60 Age 60 - 64 Age 65 - 74 Age 75 - 84 Age 85+ Total Clients Avg Age
Total
Avg Age
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 1 of 5 demo_all_prvrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Ethnicity
Provider Hispanic Other Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Race
American Indian Native Hawaiian Other Provider Asian Alaska Native Black Pacific Islander Minority White Multiple Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Gender
Provider Male Female Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 4 of 5 demo_all_prvrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Monthly Income
Provider 0 - - Higher than Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 5 of 5 demo_all_prvrdf
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None
Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Total Persons Served 0
Age lt 60 Years 0 0
Age 60 - 64 0 0
Age 65 - 74 0 0
Age 75 - 84 0 0
Age 85+ 0 0
Total Age 0 0
Average 000
Ethnicity Hispanic 0 0
Other Ethnicity 0 0
Unknown Ethnicity 0 0
Total 0 0
Race Asian 0 0
American Indian Alaska Native 0 0
Black 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority 0 0
White 0 0
Multiple 0 0
Unknown 0 0
Total 0 0
Sex Male 0 0
Female 0 0
Unknown Sex 0 0
Total 0 0
Monthly Income 0 - 0 0
- 0 0
Higher than 0 0
Unknown 0 0
Total 0 0
Report run on 08312018 1058 AM Page 1 of 2 demo_by_prov_detrdf Report run byRSHQALL Dispose of this report so that it can not be read or reconstructed
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Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Client ID Date Of Birth Ethnicity Race Sex Individual Monthly Income
Report run on 08312018 1058 AM Page 2 of 2 demo_by_prov_detrdf Report run byRSHQALL Dispose of this report so that it can not be read or reconstructed
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Demographics of Clients OAA Registered Served Only PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 City All Cities Program All Programs Service All Services County ALL COUNTIES Table OAA Registered Services Only Low Income Medium Income
Total Persons Served 0
Agelt 60 Years
Age 60 - 64
Age 65 - 74
Age 75 - 84
Age 85+
0
0
0
0
0
0
0
0
0
0
Monthly Income
0 -
-Higher than
Unknown
0
0
0
0
0
0
0
0
Total
Average
0
000
0 Total 0 0
Ethnicity Hispanic
Other
Unknown
0
0
0
0
0
0
Living Situation
Alone
Null
Policy Change
0
0
0
0
0
0
Total 0 0 Unknown
With Caregiver
0
0
0
0
Race Asian 0 0
With Other
With Other Caregiver
0
0
0
0
American Indian Alaska Native
Black
0
0
0
0Total Living Situation 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority
White
0
0
0
0 Limited English Proficiency
Multiple
Unknown
Total Race
0
0
0
0
0
0
Yes
No
Unknown
0
0
0
0
0
0
Total 0 0
Sex Male
Female
Unknown
0
0
0
0
0
0
Total 0 0
Report run on 08312018 1056 AM Page 1 of 1 demo_by_provrdf
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Disaster Assistance Clients for a Provider PSA ALL Provider All Providers Location 0000 Worker All Workers City All Cities Zip Code All Zip Codes Sort By ZIP
Provider 1036 Provider Name Location 0000 Worker CIRTS18634
Need Care Client Name Address City Zip County Phone Asst Reg Situation Relat Care phone Care Name
34946 N WO DA 000 SAINT JAMES DRIVE CENTRAL (025) 101-0620 Test NameTest Name SAINT LUCIE (005) 100-0369 Y
Client is active and no assessment information is available Special Shelter and Special Registry are unknown
Report run on 08312018 1102 AM Page 1 of 8 disaster_by_provrdf
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
Total by PSA 0
Report run on 08312018 1111 AM Page 1 of 5 eheap_exceptionsrdf
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
ALACH BAKER BAY BRADF BREVA BROWA CALHO CHARL CITRUS CLAY COLLIE COLUM DESOT DIXIE DUVAL ESCAM FLAGL FRANK GADSDAssisted Household Report UA ORD RD RD UN OTTE R BIA O BIA ER LIN EN
1 of Household Assisted 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Households AssistedWith Gross Income
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C 100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D 125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
3 Households with at leastOne member
A 60 Years or older 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B Disabled 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C Age 5 years or under 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D Under 60 Years Old 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Undup Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Assisted
Applicant Household Report
of Applicant Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Energy Assisted Household Report
County of Assisted
Households
Households Assisted By Poverty Level
Under 75 75 - 100 101 - 125 126 - 150 Over 150 60 Years or older
At least one member who is
Age 5 years Age 2 years Age 3 years Disabled or younger and younger through 5
Under 60 Years Old
Undup Households
Assisted
Energy Assistance Total
Report run on 08312018 1107 AM Page 1 of 3 eheap_summaryrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Unduplicated Total 0 0
County of Assisted
Households Under 75 75 - 100
Households Assisted By Poverty Level
101 - 125 126 - 150 Over 150 60 Years or older Disabled
Age 5 years or younger
Age 2 years and younger
Age 3 years through 5
Under 60 Years Old
At least one member who is
Undup Households
Assisted
Other Assisted Household Report
Other Assistance Total
Report run on 08312018 1107 AM Page 2 of 3 eheap_summaryrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Applicant Household Report
County of Applicant
Households Under 75 75 - 100 101 - 125 126 - 150 Over 150 Income data
unavailable
Total 0
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01
Enrollment Active Consumer Count by Program PSA ALL Provider ALL PROVIDERS
County Description Program Count of Clients
BREVARD
ADI
CCE
HCE
LSP
NDP
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
MLTC
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
31
57
44
5
62
123
141
26
9
7
5
40
5
50
67
129
2
19
42
29
1
233
79
63
8
2
14
3
37
14
47
3
3
33
127
10
02
03
04
ALACHUA
BAKER
BAY
BRADFORD
Report run on 08312018 1148 AM Page 1 of 18 actv_countrdf
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05
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Enrollment Terminations with Reasons PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 Program All Programs Program Status ALL Program Status Worker ALL WORKERS
Last First Program Medicaid Provider Start End Name Name Client ID Status Description Worker Number Program Location Enrollment Enrollment
Count 0
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Enrollments with Care Plan Report
PSA ALL Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTIVE STATUS Care Plan Service ALL SERVICES Care Plan Start 01012017 Care Plan End 12312017
Care Plan Care Plan Care Plan Client Name
Unduplicated Client Count 0
Client ID Program Status Worker Start Date End Date Service
Report run on 08312018 1054 AM Page 1 of 1 enroll_careplrdf Report run by RSHQALL Dispose of this report so that it cannot be read or reconstructed
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PSA CLIENT_ID CLIENT_NAME OWNER PROVIDER_ID ASSESSMENT_DATE ASSESSOR_NAME MEDICAID_NUMBER CAREGIVER_CHANGE ENVIRONMENT_CHANGE HEALTH_CHANGE INCOME_CHANGE SITUATION_CHANGE INITIAL_ASSM ANNUAL_ASSM SSN REFERRAL_SOURCE 1114 N N N N Y N 771771777 SELFFAMILY 812017 JANE CASEWORKER 2 1001141633 TEST TEST N
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Fixed Service Costs List PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Provider Location County Program Service Reimbursement Unit Rate Provider Cost Per Unit Begin Valid End Valid
Count 0
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Active PACE Clients Who are ACTV APCL or APPL in Another Program PSA ALL
Provider ALL
-------- Active PACE Clients Information -------- ------ Other Programs Information ----
PSA Owner ID Client ID Client Name Provider Location Program Program Status
Total Count 0
Unduplicated Client Count 0
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ACTV CCE HCE and ADI Clients with No Care Plan PSA ALL
Program ALL PROGRAMS Provider ALL PROVIDERS
Owner All Owners
Enrollment Information PSA Client ID Name Owner Provider Loc Program Start Date Worker
01 4062521310 Test Name 1911 1911 0932 CCE 03272014 CIRTS29059
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ACTV CCE HCE and ADI Clients with No Care Plan PSA ALL
Program ALL PROGRAMS Provider ALL PROVIDERS
Owner All Owners
PSA Client ID Name Owner Enrollment Information
Provider Loc Program Start Date Worker
4061605936 Test Name 1785 1927 0072 ADI 07202006 CIRTS26739
11
Duplicated Count 72 Unduplicated Counts 70
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ACTV APPL APCL Clients who have moved to another PSA PSA ALL
Provider ALL PROVIDERS
Address Enrollment Client ID Client Name Provider Loc Program Program Start PSA PSA Status Enrollment
01A 02 4062760605 1191 0072 CCE ACTV 11082011 Test Name
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Aging Network Provider Information Report PSA ALL
Address PSA Provider Loc Provider Name Type Provider Address Telephone
01 1147 B
1147
0072 Provider Name
0073 Provider Name B
1147
1147
0100 Provider Name
0179 Provider Name B
1271 B
1271 B
1271
0000 Provider Name
0001 Provider Name
0002 Provider Name B
1271 B
1271
0003 Provider Name
0004 Provider Name B
1271 B
1271
0072 Provider Name
0073 Provider Name B
1271 0100 Provider Name B
1271 B
1271 B
1271 B
1271 B
1271
0101 Provider Name
0138 Provider Name
0179 Provider Name
0286 Provider Name
0287 Provider Name B
123 Provider CALICO DRIVE STAYTON FL 59255
123 Provider TERRA COTTA STREET DARRINGTON
FL 57399
123 Provider LANGTOWN ROAD DARRINGTON FL 57399
123 Provider POINTE LANE Bonum integritas corporis misDARRINGTON FL 58398
123 Provider OAK DRIVE SUNNYVALE MO 83407
123 Provider HOTT STREET DARRINGTON FL 58398
123 Provider GRASSELLI STREET DARRINGTON FL 68396
123 Provider HEAVENS WAY MORRISONS CROSSROADS AL 33165
123 Provider GOOSETOWN DRIVE MIDVILLE
FL 93176
123 Provider PIKE STREET BELLOWS FALLS
FL 48405
123 Provider GLENVIEW DRIVE SUSSEX FL
123 Provider JONES AVENUE BLYTHEVILLE
FL 14027
123 Provider HENERY STREET SUSSEX FL
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Aging Network Provider Information Report PSA ALL
PSA Provider Loc Provider Name Address Type Provider Address Telephone
11 1952 B
1952 B
1952 B
1952 B
1952 B
1952 B
1952 B
123 Test Street ELLSINORE FL 38234 3789 WHITE
123 Test Street OHATCHEE FL 45235 3408 NORMA
123 Test Street WHITE CLOUD FL 46226
123 Test Street NEOSHO FL 06231
123 Test Street WHITE CLOUD FL 16168 3678 OLD
123 Test StreetWHITE CLOUD FL 06231 184 GRANT
123 Test Street WHITE CLOUD FL 93236
1952
1955
1956
B 3123 Test Street Quid censes in Latino fore IaWHITE CLOUD FL 70226
1957
0Provider Name
0Provider Name
0Provider Name
0Provider Name
0Provider Name
0Provider Name
0Provider Name
0Provider Name
0Provider Name
0Provider Name
0Provider Name B 123 Test Street Sed ad rem redeamus ComprehenWHITE CLOUD FL 38227
1957
1958
Count
0474 Provider Name
0072 Provider Name
427
B 123 Test Street BRANCH ROAD Quid ergo hoc loco intellegit WHITE CLOUD FL 25224
Count Total 3117
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Aging Network Providers Report PSA ALL
PSA 01
Provider 1271 Provider Name Provider Name
Location 0000 Location Name Provider Name
Location Business Address 3123 Test Drive DARRINGTON FL 58398
County Served OKALOOSA Phone Fax Location Contact
Provider Director Provider Profit Status Non-Profit
ACCESS_PT CCE_LA N HCE OAA OTHER
ADI EHEAP LSP RELF
CCE Y FOCAL_PT NSIP SR_CTR
Provider 1271 Provider Name Provider Name
Location 0001 Location Name Provider Name
Location Business Address 1234 Test OAK DRIVE SUNNYVALE MO 83407
Phone Fax Location Contact County Served OKALOOSA
Provider Director Provider Profit Status Non-Profit
ACCESS_PT CCE_LA N HCE OAA OTHER
ADI EHEAP LSP RELF
CCE Y FOCAL_PT NSIP SR_CTR
Provider 1271 Provider Name Provider Name
Location 0004 Location Name Provider Name
Location Business Address 1123 Test HEAVENS WAY MORRISONS CROSSROADS AL
33165 Phone County Served OKALOOSA Fax Location Contact
Provider Director Provider Profit Status Non-Profit
ACCESS_PT CCE_LA N HCE Y OAA OTHER
ADI EHEAP LSP RELF
CCE FOCAL_PT NSIP SR_CTR
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Start End Worker Most Recent Nutr Medicaid Program Provider Location Client ID Client Name Status Enrollment Enrollment Worker Active Score Number
O3C1 1036 0000 4061653427 Test Name ACTV 09102013 CIRTS20804 Y 1
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Start End Worker Most Recent Nutr Medicaid Program Provider Location Client ID Client Name Status Enrollment Enrollment Worker Active Score Number
O3C1 1036 0000 4061638016 Test Name ACTV 09122013 CIRTS20804 Y 2
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Start End Worker Most Recent Nutr Medicaid Program Provider Location Client ID Client Name Status Enrollment Enrollment Worker Active Score Number
O3C2 1036 0000 4062000152 Test Name ACTV 02072011 CIRTS23407 N 3
1036 0000 4061594062 ISAACS HATTIE ACTV 11192012 CIRTS20804 Y 5
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Start End Worker Most Recent Nutr Medicaid Program Provider Location Client ID Client Name Status Enrollment Enrollment Worker Active Score Number
O3C2 1036 0000 4062379505 Test Name ACTV 11192012 CIRTS20804 Y 5
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Start End Worker Most Recent Nutr Medicaid Program Provider Location Client ID Client Name Status Enrollment Enrollment Worker Active Score Number
O3C2 1036 0000 4062401063 Test Name ACTV 10162013 CIRTS20804 Y 3
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Provider Location Client ID Client Name Program Status
Start Enrollment
End Enrollment Worker
Worker Active
Most Recent Nutr Score
Medicaid Number
O3C2 1036 0000 4062538939 ACTV 12082000 CIRTS20388 Y Test Name
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All Enrollments Counts During Date Range PSA ALL Start Date 01012017 End Date Location 0000 Provider Program Program Status
12312017 ALL PROVIDERS
ACTV
Group By Program Provider Location
Program Provider Location Client Count O3C1 1036 0000 45
1951 0000 3
O3C2 1036 0000 113
OA3E 1821 0000 2
OA3ES 1821 0000 1
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C1 1036 0000 4061950299 Test Name ACTV 04072011 CIRTS23407 N 11
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C1 1036 4062586019 Test Name ACTV 12292008 CIRTS23407 N 1
Total for Location 45
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C1 1951 0000 4062452921 Test Name ACTV 03301989 CIRTS22695 N 10
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4062786256 Test Name ACTV 09232013 CIRTS20804 Y 4 1
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4062380426 Test Name ACTV 04112012 CIRTS23407 N 55 2
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4061608826 Test Name ACTV 08102011 CIRTS18634 Y 7 3
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4062615533 Test Name ACTV 10032013 CIRTS20804 Y 6 3
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start Enrollment
End Enrollment Worker
Worker Active
Medicaid Number
Most Recent Nutr Score Rank
O3C2 1036 4062466582 Test Name ACTV 10262010 CIRTS23407 N 105 2
Total for Location 113
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PSA
APCL Clients With No Services ALL Owner All Owners Provider ALL PROVIDERS
Start Date 01012017 End Date 12312017
Includes Clients Receiving Only CM INSC SCAS CA REFE Services
PSA Client ID Client Name Owner Provider Program
Count 0
Unduplicated Clients Count 0
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APCL Clients With Services PSA ALL Owner All Owners Provider ALL PROVIDERS Start Date 01012017 End Date 12312017
Exclude CM CA INSC REFE SCAS
PSA Client ID Name Owner Provider Program 10 4062527553 Test Name 1539 1929 CCE
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APCL Clients With Services PSA ALL Owner All Owners Provider ALL PROVIDERS Start Date 01012017 End Date 12312017
Exclude CM CA INSC REFE SCAS
PSA Client ID Name Owner Provider Program 11 4062732638 Test Name 1177 1177 LTCC
Total 21067
Unduplicated clients count 12460
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APS Assessments PSA ALL Risk Level ALL Owner All Owners Referral Date From 01012017 To 12312017
Order by Referral Date and Owner ID
PSA 03
Ref Date Owner ID Client ID Client Name Risk Level Asmt Type Asmt Date
03032017 1390 4062058415 L 701A 03302018 Test Name
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APS Assessments PSA ALL Risk Level ALL Owner All Owners Referral Date From 01012017 To 12312017
Order by Referral Date and Owner ID
12042017 1980 4061617559 H 701B 12072017 Test Name
Assessment Count for the PSA 52
PSA 04A
Ref Date Owner ID Client ID
09102017 4062308458
Client Name
Test Name
Risk Level
H
Asmt Type
O
Asmt Date
09162017
Assessment Count for the PSA 2
Risk Level H
M
L
Count of Assessments 138
23
21
Total Count of Assessments 182
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APS Repeat Referrals in a Time Range
PSA ALL Owner All Owners
Start Date 01012017 End Date 12312017
Current DOEA CIRTS Cirts SSN if Risk Date Created PSA Owner Abuse No different than DCF DCF SSN Name County Level Date of Birth Date Sent by DCF
Count 0
Unduplicated Client Count by PSA
PSA Count SSN
Total
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Assessed Prioritized Consumer List PSA ALL Provider ALL PROVIDERS Program AC County ALL COUNTIES
County Program Consumer Name Client ID
Total Count 0
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Assessment Due Report PSA 01 Start Date 01012017 End Date 08312018 Owner ALL PROVIDERS Worker ALL WORKERS Program Status ACTV and APCL Assessment Type Needed ALL
Overdue and missing assessments are always listed
Owner ID 1065
Client ID Client Name
Owner Assessor ID
Date of Birth
06281928
CIRTS28099
County of Service
GULF
Worker Name HARPER KENNY
Zip Assessment PSA Date
32534 01 01022014
Type
701A
Active Y
Nutr PriorityScore Score
11 58
Rank
5
Due Date
01022015
Status
701S OVERDUE
LTCC APPL Start Date
03252014 4062235673 Test name
Total Clients for Worker 1
Total Clients for Owner 1
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Assessment Due Report PSA 01 Start Date 01012017 End Date 08312018 Owner ALL PROVIDERS Worker ALL WORKERS Program Status ACTV and APCL Assessment Type Needed ALL
Overdue and missing assessments are always listed
Summary by PSA
PSA 01 701A Overdue 1
701B Overdue 213
701C Overdue 0
701S Overdue 157
No 701A 0
No 701B 2
No 701C 0
No 701S 0
701A Not Overdue 0
701B Not Overdue 0
701C Not Overdue 0
701S Not Overdue 0
701S Optional 0
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CIC Service Units and Costs Projections County SummaryPSA 99 Program CCE
Start Date 01012017 End Date 12312017
County LEON
Total Total Total Avg Max Projected
StateFederal Projected Reimbursement Provider Unduplicated Provider Service Share Service Units Unit Rate Cost Per Unit Client Count
Report Total
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CIC Service Units and Costs Projections Provider SummaryPSA ALL Provider ALL PROVIDERS Program FEDERALLY FUNDED (0101 TO 1231) Year 2017 From 01012017 To 12312017
PSA County Program Service Total State
Federal Share
Total Projected
Service Units
Avg Reimbursement
Unit Rate
Max Provider
Cost Per Unit
Total Projected Unduplicated Client Count
02 FRANKLIN O3C1 CONGREGATE MEALS $810300 1710 15
Program Total
County Total
$810300
$810300
GULF O3C1 CONGREGATE MEALS $25205 3 5
Program Total $25205
O3C2 HOME DELIVERED MEALS $25205 3 6
Program Total
County Total
$25205
$50411
LEON O3C1 CONGREGATE MEALS $621300 1311 15
CONGREGATE MEALS GUEST
CONGREGATE MEALS VOLUNTEERS
$252055
$277260
25
30
2
5
Program Total $1150615
O3C2 HOME DELIVERED MEAL GUEST $252055 25 3
Program Total $252055
OA3D PEARLS (SESSION 5)
PEARLS (SESSION 6)
PEARLS (SESSION 7)
PEARLS (SESSION 8)
$10247
$10247
$10247
$10247
10
10
10
10
3
3
3
3
Program Total $40988
OA3E RESPITE IN-HOME $200 2 2
Program Total
County Total
$200
$1443858
WAKULLA O3C2 EMERGENCY HOME DELIVERED SHELF MEALS
$8065604 14899 90
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CIC Service Units and Costs Projections - PSA Summary
PSA ALL Program CCE
Strat Date 01012017 End Date 12312017
Total
PSA County Provider Service
Total State Federal
Share
Total Projected
Service Units
Avg Reimbursement
Unit Rate
Max Projected Provider Unduplicated
Cost Per Unit Client Count
02 LEON SOUTHERN SERVICE CASE MANAGEMENT PROVIDER EMERGENCY HOME DELIVERED SHELF MEALS
$2175533
$602000
483
689
32
20
HOME DELIVERED MEALS $530262 993 5
MATERIAL AID $1994536 199
Provider Total $5302331
CountyTotal $5302331
WAKULLA SOUTHERN SERVICE CASE MANAGEMENT PROVIDER EMERGENCY HOME DELIVERED SHELF MEALS
$2175533
$1240200
483
689
32
5
MATERIAL AID $1994536 199
Provider Total $5410269
CountyTotal $5410269
PSA Total $10712599
05 PINELLAS BURSTEIN-APPLEBEE ADULT DAY CARE $000 0 $900 $1000 0
COUNSELING (MENTAL HEALTH COUNSELINGSCREENING) - INDIVIDUAL
Provider Total
$000
$000
0 $6600 $7700 0
CountyTotal $000
PSA Total $000
Report Total $10712599
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CID Service Units and Costs Projections - PSA SummaryPSA ALL Program CCE
Start Date 01012017 End Date 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
PSA County Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
02 LEON CASE MANAGEMENT $2175533 483
EMERGENCY HOME $602000 689DELIVERED SHELF MEALS HOME DELIVERED MEALS $530262 993
MATERIAL AID $1994536 199
County Total $5302331 2364
WAKULLA CASE MANAGEMENT $2175533 483
EMERGENCY HOME $1240200 689DELIVERED SHELF MEALS MATERIAL AID $1994536 199
County Total $5410269 1371
PSA Total $10712599 3735
05 PINELLAS ADULT DAY CARE $000 0
COUNSELING (MENTAL $000 0 HEALTH COUNSELINGSCREENING) - INDIVIDUAL
County Total $000 0
PSA Total $000 0
Report Total $10712599 3735
$900 $900 $900 $1000 $1000 $1000
$6600 $6600 $6600 $7700 $7700 $7700
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CID Service Units and Costs Projections County SummaryPSA 99
Program CCE County LEON
Start Date 01012017 End Date 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
Report Total
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CIE Service Units and Costs Projections - PSA Summary - All Programs
PSA 99 Program FEDERALLY FUNDED (0101 TO 1231) Year 2017 From 01012017 To 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
Program Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
Report Total
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CIE Service Units and Costs Projections - PSA Summary
PSA ALL Program CCE
Start Date 01012017 End Date 12312017
Avg High Low Total Total Avg High Low Provider Provider Provider
StateFederal Projected Reimbursement Reimbursement Reimbursement Cost Cost CostPSA
02
Service
CASE MANAGEMENT
Share
$4351066
Service Units
966
Unit Rate Unit Rate Unit Rate Per Unit Per Unit Per Unit
EMERGENCY HOME DELIVERED SHELF MEALS $1842200 1378
HOME DELIVERED MEALS $530262 993
MATERIAL AID $3989071 398
PSA Total $10712599 3735
05 ADULT DAY CARE $000 0 $900 $900 $900 $1000 $1000 $1000
COUNSELING (MENTAL HEALTH $000 0 $6600 $6600 $6600 $7700 $7700 $7700 COUNSELINGSCREENING) - INDIVIDUAL
PSA Total $000 0
Report Total $10712599 3735
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CAREGIVER SEARCH REPORT
SEARCH RESULTS FOR CONSUMERS
Criteria First Name Last Name SSN PSA ALL
Client Name Client SSN Caregiver Name Caregiver SSN
000000000 000000000 Test Name Test Name
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CARES Referrals in a Time Range PSA ALL
Start Date 01012017 End Date 12312017
Referred to ALL REFERRALS
Referring PSA Employee Name Client Name Client ID
Referral Imminent NH Admit Aging Date Risk Date Referred To Cares Provider Name Received Date
03A 4061561263 Test Name Test Name 09242017 Y 05292017 ARC or ADRC 09252017
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CARES Referrals in a Time Range PSA ALL
Start Date 01012017 End Date 12312017
Referred to ALL REFERRALS
Referring PSA Employee Name Client Name Client ID
Referral Date
Imminent Risk
NH Admit Date Referred To Cares Provider Name
Aging Received Date
04B Test Name Test Name 4061738075 04082017 N ARC or ADRC Test Name 04082017
Total Clients 110
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CARES Referrals not acknowledged by the Aging Network PSA ALL For Referrals after 01012017 Owner ID ALL Owners
Unduplicated Client count Cares Office Total Clients Count
Report Total
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
CIRTS Issue PSA Client ID Client Name Program
Program Status Start Provider Enrollment ID Provider Name
APCL CLIENT WITH DATE OF DEATH 08 4061759417 Test Name OA3B APCL 07232013 1141 WESTERN WORLD RADIO
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
Program Start Provider CIRTS Issue PSA Client ID Client Name Program Status Enrollment ID Provider Name
06 LTCC APCL 01242014 1514 4061713685 Test Name APCL CLIENT WITH DATE OF DEATH CENTRAL THE ORIGINAL HOUSE OF PIES
Count 503
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Civil Rights PSA ALL Provider ALL PROVIDERS Program AC Start Date 01012017 End Date 12312017 The Poverty Level for Single is The Poverty Level for Couple is Sort by County
County Unduplicated Count
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Client Information Report Start Date 01012017 End Date 12312017
Client ID 1001141246
Emergency
Client Name Test Name
Telephone () - Address 78 TEST STREET TALLAHASSEE FL 32399
Most Recent Caregiver Information Date Updated
Doctor
Comments
Client Demographic Information
Birth Date 06041940 Race W
Owner ID Ethnicity O
Most Recent Income Information
Ind Mon Inc Cpl Mon Inc
Ind Assets Couple Assets
Most Recent Assessment Information
Asmt Date Ref Risk Lvl
Asmt Site Spec Shel
AsmtType Spec Reg
Ref Date Primary CG
Ref Source Living Sit
Enrollment Information
Sex
Marital Status
F
S
Medicaid Number
ADL Score
ADL Count
IADL Score
IADL Count
Memory Score
Priority Score
Env Score
Nutr Score
Risk Score
Social Score
Rank
Provider Location Program Program Status Worker Start Date End Date
Care Plan Service Needed
Date Service Units Type Frq End Date
Care Plan Service Planned
Program Service Units Type Frq Start Date End Date
Services Received between 01012017 and 12312017
Service Billed Provider Location Worker Program Service Date Units Unit Type Amount
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Provider N
Client Service Units Report PSA ALL Provider ALL PROVIDERS Location 0000
Program ALL PROGRAMS Service ALL SERVICES Worker ALL WORKERS
City ALL CITIES Include Zero Unit N Include Aggregate N Calculated Amount equals the number of Units Provided times Fixed Cost if it existsService Start Date 01012017 Service End Date 12312017 If Fixed Cost does not exist Calculated
Group by PSA Provider Location Client Name County Worker Amount equals Billed Amount
Unduplicated Client Count 0 Grand Total 000 $000
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Clients In Common PSA All Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 County All Counties Worker All Workers
County JEFFERSON
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
MIAMI-DADE
0 0 0 0 0 0 0 0 0
4061539538 Test NameCounty Count
County
0 01
X
0 1
X
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
4061650856 Test Name X 4061486560 Test Name X 4062452921 Test Name X
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Clients Served Not Enrolled PSA ALL Start Date 01012017 End Date 12312017 Locations 0000 Provider All Providers
Service Service Min Serv Max Serv Program Start End Enrollment PSA Provider Location Program Consumer Name Client ID Service Date Date Status Enrollment Enrollment Provider
Count 0
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
4061472791 04
09
1092
1291
0072
0042
LTCC
LTCC
APCL
APCL
4062714543 06
06
1514
1762
0072
5006
LTCC
LTCC
APCL
APPL
4061802246 11
06
1177
1514
0179
0072
LTCC
LTCC
APCL
APCL
4061563719 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062644312 06
08
1514
1771
0072
0896
LTCC
LTCC
APCL
APCL
1001141670 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
1001141671 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
4062375003 07
05
05
07
1263
1755
1638
1263
0368
0072
0072
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062155124 06
06
1762
1514
0072
0072
LTCC
LTCC
APPL
APCL
4061743886 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0369
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4061499927 06
06
1514
1762
0072
5005
LTCC
LTCC
APCL
APPL
4061583524 08
06
1144
1514
0896
0072
LTCC
LTCC
APCL
APCL
4062694843 06
03
1514
1922
0072
0179
LTCC
LTCC
APCL
APCL
4062744517 07
06
1263
1514
0369
0072
LTCC
LTCC
APCL
APCL
4062005488 10
11
10
11
1929
1177
1164
1177
0072
0073
0179
0179
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
Total Count 15
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CODE DESCRIPTIONS Category ALL STATE TABLES
Code Description Active Available To Code Category
0 UNKNOWN Y CARES SUBJECTIVE_HEALTH_EVALUATION
01 ALACHUA Y COMMON COUNTIES
02 BAKER Y COMMON COUNTIES
03 BAY Y COMMON COUNTIES
04 BRADFORD Y COMMON COUNTIES
05 BREVARD Y COMMON COUNTIES
06 BROWARD Y COMMON COUNTIES
07 CALHOUN Y COMMON COUNTIES
08 CHARLOTTE Y COMMON COUNTIES
09 CITRUS Y COMMON COUNTIES
1 EXCELLENT Y CARES SUBJECTIVE_HEALTH_EVALUATION
10 CLAY Y COMMON COUNTIES
11 COLLIER Y COMMON COUNTIES
12 COLUMBIA Y COMMON COUNTIES
13 MIAMI-DADE Y COMMON COUNTIES
14 DESOTO Y COMMON COUNTIES
15 DIXIE Y COMMON COUNTIES
16 DUVAL Y COMMON COUNTIES
17 ESCAMBIA Y COMMON COUNTIES
18 FLAGLER Y COMMON COUNTIES
19 FRANKLIN Y COMMON COUNTIES
2 GOOD Y CARES SUBJECTIVE_HEALTH_EVALUATION
20 GADSDEN Y COMMON COUNTIES
21 GILCHRIST Y COMMON COUNTIES
22 GLADES Y COMMON COUNTIES
23 GULF Y COMMON COUNTIES
24 HAMILTON Y COMMON COUNTIES
25 HARDEE Y COMMON COUNTIES
26 HENDRY Y COMMON COUNTIES
27 HERNANDO Y COMMON COUNTIES
28 HIGHLANDS Y COMMON COUNTIES
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CONSUMER AGE VERIFICATION REPORT PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Program AC
Age at Start
Enroll or Start Enroll Provider Program Description Consumer Name Client ID DOB Svc date or Svc Date
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Contract Budget Information PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Program Service Provider Location County Served Provider Contract
Projected Service
Units Unit Measure
Projected Unduplicated
State Federal Share Client Count Begin Date End Date
Row Count 0 Amount Total
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Start Enroll Latest Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Date Asmt Date Worker
O3C1 1036 000 4061653427 Test CENTRAL 34982 W M 07091930 09102013 09102013 CIRTS20804 0 Name
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Start Enroll Date
Latest Asmt Date Worker
4061593624 Test Name CENTRAL 34946 B F 11261940 12012011 12312013 CIRTS23407
Count 164
Unduplicated Client Count 163
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Assessments After DOD Report
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Owner 1025
The shaded records indicate clients who have different DOBs andor different names
Assemt Current PSA Owner Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Owner Assessor
Provider Assessor
Assemt Date
Assemt Type
Unduplicated Count Total 0
Report run on 08312018 0206 PM Page 1 of 1 vs_assmrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Open Enrollments
The Vital Statistics Data for 07192002 - 09112014PSA ALL Provider ALL Program Status ACTV Include MLTC ACTVS N
The shaded records indicate clients who have different DOBs andor different names
Enroll PSA
Enrollment Provider Loc Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Enroll Program Status
Enroll Program
Current Owner ID
02 1065 0072 4062244026 Test Name Test Name 10222004 03231917 03231917 ACTV CCE 1065
Count of enrollments for the Provider 1
Count of enrollments for the PSA 1
Count of enrollments for the Report 1
Unduplicated Count of Individuals with open enrollments and DOD PSA Total Clients Count
02 1
Total 1
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Report run on 08312018 0207 PM Page 1 of 3 vs_servicesrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Unduplicated count of individuals with Services after DOD
PSA Total Clients Count
Report Total
Report run on 08312018 0207 PM Page 2 of 3 vs_servicesrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
List of Clients with PSA table entry for SERVICES_AFTER_DOD
Unduplicated Count Total 0
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Age
Provider
Total
Age lt 60 Age 60 - 64 Age 65 - 74 Age 75 - 84 Age 85+ Total Clients Avg Age
Total
Avg Age
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Ethnicity
Provider Hispanic Other Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Race
American Indian Native Hawaiian Other Provider Asian Alaska Native Black Pacific Islander Minority White Multiple Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Gender
Provider Male Female Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Monthly Income
Provider 0 - - Higher than Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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None
Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Total Persons Served 0
Age lt 60 Years 0 0
Age 60 - 64 0 0
Age 65 - 74 0 0
Age 75 - 84 0 0
Age 85+ 0 0
Total Age 0 0
Average 000
Ethnicity Hispanic 0 0
Other Ethnicity 0 0
Unknown Ethnicity 0 0
Total 0 0
Race Asian 0 0
American Indian Alaska Native 0 0
Black 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority 0 0
White 0 0
Multiple 0 0
Unknown 0 0
Total 0 0
Sex Male 0 0
Female 0 0
Unknown Sex 0 0
Total 0 0
Monthly Income 0 - 0 0
- 0 0
Higher than 0 0
Unknown 0 0
Total 0 0
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Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Client ID Date Of Birth Ethnicity Race Sex Individual Monthly Income
Report run on 08312018 1058 AM Page 2 of 2 demo_by_prov_detrdf Report run byRSHQALL Dispose of this report so that it can not be read or reconstructed
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Demographics of Clients OAA Registered Served Only PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 City All Cities Program All Programs Service All Services County ALL COUNTIES Table OAA Registered Services Only Low Income Medium Income
Total Persons Served 0
Agelt 60 Years
Age 60 - 64
Age 65 - 74
Age 75 - 84
Age 85+
0
0
0
0
0
0
0
0
0
0
Monthly Income
0 -
-Higher than
Unknown
0
0
0
0
0
0
0
0
Total
Average
0
000
0 Total 0 0
Ethnicity Hispanic
Other
Unknown
0
0
0
0
0
0
Living Situation
Alone
Null
Policy Change
0
0
0
0
0
0
Total 0 0 Unknown
With Caregiver
0
0
0
0
Race Asian 0 0
With Other
With Other Caregiver
0
0
0
0
American Indian Alaska Native
Black
0
0
0
0Total Living Situation 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority
White
0
0
0
0 Limited English Proficiency
Multiple
Unknown
Total Race
0
0
0
0
0
0
Yes
No
Unknown
0
0
0
0
0
0
Total 0 0
Sex Male
Female
Unknown
0
0
0
0
0
0
Total 0 0
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Disaster Assistance Clients for a Provider PSA ALL Provider All Providers Location 0000 Worker All Workers City All Cities Zip Code All Zip Codes Sort By ZIP
Provider 1036 Provider Name Location 0000 Worker CIRTS18634
Need Care Client Name Address City Zip County Phone Asst Reg Situation Relat Care phone Care Name
34946 N WO DA 000 SAINT JAMES DRIVE CENTRAL (025) 101-0620 Test NameTest Name SAINT LUCIE (005) 100-0369 Y
Client is active and no assessment information is available Special Shelter and Special Registry are unknown
Report run on 08312018 1102 AM Page 1 of 8 disaster_by_provrdf
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
Total by PSA 0
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
ALACH BAKER BAY BRADF BREVA BROWA CALHO CHARL CITRUS CLAY COLLIE COLUM DESOT DIXIE DUVAL ESCAM FLAGL FRANK GADSDAssisted Household Report UA ORD RD RD UN OTTE R BIA O BIA ER LIN EN
1 of Household Assisted 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Households AssistedWith Gross Income
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C 100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D 125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
3 Households with at leastOne member
A 60 Years or older 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B Disabled 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C Age 5 years or under 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D Under 60 Years Old 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Undup Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Assisted
Applicant Household Report
of Applicant Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Energy Assisted Household Report
County of Assisted
Households
Households Assisted By Poverty Level
Under 75 75 - 100 101 - 125 126 - 150 Over 150 60 Years or older
At least one member who is
Age 5 years Age 2 years Age 3 years Disabled or younger and younger through 5
Under 60 Years Old
Undup Households
Assisted
Energy Assistance Total
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Unduplicated Total 0 0
County of Assisted
Households Under 75 75 - 100
Households Assisted By Poverty Level
101 - 125 126 - 150 Over 150 60 Years or older Disabled
Age 5 years or younger
Age 2 years and younger
Age 3 years through 5
Under 60 Years Old
At least one member who is
Undup Households
Assisted
Other Assisted Household Report
Other Assistance Total
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Applicant Household Report
County of Applicant
Households Under 75 75 - 100 101 - 125 126 - 150 Over 150 Income data
unavailable
Total 0
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01
Enrollment Active Consumer Count by Program PSA ALL Provider ALL PROVIDERS
County Description Program Count of Clients
BREVARD
ADI
CCE
HCE
LSP
NDP
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
MLTC
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
31
57
44
5
62
123
141
26
9
7
5
40
5
50
67
129
2
19
42
29
1
233
79
63
8
2
14
3
37
14
47
3
3
33
127
10
02
03
04
ALACHUA
BAKER
BAY
BRADFORD
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Enrollment Terminations with Reasons PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 Program All Programs Program Status ALL Program Status Worker ALL WORKERS
Last First Program Medicaid Provider Start End Name Name Client ID Status Description Worker Number Program Location Enrollment Enrollment
Count 0
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Enrollments with Care Plan Report
PSA ALL Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTIVE STATUS Care Plan Service ALL SERVICES Care Plan Start 01012017 Care Plan End 12312017
Care Plan Care Plan Care Plan Client Name
Unduplicated Client Count 0
Client ID Program Status Worker Start Date End Date Service
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PSA CLIENT_ID CLIENT_NAME OWNER PROVIDER_ID ASSESSMENT_DATE ASSESSOR_NAME MEDICAID_NUMBER CAREGIVER_CHANGE ENVIRONMENT_CHANGE HEALTH_CHANGE INCOME_CHANGE SITUATION_CHANGE INITIAL_ASSM ANNUAL_ASSM SSN REFERRAL_SOURCE 1114 N N N N Y N 771771777 SELFFAMILY 812017 JANE CASEWORKER 2 1001141633 TEST TEST N
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Fixed Service Costs List PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Provider Location County Program Service Reimbursement Unit Rate Provider Cost Per Unit Begin Valid End Valid
Count 0
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ACTV CCE HCE and ADI Clients with No Care Plan PSA ALL
Program ALL PROGRAMS Provider ALL PROVIDERS
Owner All Owners
Enrollment Information PSA Client ID Name Owner Provider Loc Program Start Date Worker
01 4062521310 Test Name 1911 1911 0932 CCE 03272014 CIRTS29059
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ACTV CCE HCE and ADI Clients with No Care Plan PSA ALL
Program ALL PROGRAMS Provider ALL PROVIDERS
Owner All Owners
PSA Client ID Name Owner Enrollment Information
Provider Loc Program Start Date Worker
4061605936 Test Name 1785 1927 0072 ADI 07202006 CIRTS26739
11
Duplicated Count 72 Unduplicated Counts 70
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ACTV APPL APCL Clients who have moved to another PSA PSA ALL
Provider ALL PROVIDERS
Address Enrollment Client ID Client Name Provider Loc Program Program Start PSA PSA Status Enrollment
01A 02 4062760605 1191 0072 CCE ACTV 11082011 Test Name
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Aging Network Provider Information Report PSA ALL
Address PSA Provider Loc Provider Name Type Provider Address Telephone
01 1147 B
1147
0072 Provider Name
0073 Provider Name B
1147
1147
0100 Provider Name
0179 Provider Name B
1271 B
1271 B
1271
0000 Provider Name
0001 Provider Name
0002 Provider Name B
1271 B
1271
0003 Provider Name
0004 Provider Name B
1271 B
1271
0072 Provider Name
0073 Provider Name B
1271 0100 Provider Name B
1271 B
1271 B
1271 B
1271 B
1271
0101 Provider Name
0138 Provider Name
0179 Provider Name
0286 Provider Name
0287 Provider Name B
123 Provider CALICO DRIVE STAYTON FL 59255
123 Provider TERRA COTTA STREET DARRINGTON
FL 57399
123 Provider LANGTOWN ROAD DARRINGTON FL 57399
123 Provider POINTE LANE Bonum integritas corporis misDARRINGTON FL 58398
123 Provider OAK DRIVE SUNNYVALE MO 83407
123 Provider HOTT STREET DARRINGTON FL 58398
123 Provider GRASSELLI STREET DARRINGTON FL 68396
123 Provider HEAVENS WAY MORRISONS CROSSROADS AL 33165
123 Provider GOOSETOWN DRIVE MIDVILLE
FL 93176
123 Provider PIKE STREET BELLOWS FALLS
FL 48405
123 Provider GLENVIEW DRIVE SUSSEX FL
123 Provider JONES AVENUE BLYTHEVILLE
FL 14027
123 Provider HENERY STREET SUSSEX FL
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Aging Network Provider Information Report PSA ALL
PSA Provider Loc Provider Name Address Type Provider Address Telephone
11 1952 B
1952 B
1952 B
1952 B
1952 B
1952 B
1952 B
123 Test Street ELLSINORE FL 38234 3789 WHITE
123 Test Street OHATCHEE FL 45235 3408 NORMA
123 Test Street WHITE CLOUD FL 46226
123 Test Street NEOSHO FL 06231
123 Test Street WHITE CLOUD FL 16168 3678 OLD
123 Test StreetWHITE CLOUD FL 06231 184 GRANT
123 Test Street WHITE CLOUD FL 93236
1952
1955
1956
B 3123 Test Street Quid censes in Latino fore IaWHITE CLOUD FL 70226
1957
0Provider Name
0Provider Name
0Provider Name
0Provider Name
0Provider Name
0Provider Name
0Provider Name
0Provider Name
0Provider Name
0Provider Name
0Provider Name B 123 Test Street Sed ad rem redeamus ComprehenWHITE CLOUD FL 38227
1957
1958
Count
0474 Provider Name
0072 Provider Name
427
B 123 Test Street BRANCH ROAD Quid ergo hoc loco intellegit WHITE CLOUD FL 25224
Count Total 3117
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Aging Network Providers Report PSA ALL
PSA 01
Provider 1271 Provider Name Provider Name
Location 0000 Location Name Provider Name
Location Business Address 3123 Test Drive DARRINGTON FL 58398
County Served OKALOOSA Phone Fax Location Contact
Provider Director Provider Profit Status Non-Profit
ACCESS_PT CCE_LA N HCE OAA OTHER
ADI EHEAP LSP RELF
CCE Y FOCAL_PT NSIP SR_CTR
Provider 1271 Provider Name Provider Name
Location 0001 Location Name Provider Name
Location Business Address 1234 Test OAK DRIVE SUNNYVALE MO 83407
Phone Fax Location Contact County Served OKALOOSA
Provider Director Provider Profit Status Non-Profit
ACCESS_PT CCE_LA N HCE OAA OTHER
ADI EHEAP LSP RELF
CCE Y FOCAL_PT NSIP SR_CTR
Provider 1271 Provider Name Provider Name
Location 0004 Location Name Provider Name
Location Business Address 1123 Test HEAVENS WAY MORRISONS CROSSROADS AL
33165 Phone County Served OKALOOSA Fax Location Contact
Provider Director Provider Profit Status Non-Profit
ACCESS_PT CCE_LA N HCE Y OAA OTHER
ADI EHEAP LSP RELF
CCE FOCAL_PT NSIP SR_CTR
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Start End Worker Most Recent Nutr Medicaid Program Provider Location Client ID Client Name Status Enrollment Enrollment Worker Active Score Number
O3C1 1036 0000 4061653427 Test Name ACTV 09102013 CIRTS20804 Y 1
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Start End Worker Most Recent Nutr Medicaid Program Provider Location Client ID Client Name Status Enrollment Enrollment Worker Active Score Number
O3C1 1036 0000 4061638016 Test Name ACTV 09122013 CIRTS20804 Y 2
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Start End Worker Most Recent Nutr Medicaid Program Provider Location Client ID Client Name Status Enrollment Enrollment Worker Active Score Number
O3C2 1036 0000 4062000152 Test Name ACTV 02072011 CIRTS23407 N 3
1036 0000 4061594062 ISAACS HATTIE ACTV 11192012 CIRTS20804 Y 5
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Start End Worker Most Recent Nutr Medicaid Program Provider Location Client ID Client Name Status Enrollment Enrollment Worker Active Score Number
O3C2 1036 0000 4062379505 Test Name ACTV 11192012 CIRTS20804 Y 5
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Start End Worker Most Recent Nutr Medicaid Program Provider Location Client ID Client Name Status Enrollment Enrollment Worker Active Score Number
O3C2 1036 0000 4062401063 Test Name ACTV 10162013 CIRTS20804 Y 3
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Provider Location Client ID Client Name Program Status
Start Enrollment
End Enrollment Worker
Worker Active
Most Recent Nutr Score
Medicaid Number
O3C2 1036 0000 4062538939 ACTV 12082000 CIRTS20388 Y Test Name
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All Enrollments Counts During Date Range PSA ALL Start Date 01012017 End Date Location 0000 Provider Program Program Status
12312017 ALL PROVIDERS
ACTV
Group By Program Provider Location
Program Provider Location Client Count O3C1 1036 0000 45
1951 0000 3
O3C2 1036 0000 113
OA3E 1821 0000 2
OA3ES 1821 0000 1
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C1 1036 0000 4061950299 Test Name ACTV 04072011 CIRTS23407 N 11
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C1 1036 4062586019 Test Name ACTV 12292008 CIRTS23407 N 1
Total for Location 45
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C1 1951 0000 4062452921 Test Name ACTV 03301989 CIRTS22695 N 10
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4062786256 Test Name ACTV 09232013 CIRTS20804 Y 4 1
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4062380426 Test Name ACTV 04112012 CIRTS23407 N 55 2
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4061608826 Test Name ACTV 08102011 CIRTS18634 Y 7 3
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4062615533 Test Name ACTV 10032013 CIRTS20804 Y 6 3
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start Enrollment
End Enrollment Worker
Worker Active
Medicaid Number
Most Recent Nutr Score Rank
O3C2 1036 4062466582 Test Name ACTV 10262010 CIRTS23407 N 105 2
Total for Location 113
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PSA
APCL Clients With No Services ALL Owner All Owners Provider ALL PROVIDERS
Start Date 01012017 End Date 12312017
Includes Clients Receiving Only CM INSC SCAS CA REFE Services
PSA Client ID Client Name Owner Provider Program
Count 0
Unduplicated Clients Count 0
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APCL Clients With Services PSA ALL Owner All Owners Provider ALL PROVIDERS Start Date 01012017 End Date 12312017
Exclude CM CA INSC REFE SCAS
PSA Client ID Name Owner Provider Program 10 4062527553 Test Name 1539 1929 CCE
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APCL Clients With Services PSA ALL Owner All Owners Provider ALL PROVIDERS Start Date 01012017 End Date 12312017
Exclude CM CA INSC REFE SCAS
PSA Client ID Name Owner Provider Program 11 4062732638 Test Name 1177 1177 LTCC
Total 21067
Unduplicated clients count 12460
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APS Assessments PSA ALL Risk Level ALL Owner All Owners Referral Date From 01012017 To 12312017
Order by Referral Date and Owner ID
PSA 03
Ref Date Owner ID Client ID Client Name Risk Level Asmt Type Asmt Date
03032017 1390 4062058415 L 701A 03302018 Test Name
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APS Assessments PSA ALL Risk Level ALL Owner All Owners Referral Date From 01012017 To 12312017
Order by Referral Date and Owner ID
12042017 1980 4061617559 H 701B 12072017 Test Name
Assessment Count for the PSA 52
PSA 04A
Ref Date Owner ID Client ID
09102017 4062308458
Client Name
Test Name
Risk Level
H
Asmt Type
O
Asmt Date
09162017
Assessment Count for the PSA 2
Risk Level H
M
L
Count of Assessments 138
23
21
Total Count of Assessments 182
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APS Repeat Referrals in a Time Range
PSA ALL Owner All Owners
Start Date 01012017 End Date 12312017
Current DOEA CIRTS Cirts SSN if Risk Date Created PSA Owner Abuse No different than DCF DCF SSN Name County Level Date of Birth Date Sent by DCF
Count 0
Unduplicated Client Count by PSA
PSA Count SSN
Total
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Assessed Prioritized Consumer List PSA ALL Provider ALL PROVIDERS Program AC County ALL COUNTIES
County Program Consumer Name Client ID
Total Count 0
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Assessment Due Report PSA 01 Start Date 01012017 End Date 08312018 Owner ALL PROVIDERS Worker ALL WORKERS Program Status ACTV and APCL Assessment Type Needed ALL
Overdue and missing assessments are always listed
Owner ID 1065
Client ID Client Name
Owner Assessor ID
Date of Birth
06281928
CIRTS28099
County of Service
GULF
Worker Name HARPER KENNY
Zip Assessment PSA Date
32534 01 01022014
Type
701A
Active Y
Nutr PriorityScore Score
11 58
Rank
5
Due Date
01022015
Status
701S OVERDUE
LTCC APPL Start Date
03252014 4062235673 Test name
Total Clients for Worker 1
Total Clients for Owner 1
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Assessment Due Report PSA 01 Start Date 01012017 End Date 08312018 Owner ALL PROVIDERS Worker ALL WORKERS Program Status ACTV and APCL Assessment Type Needed ALL
Overdue and missing assessments are always listed
Summary by PSA
PSA 01 701A Overdue 1
701B Overdue 213
701C Overdue 0
701S Overdue 157
No 701A 0
No 701B 2
No 701C 0
No 701S 0
701A Not Overdue 0
701B Not Overdue 0
701C Not Overdue 0
701S Not Overdue 0
701S Optional 0
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CIC Service Units and Costs Projections County SummaryPSA 99 Program CCE
Start Date 01012017 End Date 12312017
County LEON
Total Total Total Avg Max Projected
StateFederal Projected Reimbursement Provider Unduplicated Provider Service Share Service Units Unit Rate Cost Per Unit Client Count
Report Total
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CIC Service Units and Costs Projections Provider SummaryPSA ALL Provider ALL PROVIDERS Program FEDERALLY FUNDED (0101 TO 1231) Year 2017 From 01012017 To 12312017
PSA County Program Service Total State
Federal Share
Total Projected
Service Units
Avg Reimbursement
Unit Rate
Max Provider
Cost Per Unit
Total Projected Unduplicated Client Count
02 FRANKLIN O3C1 CONGREGATE MEALS $810300 1710 15
Program Total
County Total
$810300
$810300
GULF O3C1 CONGREGATE MEALS $25205 3 5
Program Total $25205
O3C2 HOME DELIVERED MEALS $25205 3 6
Program Total
County Total
$25205
$50411
LEON O3C1 CONGREGATE MEALS $621300 1311 15
CONGREGATE MEALS GUEST
CONGREGATE MEALS VOLUNTEERS
$252055
$277260
25
30
2
5
Program Total $1150615
O3C2 HOME DELIVERED MEAL GUEST $252055 25 3
Program Total $252055
OA3D PEARLS (SESSION 5)
PEARLS (SESSION 6)
PEARLS (SESSION 7)
PEARLS (SESSION 8)
$10247
$10247
$10247
$10247
10
10
10
10
3
3
3
3
Program Total $40988
OA3E RESPITE IN-HOME $200 2 2
Program Total
County Total
$200
$1443858
WAKULLA O3C2 EMERGENCY HOME DELIVERED SHELF MEALS
$8065604 14899 90
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CIC Service Units and Costs Projections - PSA Summary
PSA ALL Program CCE
Strat Date 01012017 End Date 12312017
Total
PSA County Provider Service
Total State Federal
Share
Total Projected
Service Units
Avg Reimbursement
Unit Rate
Max Projected Provider Unduplicated
Cost Per Unit Client Count
02 LEON SOUTHERN SERVICE CASE MANAGEMENT PROVIDER EMERGENCY HOME DELIVERED SHELF MEALS
$2175533
$602000
483
689
32
20
HOME DELIVERED MEALS $530262 993 5
MATERIAL AID $1994536 199
Provider Total $5302331
CountyTotal $5302331
WAKULLA SOUTHERN SERVICE CASE MANAGEMENT PROVIDER EMERGENCY HOME DELIVERED SHELF MEALS
$2175533
$1240200
483
689
32
5
MATERIAL AID $1994536 199
Provider Total $5410269
CountyTotal $5410269
PSA Total $10712599
05 PINELLAS BURSTEIN-APPLEBEE ADULT DAY CARE $000 0 $900 $1000 0
COUNSELING (MENTAL HEALTH COUNSELINGSCREENING) - INDIVIDUAL
Provider Total
$000
$000
0 $6600 $7700 0
CountyTotal $000
PSA Total $000
Report Total $10712599
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CID Service Units and Costs Projections - PSA SummaryPSA ALL Program CCE
Start Date 01012017 End Date 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
PSA County Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
02 LEON CASE MANAGEMENT $2175533 483
EMERGENCY HOME $602000 689DELIVERED SHELF MEALS HOME DELIVERED MEALS $530262 993
MATERIAL AID $1994536 199
County Total $5302331 2364
WAKULLA CASE MANAGEMENT $2175533 483
EMERGENCY HOME $1240200 689DELIVERED SHELF MEALS MATERIAL AID $1994536 199
County Total $5410269 1371
PSA Total $10712599 3735
05 PINELLAS ADULT DAY CARE $000 0
COUNSELING (MENTAL $000 0 HEALTH COUNSELINGSCREENING) - INDIVIDUAL
County Total $000 0
PSA Total $000 0
Report Total $10712599 3735
$900 $900 $900 $1000 $1000 $1000
$6600 $6600 $6600 $7700 $7700 $7700
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CID Service Units and Costs Projections County SummaryPSA 99
Program CCE County LEON
Start Date 01012017 End Date 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
Report Total
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CIE Service Units and Costs Projections - PSA Summary - All Programs
PSA 99 Program FEDERALLY FUNDED (0101 TO 1231) Year 2017 From 01012017 To 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
Program Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
Report Total
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CIE Service Units and Costs Projections - PSA Summary
PSA ALL Program CCE
Start Date 01012017 End Date 12312017
Avg High Low Total Total Avg High Low Provider Provider Provider
StateFederal Projected Reimbursement Reimbursement Reimbursement Cost Cost CostPSA
02
Service
CASE MANAGEMENT
Share
$4351066
Service Units
966
Unit Rate Unit Rate Unit Rate Per Unit Per Unit Per Unit
EMERGENCY HOME DELIVERED SHELF MEALS $1842200 1378
HOME DELIVERED MEALS $530262 993
MATERIAL AID $3989071 398
PSA Total $10712599 3735
05 ADULT DAY CARE $000 0 $900 $900 $900 $1000 $1000 $1000
COUNSELING (MENTAL HEALTH $000 0 $6600 $6600 $6600 $7700 $7700 $7700 COUNSELINGSCREENING) - INDIVIDUAL
PSA Total $000 0
Report Total $10712599 3735
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CAREGIVER SEARCH REPORT
SEARCH RESULTS FOR CONSUMERS
Criteria First Name Last Name SSN PSA ALL
Client Name Client SSN Caregiver Name Caregiver SSN
000000000 000000000 Test Name Test Name
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CARES Referrals in a Time Range PSA ALL
Start Date 01012017 End Date 12312017
Referred to ALL REFERRALS
Referring PSA Employee Name Client Name Client ID
Referral Imminent NH Admit Aging Date Risk Date Referred To Cares Provider Name Received Date
03A 4061561263 Test Name Test Name 09242017 Y 05292017 ARC or ADRC 09252017
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CARES Referrals in a Time Range PSA ALL
Start Date 01012017 End Date 12312017
Referred to ALL REFERRALS
Referring PSA Employee Name Client Name Client ID
Referral Date
Imminent Risk
NH Admit Date Referred To Cares Provider Name
Aging Received Date
04B Test Name Test Name 4061738075 04082017 N ARC or ADRC Test Name 04082017
Total Clients 110
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CARES Referrals not acknowledged by the Aging Network PSA ALL For Referrals after 01012017 Owner ID ALL Owners
Unduplicated Client count Cares Office Total Clients Count
Report Total
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
CIRTS Issue PSA Client ID Client Name Program
Program Status Start Provider Enrollment ID Provider Name
APCL CLIENT WITH DATE OF DEATH 08 4061759417 Test Name OA3B APCL 07232013 1141 WESTERN WORLD RADIO
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
Program Start Provider CIRTS Issue PSA Client ID Client Name Program Status Enrollment ID Provider Name
06 LTCC APCL 01242014 1514 4061713685 Test Name APCL CLIENT WITH DATE OF DEATH CENTRAL THE ORIGINAL HOUSE OF PIES
Count 503
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Civil Rights PSA ALL Provider ALL PROVIDERS Program AC Start Date 01012017 End Date 12312017 The Poverty Level for Single is The Poverty Level for Couple is Sort by County
County Unduplicated Count
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Client Information Report Start Date 01012017 End Date 12312017
Client ID 1001141246
Emergency
Client Name Test Name
Telephone () - Address 78 TEST STREET TALLAHASSEE FL 32399
Most Recent Caregiver Information Date Updated
Doctor
Comments
Client Demographic Information
Birth Date 06041940 Race W
Owner ID Ethnicity O
Most Recent Income Information
Ind Mon Inc Cpl Mon Inc
Ind Assets Couple Assets
Most Recent Assessment Information
Asmt Date Ref Risk Lvl
Asmt Site Spec Shel
AsmtType Spec Reg
Ref Date Primary CG
Ref Source Living Sit
Enrollment Information
Sex
Marital Status
F
S
Medicaid Number
ADL Score
ADL Count
IADL Score
IADL Count
Memory Score
Priority Score
Env Score
Nutr Score
Risk Score
Social Score
Rank
Provider Location Program Program Status Worker Start Date End Date
Care Plan Service Needed
Date Service Units Type Frq End Date
Care Plan Service Planned
Program Service Units Type Frq Start Date End Date
Services Received between 01012017 and 12312017
Service Billed Provider Location Worker Program Service Date Units Unit Type Amount
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Provider N
Client Service Units Report PSA ALL Provider ALL PROVIDERS Location 0000
Program ALL PROGRAMS Service ALL SERVICES Worker ALL WORKERS
City ALL CITIES Include Zero Unit N Include Aggregate N Calculated Amount equals the number of Units Provided times Fixed Cost if it existsService Start Date 01012017 Service End Date 12312017 If Fixed Cost does not exist Calculated
Group by PSA Provider Location Client Name County Worker Amount equals Billed Amount
Unduplicated Client Count 0 Grand Total 000 $000
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Clients In Common PSA All Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 County All Counties Worker All Workers
County JEFFERSON
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
MIAMI-DADE
0 0 0 0 0 0 0 0 0
4061539538 Test NameCounty Count
County
0 01
X
0 1
X
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
4061650856 Test Name X 4061486560 Test Name X 4062452921 Test Name X
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Clients Served Not Enrolled PSA ALL Start Date 01012017 End Date 12312017 Locations 0000 Provider All Providers
Service Service Min Serv Max Serv Program Start End Enrollment PSA Provider Location Program Consumer Name Client ID Service Date Date Status Enrollment Enrollment Provider
Count 0
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
4061472791 04
09
1092
1291
0072
0042
LTCC
LTCC
APCL
APCL
4062714543 06
06
1514
1762
0072
5006
LTCC
LTCC
APCL
APPL
4061802246 11
06
1177
1514
0179
0072
LTCC
LTCC
APCL
APCL
4061563719 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062644312 06
08
1514
1771
0072
0896
LTCC
LTCC
APCL
APCL
1001141670 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
1001141671 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
4062375003 07
05
05
07
1263
1755
1638
1263
0368
0072
0072
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062155124 06
06
1762
1514
0072
0072
LTCC
LTCC
APPL
APCL
4061743886 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0369
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4061499927 06
06
1514
1762
0072
5005
LTCC
LTCC
APCL
APPL
4061583524 08
06
1144
1514
0896
0072
LTCC
LTCC
APCL
APCL
4062694843 06
03
1514
1922
0072
0179
LTCC
LTCC
APCL
APCL
4062744517 07
06
1263
1514
0369
0072
LTCC
LTCC
APCL
APCL
4062005488 10
11
10
11
1929
1177
1164
1177
0072
0073
0179
0179
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
Total Count 15
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CODE DESCRIPTIONS Category ALL STATE TABLES
Code Description Active Available To Code Category
0 UNKNOWN Y CARES SUBJECTIVE_HEALTH_EVALUATION
01 ALACHUA Y COMMON COUNTIES
02 BAKER Y COMMON COUNTIES
03 BAY Y COMMON COUNTIES
04 BRADFORD Y COMMON COUNTIES
05 BREVARD Y COMMON COUNTIES
06 BROWARD Y COMMON COUNTIES
07 CALHOUN Y COMMON COUNTIES
08 CHARLOTTE Y COMMON COUNTIES
09 CITRUS Y COMMON COUNTIES
1 EXCELLENT Y CARES SUBJECTIVE_HEALTH_EVALUATION
10 CLAY Y COMMON COUNTIES
11 COLLIER Y COMMON COUNTIES
12 COLUMBIA Y COMMON COUNTIES
13 MIAMI-DADE Y COMMON COUNTIES
14 DESOTO Y COMMON COUNTIES
15 DIXIE Y COMMON COUNTIES
16 DUVAL Y COMMON COUNTIES
17 ESCAMBIA Y COMMON COUNTIES
18 FLAGLER Y COMMON COUNTIES
19 FRANKLIN Y COMMON COUNTIES
2 GOOD Y CARES SUBJECTIVE_HEALTH_EVALUATION
20 GADSDEN Y COMMON COUNTIES
21 GILCHRIST Y COMMON COUNTIES
22 GLADES Y COMMON COUNTIES
23 GULF Y COMMON COUNTIES
24 HAMILTON Y COMMON COUNTIES
25 HARDEE Y COMMON COUNTIES
26 HENDRY Y COMMON COUNTIES
27 HERNANDO Y COMMON COUNTIES
28 HIGHLANDS Y COMMON COUNTIES
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CONSUMER AGE VERIFICATION REPORT PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Program AC
Age at Start
Enroll or Start Enroll Provider Program Description Consumer Name Client ID DOB Svc date or Svc Date
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Contract Budget Information PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Program Service Provider Location County Served Provider Contract
Projected Service
Units Unit Measure
Projected Unduplicated
State Federal Share Client Count Begin Date End Date
Row Count 0 Amount Total
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Start Enroll Latest Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Date Asmt Date Worker
O3C1 1036 000 4061653427 Test CENTRAL 34982 W M 07091930 09102013 09102013 CIRTS20804 0 Name
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Start Enroll Date
Latest Asmt Date Worker
4061593624 Test Name CENTRAL 34946 B F 11261940 12012011 12312013 CIRTS23407
Count 164
Unduplicated Client Count 163
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Assessments After DOD Report
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Owner 1025
The shaded records indicate clients who have different DOBs andor different names
Assemt Current PSA Owner Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Owner Assessor
Provider Assessor
Assemt Date
Assemt Type
Unduplicated Count Total 0
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Open Enrollments
The Vital Statistics Data for 07192002 - 09112014PSA ALL Provider ALL Program Status ACTV Include MLTC ACTVS N
The shaded records indicate clients who have different DOBs andor different names
Enroll PSA
Enrollment Provider Loc Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Enroll Program Status
Enroll Program
Current Owner ID
02 1065 0072 4062244026 Test Name Test Name 10222004 03231917 03231917 ACTV CCE 1065
Count of enrollments for the Provider 1
Count of enrollments for the PSA 1
Count of enrollments for the Report 1
Unduplicated Count of Individuals with open enrollments and DOD PSA Total Clients Count
02 1
Total 1
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Unduplicated count of individuals with Services after DOD
PSA Total Clients Count
Report Total
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
List of Clients with PSA table entry for SERVICES_AFTER_DOD
Unduplicated Count Total 0
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Age
Provider
Total
Age lt 60 Age 60 - 64 Age 65 - 74 Age 75 - 84 Age 85+ Total Clients Avg Age
Total
Avg Age
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Ethnicity
Provider Hispanic Other Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Race
American Indian Native Hawaiian Other Provider Asian Alaska Native Black Pacific Islander Minority White Multiple Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Gender
Provider Male Female Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Monthly Income
Provider 0 - - Higher than Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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None
Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Total Persons Served 0
Age lt 60 Years 0 0
Age 60 - 64 0 0
Age 65 - 74 0 0
Age 75 - 84 0 0
Age 85+ 0 0
Total Age 0 0
Average 000
Ethnicity Hispanic 0 0
Other Ethnicity 0 0
Unknown Ethnicity 0 0
Total 0 0
Race Asian 0 0
American Indian Alaska Native 0 0
Black 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority 0 0
White 0 0
Multiple 0 0
Unknown 0 0
Total 0 0
Sex Male 0 0
Female 0 0
Unknown Sex 0 0
Total 0 0
Monthly Income 0 - 0 0
- 0 0
Higher than 0 0
Unknown 0 0
Total 0 0
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Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Client ID Date Of Birth Ethnicity Race Sex Individual Monthly Income
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Demographics of Clients OAA Registered Served Only PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 City All Cities Program All Programs Service All Services County ALL COUNTIES Table OAA Registered Services Only Low Income Medium Income
Total Persons Served 0
Agelt 60 Years
Age 60 - 64
Age 65 - 74
Age 75 - 84
Age 85+
0
0
0
0
0
0
0
0
0
0
Monthly Income
0 -
-Higher than
Unknown
0
0
0
0
0
0
0
0
Total
Average
0
000
0 Total 0 0
Ethnicity Hispanic
Other
Unknown
0
0
0
0
0
0
Living Situation
Alone
Null
Policy Change
0
0
0
0
0
0
Total 0 0 Unknown
With Caregiver
0
0
0
0
Race Asian 0 0
With Other
With Other Caregiver
0
0
0
0
American Indian Alaska Native
Black
0
0
0
0Total Living Situation 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority
White
0
0
0
0 Limited English Proficiency
Multiple
Unknown
Total Race
0
0
0
0
0
0
Yes
No
Unknown
0
0
0
0
0
0
Total 0 0
Sex Male
Female
Unknown
0
0
0
0
0
0
Total 0 0
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Disaster Assistance Clients for a Provider PSA ALL Provider All Providers Location 0000 Worker All Workers City All Cities Zip Code All Zip Codes Sort By ZIP
Provider 1036 Provider Name Location 0000 Worker CIRTS18634
Need Care Client Name Address City Zip County Phone Asst Reg Situation Relat Care phone Care Name
34946 N WO DA 000 SAINT JAMES DRIVE CENTRAL (025) 101-0620 Test NameTest Name SAINT LUCIE (005) 100-0369 Y
Client is active and no assessment information is available Special Shelter and Special Registry are unknown
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
Total by PSA 0
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
ALACH BAKER BAY BRADF BREVA BROWA CALHO CHARL CITRUS CLAY COLLIE COLUM DESOT DIXIE DUVAL ESCAM FLAGL FRANK GADSDAssisted Household Report UA ORD RD RD UN OTTE R BIA O BIA ER LIN EN
1 of Household Assisted 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Households AssistedWith Gross Income
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C 100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D 125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
3 Households with at leastOne member
A 60 Years or older 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B Disabled 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C Age 5 years or under 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D Under 60 Years Old 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Undup Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Assisted
Applicant Household Report
of Applicant Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Energy Assisted Household Report
County of Assisted
Households
Households Assisted By Poverty Level
Under 75 75 - 100 101 - 125 126 - 150 Over 150 60 Years or older
At least one member who is
Age 5 years Age 2 years Age 3 years Disabled or younger and younger through 5
Under 60 Years Old
Undup Households
Assisted
Energy Assistance Total
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Unduplicated Total 0 0
County of Assisted
Households Under 75 75 - 100
Households Assisted By Poverty Level
101 - 125 126 - 150 Over 150 60 Years or older Disabled
Age 5 years or younger
Age 2 years and younger
Age 3 years through 5
Under 60 Years Old
At least one member who is
Undup Households
Assisted
Other Assisted Household Report
Other Assistance Total
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Applicant Household Report
County of Applicant
Households Under 75 75 - 100 101 - 125 126 - 150 Over 150 Income data
unavailable
Total 0
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01
Enrollment Active Consumer Count by Program PSA ALL Provider ALL PROVIDERS
County Description Program Count of Clients
BREVARD
ADI
CCE
HCE
LSP
NDP
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
MLTC
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
31
57
44
5
62
123
141
26
9
7
5
40
5
50
67
129
2
19
42
29
1
233
79
63
8
2
14
3
37
14
47
3
3
33
127
10
02
03
04
ALACHUA
BAKER
BAY
BRADFORD
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Enrollment Terminations with Reasons PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 Program All Programs Program Status ALL Program Status Worker ALL WORKERS
Last First Program Medicaid Provider Start End Name Name Client ID Status Description Worker Number Program Location Enrollment Enrollment
Count 0
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Enrollments with Care Plan Report
PSA ALL Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTIVE STATUS Care Plan Service ALL SERVICES Care Plan Start 01012017 Care Plan End 12312017
Care Plan Care Plan Care Plan Client Name
Unduplicated Client Count 0
Client ID Program Status Worker Start Date End Date Service
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PSA CLIENT_ID CLIENT_NAME OWNER PROVIDER_ID ASSESSMENT_DATE ASSESSOR_NAME MEDICAID_NUMBER CAREGIVER_CHANGE ENVIRONMENT_CHANGE HEALTH_CHANGE INCOME_CHANGE SITUATION_CHANGE INITIAL_ASSM ANNUAL_ASSM SSN REFERRAL_SOURCE 1114 N N N N Y N 771771777 SELFFAMILY 812017 JANE CASEWORKER 2 1001141633 TEST TEST N
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Fixed Service Costs List PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Provider Location County Program Service Reimbursement Unit Rate Provider Cost Per Unit Begin Valid End Valid
Count 0
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ACTV CCE HCE and ADI Clients with No Care Plan PSA ALL
Program ALL PROGRAMS Provider ALL PROVIDERS
Owner All Owners
PSA Client ID Name Owner Enrollment Information
Provider Loc Program Start Date Worker
4061605936 Test Name 1785 1927 0072 ADI 07202006 CIRTS26739
11
Duplicated Count 72 Unduplicated Counts 70
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ACTV APPL APCL Clients who have moved to another PSA PSA ALL
Provider ALL PROVIDERS
Address Enrollment Client ID Client Name Provider Loc Program Program Start PSA PSA Status Enrollment
01A 02 4062760605 1191 0072 CCE ACTV 11082011 Test Name
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Aging Network Provider Information Report PSA ALL
Address PSA Provider Loc Provider Name Type Provider Address Telephone
01 1147 B
1147
0072 Provider Name
0073 Provider Name B
1147
1147
0100 Provider Name
0179 Provider Name B
1271 B
1271 B
1271
0000 Provider Name
0001 Provider Name
0002 Provider Name B
1271 B
1271
0003 Provider Name
0004 Provider Name B
1271 B
1271
0072 Provider Name
0073 Provider Name B
1271 0100 Provider Name B
1271 B
1271 B
1271 B
1271 B
1271
0101 Provider Name
0138 Provider Name
0179 Provider Name
0286 Provider Name
0287 Provider Name B
123 Provider CALICO DRIVE STAYTON FL 59255
123 Provider TERRA COTTA STREET DARRINGTON
FL 57399
123 Provider LANGTOWN ROAD DARRINGTON FL 57399
123 Provider POINTE LANE Bonum integritas corporis misDARRINGTON FL 58398
123 Provider OAK DRIVE SUNNYVALE MO 83407
123 Provider HOTT STREET DARRINGTON FL 58398
123 Provider GRASSELLI STREET DARRINGTON FL 68396
123 Provider HEAVENS WAY MORRISONS CROSSROADS AL 33165
123 Provider GOOSETOWN DRIVE MIDVILLE
FL 93176
123 Provider PIKE STREET BELLOWS FALLS
FL 48405
123 Provider GLENVIEW DRIVE SUSSEX FL
123 Provider JONES AVENUE BLYTHEVILLE
FL 14027
123 Provider HENERY STREET SUSSEX FL
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Aging Network Provider Information Report PSA ALL
PSA Provider Loc Provider Name Address Type Provider Address Telephone
11 1952 B
1952 B
1952 B
1952 B
1952 B
1952 B
1952 B
123 Test Street ELLSINORE FL 38234 3789 WHITE
123 Test Street OHATCHEE FL 45235 3408 NORMA
123 Test Street WHITE CLOUD FL 46226
123 Test Street NEOSHO FL 06231
123 Test Street WHITE CLOUD FL 16168 3678 OLD
123 Test StreetWHITE CLOUD FL 06231 184 GRANT
123 Test Street WHITE CLOUD FL 93236
1952
1955
1956
B 3123 Test Street Quid censes in Latino fore IaWHITE CLOUD FL 70226
1957
0Provider Name
0Provider Name
0Provider Name
0Provider Name
0Provider Name
0Provider Name
0Provider Name
0Provider Name
0Provider Name
0Provider Name
0Provider Name B 123 Test Street Sed ad rem redeamus ComprehenWHITE CLOUD FL 38227
1957
1958
Count
0474 Provider Name
0072 Provider Name
427
B 123 Test Street BRANCH ROAD Quid ergo hoc loco intellegit WHITE CLOUD FL 25224
Count Total 3117
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Aging Network Providers Report PSA ALL
PSA 01
Provider 1271 Provider Name Provider Name
Location 0000 Location Name Provider Name
Location Business Address 3123 Test Drive DARRINGTON FL 58398
County Served OKALOOSA Phone Fax Location Contact
Provider Director Provider Profit Status Non-Profit
ACCESS_PT CCE_LA N HCE OAA OTHER
ADI EHEAP LSP RELF
CCE Y FOCAL_PT NSIP SR_CTR
Provider 1271 Provider Name Provider Name
Location 0001 Location Name Provider Name
Location Business Address 1234 Test OAK DRIVE SUNNYVALE MO 83407
Phone Fax Location Contact County Served OKALOOSA
Provider Director Provider Profit Status Non-Profit
ACCESS_PT CCE_LA N HCE OAA OTHER
ADI EHEAP LSP RELF
CCE Y FOCAL_PT NSIP SR_CTR
Provider 1271 Provider Name Provider Name
Location 0004 Location Name Provider Name
Location Business Address 1123 Test HEAVENS WAY MORRISONS CROSSROADS AL
33165 Phone County Served OKALOOSA Fax Location Contact
Provider Director Provider Profit Status Non-Profit
ACCESS_PT CCE_LA N HCE Y OAA OTHER
ADI EHEAP LSP RELF
CCE FOCAL_PT NSIP SR_CTR
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Start End Worker Most Recent Nutr Medicaid Program Provider Location Client ID Client Name Status Enrollment Enrollment Worker Active Score Number
O3C1 1036 0000 4061653427 Test Name ACTV 09102013 CIRTS20804 Y 1
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Start End Worker Most Recent Nutr Medicaid Program Provider Location Client ID Client Name Status Enrollment Enrollment Worker Active Score Number
O3C1 1036 0000 4061638016 Test Name ACTV 09122013 CIRTS20804 Y 2
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Start End Worker Most Recent Nutr Medicaid Program Provider Location Client ID Client Name Status Enrollment Enrollment Worker Active Score Number
O3C2 1036 0000 4062000152 Test Name ACTV 02072011 CIRTS23407 N 3
1036 0000 4061594062 ISAACS HATTIE ACTV 11192012 CIRTS20804 Y 5
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Start End Worker Most Recent Nutr Medicaid Program Provider Location Client ID Client Name Status Enrollment Enrollment Worker Active Score Number
O3C2 1036 0000 4062379505 Test Name ACTV 11192012 CIRTS20804 Y 5
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Start End Worker Most Recent Nutr Medicaid Program Provider Location Client ID Client Name Status Enrollment Enrollment Worker Active Score Number
O3C2 1036 0000 4062401063 Test Name ACTV 10162013 CIRTS20804 Y 3
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Provider Location Client ID Client Name Program Status
Start Enrollment
End Enrollment Worker
Worker Active
Most Recent Nutr Score
Medicaid Number
O3C2 1036 0000 4062538939 ACTV 12082000 CIRTS20388 Y Test Name
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All Enrollments Counts During Date Range PSA ALL Start Date 01012017 End Date Location 0000 Provider Program Program Status
12312017 ALL PROVIDERS
ACTV
Group By Program Provider Location
Program Provider Location Client Count O3C1 1036 0000 45
1951 0000 3
O3C2 1036 0000 113
OA3E 1821 0000 2
OA3ES 1821 0000 1
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C1 1036 0000 4061950299 Test Name ACTV 04072011 CIRTS23407 N 11
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C1 1036 4062586019 Test Name ACTV 12292008 CIRTS23407 N 1
Total for Location 45
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C1 1951 0000 4062452921 Test Name ACTV 03301989 CIRTS22695 N 10
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4062786256 Test Name ACTV 09232013 CIRTS20804 Y 4 1
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4062380426 Test Name ACTV 04112012 CIRTS23407 N 55 2
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4061608826 Test Name ACTV 08102011 CIRTS18634 Y 7 3
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4062615533 Test Name ACTV 10032013 CIRTS20804 Y 6 3
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start Enrollment
End Enrollment Worker
Worker Active
Medicaid Number
Most Recent Nutr Score Rank
O3C2 1036 4062466582 Test Name ACTV 10262010 CIRTS23407 N 105 2
Total for Location 113
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PSA
APCL Clients With No Services ALL Owner All Owners Provider ALL PROVIDERS
Start Date 01012017 End Date 12312017
Includes Clients Receiving Only CM INSC SCAS CA REFE Services
PSA Client ID Client Name Owner Provider Program
Count 0
Unduplicated Clients Count 0
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APCL Clients With Services PSA ALL Owner All Owners Provider ALL PROVIDERS Start Date 01012017 End Date 12312017
Exclude CM CA INSC REFE SCAS
PSA Client ID Name Owner Provider Program 10 4062527553 Test Name 1539 1929 CCE
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APCL Clients With Services PSA ALL Owner All Owners Provider ALL PROVIDERS Start Date 01012017 End Date 12312017
Exclude CM CA INSC REFE SCAS
PSA Client ID Name Owner Provider Program 11 4062732638 Test Name 1177 1177 LTCC
Total 21067
Unduplicated clients count 12460
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APS Assessments PSA ALL Risk Level ALL Owner All Owners Referral Date From 01012017 To 12312017
Order by Referral Date and Owner ID
PSA 03
Ref Date Owner ID Client ID Client Name Risk Level Asmt Type Asmt Date
03032017 1390 4062058415 L 701A 03302018 Test Name
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APS Assessments PSA ALL Risk Level ALL Owner All Owners Referral Date From 01012017 To 12312017
Order by Referral Date and Owner ID
12042017 1980 4061617559 H 701B 12072017 Test Name
Assessment Count for the PSA 52
PSA 04A
Ref Date Owner ID Client ID
09102017 4062308458
Client Name
Test Name
Risk Level
H
Asmt Type
O
Asmt Date
09162017
Assessment Count for the PSA 2
Risk Level H
M
L
Count of Assessments 138
23
21
Total Count of Assessments 182
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APS Repeat Referrals in a Time Range
PSA ALL Owner All Owners
Start Date 01012017 End Date 12312017
Current DOEA CIRTS Cirts SSN if Risk Date Created PSA Owner Abuse No different than DCF DCF SSN Name County Level Date of Birth Date Sent by DCF
Count 0
Unduplicated Client Count by PSA
PSA Count SSN
Total
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Assessed Prioritized Consumer List PSA ALL Provider ALL PROVIDERS Program AC County ALL COUNTIES
County Program Consumer Name Client ID
Total Count 0
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Assessment Due Report PSA 01 Start Date 01012017 End Date 08312018 Owner ALL PROVIDERS Worker ALL WORKERS Program Status ACTV and APCL Assessment Type Needed ALL
Overdue and missing assessments are always listed
Owner ID 1065
Client ID Client Name
Owner Assessor ID
Date of Birth
06281928
CIRTS28099
County of Service
GULF
Worker Name HARPER KENNY
Zip Assessment PSA Date
32534 01 01022014
Type
701A
Active Y
Nutr PriorityScore Score
11 58
Rank
5
Due Date
01022015
Status
701S OVERDUE
LTCC APPL Start Date
03252014 4062235673 Test name
Total Clients for Worker 1
Total Clients for Owner 1
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Assessment Due Report PSA 01 Start Date 01012017 End Date 08312018 Owner ALL PROVIDERS Worker ALL WORKERS Program Status ACTV and APCL Assessment Type Needed ALL
Overdue and missing assessments are always listed
Summary by PSA
PSA 01 701A Overdue 1
701B Overdue 213
701C Overdue 0
701S Overdue 157
No 701A 0
No 701B 2
No 701C 0
No 701S 0
701A Not Overdue 0
701B Not Overdue 0
701C Not Overdue 0
701S Not Overdue 0
701S Optional 0
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CIC Service Units and Costs Projections County SummaryPSA 99 Program CCE
Start Date 01012017 End Date 12312017
County LEON
Total Total Total Avg Max Projected
StateFederal Projected Reimbursement Provider Unduplicated Provider Service Share Service Units Unit Rate Cost Per Unit Client Count
Report Total
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CIC Service Units and Costs Projections Provider SummaryPSA ALL Provider ALL PROVIDERS Program FEDERALLY FUNDED (0101 TO 1231) Year 2017 From 01012017 To 12312017
PSA County Program Service Total State
Federal Share
Total Projected
Service Units
Avg Reimbursement
Unit Rate
Max Provider
Cost Per Unit
Total Projected Unduplicated Client Count
02 FRANKLIN O3C1 CONGREGATE MEALS $810300 1710 15
Program Total
County Total
$810300
$810300
GULF O3C1 CONGREGATE MEALS $25205 3 5
Program Total $25205
O3C2 HOME DELIVERED MEALS $25205 3 6
Program Total
County Total
$25205
$50411
LEON O3C1 CONGREGATE MEALS $621300 1311 15
CONGREGATE MEALS GUEST
CONGREGATE MEALS VOLUNTEERS
$252055
$277260
25
30
2
5
Program Total $1150615
O3C2 HOME DELIVERED MEAL GUEST $252055 25 3
Program Total $252055
OA3D PEARLS (SESSION 5)
PEARLS (SESSION 6)
PEARLS (SESSION 7)
PEARLS (SESSION 8)
$10247
$10247
$10247
$10247
10
10
10
10
3
3
3
3
Program Total $40988
OA3E RESPITE IN-HOME $200 2 2
Program Total
County Total
$200
$1443858
WAKULLA O3C2 EMERGENCY HOME DELIVERED SHELF MEALS
$8065604 14899 90
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CIC Service Units and Costs Projections - PSA Summary
PSA ALL Program CCE
Strat Date 01012017 End Date 12312017
Total
PSA County Provider Service
Total State Federal
Share
Total Projected
Service Units
Avg Reimbursement
Unit Rate
Max Projected Provider Unduplicated
Cost Per Unit Client Count
02 LEON SOUTHERN SERVICE CASE MANAGEMENT PROVIDER EMERGENCY HOME DELIVERED SHELF MEALS
$2175533
$602000
483
689
32
20
HOME DELIVERED MEALS $530262 993 5
MATERIAL AID $1994536 199
Provider Total $5302331
CountyTotal $5302331
WAKULLA SOUTHERN SERVICE CASE MANAGEMENT PROVIDER EMERGENCY HOME DELIVERED SHELF MEALS
$2175533
$1240200
483
689
32
5
MATERIAL AID $1994536 199
Provider Total $5410269
CountyTotal $5410269
PSA Total $10712599
05 PINELLAS BURSTEIN-APPLEBEE ADULT DAY CARE $000 0 $900 $1000 0
COUNSELING (MENTAL HEALTH COUNSELINGSCREENING) - INDIVIDUAL
Provider Total
$000
$000
0 $6600 $7700 0
CountyTotal $000
PSA Total $000
Report Total $10712599
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CID Service Units and Costs Projections - PSA SummaryPSA ALL Program CCE
Start Date 01012017 End Date 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
PSA County Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
02 LEON CASE MANAGEMENT $2175533 483
EMERGENCY HOME $602000 689DELIVERED SHELF MEALS HOME DELIVERED MEALS $530262 993
MATERIAL AID $1994536 199
County Total $5302331 2364
WAKULLA CASE MANAGEMENT $2175533 483
EMERGENCY HOME $1240200 689DELIVERED SHELF MEALS MATERIAL AID $1994536 199
County Total $5410269 1371
PSA Total $10712599 3735
05 PINELLAS ADULT DAY CARE $000 0
COUNSELING (MENTAL $000 0 HEALTH COUNSELINGSCREENING) - INDIVIDUAL
County Total $000 0
PSA Total $000 0
Report Total $10712599 3735
$900 $900 $900 $1000 $1000 $1000
$6600 $6600 $6600 $7700 $7700 $7700
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CID Service Units and Costs Projections County SummaryPSA 99
Program CCE County LEON
Start Date 01012017 End Date 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
Report Total
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CIE Service Units and Costs Projections - PSA Summary - All Programs
PSA 99 Program FEDERALLY FUNDED (0101 TO 1231) Year 2017 From 01012017 To 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
Program Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
Report Total
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CIE Service Units and Costs Projections - PSA Summary
PSA ALL Program CCE
Start Date 01012017 End Date 12312017
Avg High Low Total Total Avg High Low Provider Provider Provider
StateFederal Projected Reimbursement Reimbursement Reimbursement Cost Cost CostPSA
02
Service
CASE MANAGEMENT
Share
$4351066
Service Units
966
Unit Rate Unit Rate Unit Rate Per Unit Per Unit Per Unit
EMERGENCY HOME DELIVERED SHELF MEALS $1842200 1378
HOME DELIVERED MEALS $530262 993
MATERIAL AID $3989071 398
PSA Total $10712599 3735
05 ADULT DAY CARE $000 0 $900 $900 $900 $1000 $1000 $1000
COUNSELING (MENTAL HEALTH $000 0 $6600 $6600 $6600 $7700 $7700 $7700 COUNSELINGSCREENING) - INDIVIDUAL
PSA Total $000 0
Report Total $10712599 3735
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CAREGIVER SEARCH REPORT
SEARCH RESULTS FOR CONSUMERS
Criteria First Name Last Name SSN PSA ALL
Client Name Client SSN Caregiver Name Caregiver SSN
000000000 000000000 Test Name Test Name
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CARES Referrals in a Time Range PSA ALL
Start Date 01012017 End Date 12312017
Referred to ALL REFERRALS
Referring PSA Employee Name Client Name Client ID
Referral Imminent NH Admit Aging Date Risk Date Referred To Cares Provider Name Received Date
03A 4061561263 Test Name Test Name 09242017 Y 05292017 ARC or ADRC 09252017
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CARES Referrals in a Time Range PSA ALL
Start Date 01012017 End Date 12312017
Referred to ALL REFERRALS
Referring PSA Employee Name Client Name Client ID
Referral Date
Imminent Risk
NH Admit Date Referred To Cares Provider Name
Aging Received Date
04B Test Name Test Name 4061738075 04082017 N ARC or ADRC Test Name 04082017
Total Clients 110
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CARES Referrals not acknowledged by the Aging Network PSA ALL For Referrals after 01012017 Owner ID ALL Owners
Unduplicated Client count Cares Office Total Clients Count
Report Total
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
CIRTS Issue PSA Client ID Client Name Program
Program Status Start Provider Enrollment ID Provider Name
APCL CLIENT WITH DATE OF DEATH 08 4061759417 Test Name OA3B APCL 07232013 1141 WESTERN WORLD RADIO
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
Program Start Provider CIRTS Issue PSA Client ID Client Name Program Status Enrollment ID Provider Name
06 LTCC APCL 01242014 1514 4061713685 Test Name APCL CLIENT WITH DATE OF DEATH CENTRAL THE ORIGINAL HOUSE OF PIES
Count 503
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Civil Rights PSA ALL Provider ALL PROVIDERS Program AC Start Date 01012017 End Date 12312017 The Poverty Level for Single is The Poverty Level for Couple is Sort by County
County Unduplicated Count
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Client Information Report Start Date 01012017 End Date 12312017
Client ID 1001141246
Emergency
Client Name Test Name
Telephone () - Address 78 TEST STREET TALLAHASSEE FL 32399
Most Recent Caregiver Information Date Updated
Doctor
Comments
Client Demographic Information
Birth Date 06041940 Race W
Owner ID Ethnicity O
Most Recent Income Information
Ind Mon Inc Cpl Mon Inc
Ind Assets Couple Assets
Most Recent Assessment Information
Asmt Date Ref Risk Lvl
Asmt Site Spec Shel
AsmtType Spec Reg
Ref Date Primary CG
Ref Source Living Sit
Enrollment Information
Sex
Marital Status
F
S
Medicaid Number
ADL Score
ADL Count
IADL Score
IADL Count
Memory Score
Priority Score
Env Score
Nutr Score
Risk Score
Social Score
Rank
Provider Location Program Program Status Worker Start Date End Date
Care Plan Service Needed
Date Service Units Type Frq End Date
Care Plan Service Planned
Program Service Units Type Frq Start Date End Date
Services Received between 01012017 and 12312017
Service Billed Provider Location Worker Program Service Date Units Unit Type Amount
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Provider N
Client Service Units Report PSA ALL Provider ALL PROVIDERS Location 0000
Program ALL PROGRAMS Service ALL SERVICES Worker ALL WORKERS
City ALL CITIES Include Zero Unit N Include Aggregate N Calculated Amount equals the number of Units Provided times Fixed Cost if it existsService Start Date 01012017 Service End Date 12312017 If Fixed Cost does not exist Calculated
Group by PSA Provider Location Client Name County Worker Amount equals Billed Amount
Unduplicated Client Count 0 Grand Total 000 $000
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Clients In Common PSA All Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 County All Counties Worker All Workers
County JEFFERSON
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
MIAMI-DADE
0 0 0 0 0 0 0 0 0
4061539538 Test NameCounty Count
County
0 01
X
0 1
X
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
4061650856 Test Name X 4061486560 Test Name X 4062452921 Test Name X
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Clients Served Not Enrolled PSA ALL Start Date 01012017 End Date 12312017 Locations 0000 Provider All Providers
Service Service Min Serv Max Serv Program Start End Enrollment PSA Provider Location Program Consumer Name Client ID Service Date Date Status Enrollment Enrollment Provider
Count 0
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
4061472791 04
09
1092
1291
0072
0042
LTCC
LTCC
APCL
APCL
4062714543 06
06
1514
1762
0072
5006
LTCC
LTCC
APCL
APPL
4061802246 11
06
1177
1514
0179
0072
LTCC
LTCC
APCL
APCL
4061563719 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062644312 06
08
1514
1771
0072
0896
LTCC
LTCC
APCL
APCL
1001141670 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
1001141671 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
4062375003 07
05
05
07
1263
1755
1638
1263
0368
0072
0072
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062155124 06
06
1762
1514
0072
0072
LTCC
LTCC
APPL
APCL
4061743886 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0369
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4061499927 06
06
1514
1762
0072
5005
LTCC
LTCC
APCL
APPL
4061583524 08
06
1144
1514
0896
0072
LTCC
LTCC
APCL
APCL
4062694843 06
03
1514
1922
0072
0179
LTCC
LTCC
APCL
APCL
4062744517 07
06
1263
1514
0369
0072
LTCC
LTCC
APCL
APCL
4062005488 10
11
10
11
1929
1177
1164
1177
0072
0073
0179
0179
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
Total Count 15
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CODE DESCRIPTIONS Category ALL STATE TABLES
Code Description Active Available To Code Category
0 UNKNOWN Y CARES SUBJECTIVE_HEALTH_EVALUATION
01 ALACHUA Y COMMON COUNTIES
02 BAKER Y COMMON COUNTIES
03 BAY Y COMMON COUNTIES
04 BRADFORD Y COMMON COUNTIES
05 BREVARD Y COMMON COUNTIES
06 BROWARD Y COMMON COUNTIES
07 CALHOUN Y COMMON COUNTIES
08 CHARLOTTE Y COMMON COUNTIES
09 CITRUS Y COMMON COUNTIES
1 EXCELLENT Y CARES SUBJECTIVE_HEALTH_EVALUATION
10 CLAY Y COMMON COUNTIES
11 COLLIER Y COMMON COUNTIES
12 COLUMBIA Y COMMON COUNTIES
13 MIAMI-DADE Y COMMON COUNTIES
14 DESOTO Y COMMON COUNTIES
15 DIXIE Y COMMON COUNTIES
16 DUVAL Y COMMON COUNTIES
17 ESCAMBIA Y COMMON COUNTIES
18 FLAGLER Y COMMON COUNTIES
19 FRANKLIN Y COMMON COUNTIES
2 GOOD Y CARES SUBJECTIVE_HEALTH_EVALUATION
20 GADSDEN Y COMMON COUNTIES
21 GILCHRIST Y COMMON COUNTIES
22 GLADES Y COMMON COUNTIES
23 GULF Y COMMON COUNTIES
24 HAMILTON Y COMMON COUNTIES
25 HARDEE Y COMMON COUNTIES
26 HENDRY Y COMMON COUNTIES
27 HERNANDO Y COMMON COUNTIES
28 HIGHLANDS Y COMMON COUNTIES
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CONSUMER AGE VERIFICATION REPORT PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Program AC
Age at Start
Enroll or Start Enroll Provider Program Description Consumer Name Client ID DOB Svc date or Svc Date
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Contract Budget Information PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Program Service Provider Location County Served Provider Contract
Projected Service
Units Unit Measure
Projected Unduplicated
State Federal Share Client Count Begin Date End Date
Row Count 0 Amount Total
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Start Enroll Latest Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Date Asmt Date Worker
O3C1 1036 000 4061653427 Test CENTRAL 34982 W M 07091930 09102013 09102013 CIRTS20804 0 Name
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Start Enroll Date
Latest Asmt Date Worker
4061593624 Test Name CENTRAL 34946 B F 11261940 12012011 12312013 CIRTS23407
Count 164
Unduplicated Client Count 163
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Assessments After DOD Report
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Owner 1025
The shaded records indicate clients who have different DOBs andor different names
Assemt Current PSA Owner Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Owner Assessor
Provider Assessor
Assemt Date
Assemt Type
Unduplicated Count Total 0
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Open Enrollments
The Vital Statistics Data for 07192002 - 09112014PSA ALL Provider ALL Program Status ACTV Include MLTC ACTVS N
The shaded records indicate clients who have different DOBs andor different names
Enroll PSA
Enrollment Provider Loc Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Enroll Program Status
Enroll Program
Current Owner ID
02 1065 0072 4062244026 Test Name Test Name 10222004 03231917 03231917 ACTV CCE 1065
Count of enrollments for the Provider 1
Count of enrollments for the PSA 1
Count of enrollments for the Report 1
Unduplicated Count of Individuals with open enrollments and DOD PSA Total Clients Count
02 1
Total 1
Report run on 08312018 0205 PM Page 1 of 1 vs_open_enrollrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Report run on 08312018 0207 PM Page 1 of 3 vs_servicesrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Unduplicated count of individuals with Services after DOD
PSA Total Clients Count
Report Total
Report run on 08312018 0207 PM Page 2 of 3 vs_servicesrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
List of Clients with PSA table entry for SERVICES_AFTER_DOD
Unduplicated Count Total 0
Report run on 08312018 0207 PM Page 3 of 3 vs_servicesrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Age
Provider
Total
Age lt 60 Age 60 - 64 Age 65 - 74 Age 75 - 84 Age 85+ Total Clients Avg Age
Total
Avg Age
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 1 of 5 demo_all_prvrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Ethnicity
Provider Hispanic Other Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Race
American Indian Native Hawaiian Other Provider Asian Alaska Native Black Pacific Islander Minority White Multiple Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Gender
Provider Male Female Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 4 of 5 demo_all_prvrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Monthly Income
Provider 0 - - Higher than Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 5 of 5 demo_all_prvrdf
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None
Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Total Persons Served 0
Age lt 60 Years 0 0
Age 60 - 64 0 0
Age 65 - 74 0 0
Age 75 - 84 0 0
Age 85+ 0 0
Total Age 0 0
Average 000
Ethnicity Hispanic 0 0
Other Ethnicity 0 0
Unknown Ethnicity 0 0
Total 0 0
Race Asian 0 0
American Indian Alaska Native 0 0
Black 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority 0 0
White 0 0
Multiple 0 0
Unknown 0 0
Total 0 0
Sex Male 0 0
Female 0 0
Unknown Sex 0 0
Total 0 0
Monthly Income 0 - 0 0
- 0 0
Higher than 0 0
Unknown 0 0
Total 0 0
Report run on 08312018 1058 AM Page 1 of 2 demo_by_prov_detrdf Report run byRSHQALL Dispose of this report so that it can not be read or reconstructed
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Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Client ID Date Of Birth Ethnicity Race Sex Individual Monthly Income
Report run on 08312018 1058 AM Page 2 of 2 demo_by_prov_detrdf Report run byRSHQALL Dispose of this report so that it can not be read or reconstructed
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Demographics of Clients OAA Registered Served Only PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 City All Cities Program All Programs Service All Services County ALL COUNTIES Table OAA Registered Services Only Low Income Medium Income
Total Persons Served 0
Agelt 60 Years
Age 60 - 64
Age 65 - 74
Age 75 - 84
Age 85+
0
0
0
0
0
0
0
0
0
0
Monthly Income
0 -
-Higher than
Unknown
0
0
0
0
0
0
0
0
Total
Average
0
000
0 Total 0 0
Ethnicity Hispanic
Other
Unknown
0
0
0
0
0
0
Living Situation
Alone
Null
Policy Change
0
0
0
0
0
0
Total 0 0 Unknown
With Caregiver
0
0
0
0
Race Asian 0 0
With Other
With Other Caregiver
0
0
0
0
American Indian Alaska Native
Black
0
0
0
0Total Living Situation 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority
White
0
0
0
0 Limited English Proficiency
Multiple
Unknown
Total Race
0
0
0
0
0
0
Yes
No
Unknown
0
0
0
0
0
0
Total 0 0
Sex Male
Female
Unknown
0
0
0
0
0
0
Total 0 0
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Disaster Assistance Clients for a Provider PSA ALL Provider All Providers Location 0000 Worker All Workers City All Cities Zip Code All Zip Codes Sort By ZIP
Provider 1036 Provider Name Location 0000 Worker CIRTS18634
Need Care Client Name Address City Zip County Phone Asst Reg Situation Relat Care phone Care Name
34946 N WO DA 000 SAINT JAMES DRIVE CENTRAL (025) 101-0620 Test NameTest Name SAINT LUCIE (005) 100-0369 Y
Client is active and no assessment information is available Special Shelter and Special Registry are unknown
Report run on 08312018 1102 AM Page 1 of 8 disaster_by_provrdf
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
Total by PSA 0
Report run on 08312018 1111 AM Page 1 of 5 eheap_exceptionsrdf
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
ALACH BAKER BAY BRADF BREVA BROWA CALHO CHARL CITRUS CLAY COLLIE COLUM DESOT DIXIE DUVAL ESCAM FLAGL FRANK GADSDAssisted Household Report UA ORD RD RD UN OTTE R BIA O BIA ER LIN EN
1 of Household Assisted 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Households AssistedWith Gross Income
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C 100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D 125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
3 Households with at leastOne member
A 60 Years or older 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B Disabled 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C Age 5 years or under 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D Under 60 Years Old 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Undup Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Assisted
Applicant Household Report
of Applicant Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Energy Assisted Household Report
County of Assisted
Households
Households Assisted By Poverty Level
Under 75 75 - 100 101 - 125 126 - 150 Over 150 60 Years or older
At least one member who is
Age 5 years Age 2 years Age 3 years Disabled or younger and younger through 5
Under 60 Years Old
Undup Households
Assisted
Energy Assistance Total
Report run on 08312018 1107 AM Page 1 of 3 eheap_summaryrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Unduplicated Total 0 0
County of Assisted
Households Under 75 75 - 100
Households Assisted By Poverty Level
101 - 125 126 - 150 Over 150 60 Years or older Disabled
Age 5 years or younger
Age 2 years and younger
Age 3 years through 5
Under 60 Years Old
At least one member who is
Undup Households
Assisted
Other Assisted Household Report
Other Assistance Total
Report run on 08312018 1107 AM Page 2 of 3 eheap_summaryrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Applicant Household Report
County of Applicant
Households Under 75 75 - 100 101 - 125 126 - 150 Over 150 Income data
unavailable
Total 0
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01
Enrollment Active Consumer Count by Program PSA ALL Provider ALL PROVIDERS
County Description Program Count of Clients
BREVARD
ADI
CCE
HCE
LSP
NDP
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
MLTC
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
31
57
44
5
62
123
141
26
9
7
5
40
5
50
67
129
2
19
42
29
1
233
79
63
8
2
14
3
37
14
47
3
3
33
127
10
02
03
04
ALACHUA
BAKER
BAY
BRADFORD
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Enrollment Terminations with Reasons PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 Program All Programs Program Status ALL Program Status Worker ALL WORKERS
Last First Program Medicaid Provider Start End Name Name Client ID Status Description Worker Number Program Location Enrollment Enrollment
Count 0
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Enrollments with Care Plan Report
PSA ALL Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTIVE STATUS Care Plan Service ALL SERVICES Care Plan Start 01012017 Care Plan End 12312017
Care Plan Care Plan Care Plan Client Name
Unduplicated Client Count 0
Client ID Program Status Worker Start Date End Date Service
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PSA CLIENT_ID CLIENT_NAME OWNER PROVIDER_ID ASSESSMENT_DATE ASSESSOR_NAME MEDICAID_NUMBER CAREGIVER_CHANGE ENVIRONMENT_CHANGE HEALTH_CHANGE INCOME_CHANGE SITUATION_CHANGE INITIAL_ASSM ANNUAL_ASSM SSN REFERRAL_SOURCE 1114 N N N N Y N 771771777 SELFFAMILY 812017 JANE CASEWORKER 2 1001141633 TEST TEST N
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Fixed Service Costs List PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Provider Location County Program Service Reimbursement Unit Rate Provider Cost Per Unit Begin Valid End Valid
Count 0
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ACTV APPL APCL Clients who have moved to another PSA PSA ALL
Provider ALL PROVIDERS
Address Enrollment Client ID Client Name Provider Loc Program Program Start PSA PSA Status Enrollment
01A 02 4062760605 1191 0072 CCE ACTV 11082011 Test Name
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Aging Network Provider Information Report PSA ALL
Address PSA Provider Loc Provider Name Type Provider Address Telephone
01 1147 B
1147
0072 Provider Name
0073 Provider Name B
1147
1147
0100 Provider Name
0179 Provider Name B
1271 B
1271 B
1271
0000 Provider Name
0001 Provider Name
0002 Provider Name B
1271 B
1271
0003 Provider Name
0004 Provider Name B
1271 B
1271
0072 Provider Name
0073 Provider Name B
1271 0100 Provider Name B
1271 B
1271 B
1271 B
1271 B
1271
0101 Provider Name
0138 Provider Name
0179 Provider Name
0286 Provider Name
0287 Provider Name B
123 Provider CALICO DRIVE STAYTON FL 59255
123 Provider TERRA COTTA STREET DARRINGTON
FL 57399
123 Provider LANGTOWN ROAD DARRINGTON FL 57399
123 Provider POINTE LANE Bonum integritas corporis misDARRINGTON FL 58398
123 Provider OAK DRIVE SUNNYVALE MO 83407
123 Provider HOTT STREET DARRINGTON FL 58398
123 Provider GRASSELLI STREET DARRINGTON FL 68396
123 Provider HEAVENS WAY MORRISONS CROSSROADS AL 33165
123 Provider GOOSETOWN DRIVE MIDVILLE
FL 93176
123 Provider PIKE STREET BELLOWS FALLS
FL 48405
123 Provider GLENVIEW DRIVE SUSSEX FL
123 Provider JONES AVENUE BLYTHEVILLE
FL 14027
123 Provider HENERY STREET SUSSEX FL
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Aging Network Provider Information Report PSA ALL
PSA Provider Loc Provider Name Address Type Provider Address Telephone
11 1952 B
1952 B
1952 B
1952 B
1952 B
1952 B
1952 B
123 Test Street ELLSINORE FL 38234 3789 WHITE
123 Test Street OHATCHEE FL 45235 3408 NORMA
123 Test Street WHITE CLOUD FL 46226
123 Test Street NEOSHO FL 06231
123 Test Street WHITE CLOUD FL 16168 3678 OLD
123 Test StreetWHITE CLOUD FL 06231 184 GRANT
123 Test Street WHITE CLOUD FL 93236
1952
1955
1956
B 3123 Test Street Quid censes in Latino fore IaWHITE CLOUD FL 70226
1957
0Provider Name
0Provider Name
0Provider Name
0Provider Name
0Provider Name
0Provider Name
0Provider Name
0Provider Name
0Provider Name
0Provider Name
0Provider Name B 123 Test Street Sed ad rem redeamus ComprehenWHITE CLOUD FL 38227
1957
1958
Count
0474 Provider Name
0072 Provider Name
427
B 123 Test Street BRANCH ROAD Quid ergo hoc loco intellegit WHITE CLOUD FL 25224
Count Total 3117
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Aging Network Providers Report PSA ALL
PSA 01
Provider 1271 Provider Name Provider Name
Location 0000 Location Name Provider Name
Location Business Address 3123 Test Drive DARRINGTON FL 58398
County Served OKALOOSA Phone Fax Location Contact
Provider Director Provider Profit Status Non-Profit
ACCESS_PT CCE_LA N HCE OAA OTHER
ADI EHEAP LSP RELF
CCE Y FOCAL_PT NSIP SR_CTR
Provider 1271 Provider Name Provider Name
Location 0001 Location Name Provider Name
Location Business Address 1234 Test OAK DRIVE SUNNYVALE MO 83407
Phone Fax Location Contact County Served OKALOOSA
Provider Director Provider Profit Status Non-Profit
ACCESS_PT CCE_LA N HCE OAA OTHER
ADI EHEAP LSP RELF
CCE Y FOCAL_PT NSIP SR_CTR
Provider 1271 Provider Name Provider Name
Location 0004 Location Name Provider Name
Location Business Address 1123 Test HEAVENS WAY MORRISONS CROSSROADS AL
33165 Phone County Served OKALOOSA Fax Location Contact
Provider Director Provider Profit Status Non-Profit
ACCESS_PT CCE_LA N HCE Y OAA OTHER
ADI EHEAP LSP RELF
CCE FOCAL_PT NSIP SR_CTR
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Start End Worker Most Recent Nutr Medicaid Program Provider Location Client ID Client Name Status Enrollment Enrollment Worker Active Score Number
O3C1 1036 0000 4061653427 Test Name ACTV 09102013 CIRTS20804 Y 1
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Start End Worker Most Recent Nutr Medicaid Program Provider Location Client ID Client Name Status Enrollment Enrollment Worker Active Score Number
O3C1 1036 0000 4061638016 Test Name ACTV 09122013 CIRTS20804 Y 2
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Start End Worker Most Recent Nutr Medicaid Program Provider Location Client ID Client Name Status Enrollment Enrollment Worker Active Score Number
O3C2 1036 0000 4062000152 Test Name ACTV 02072011 CIRTS23407 N 3
1036 0000 4061594062 ISAACS HATTIE ACTV 11192012 CIRTS20804 Y 5
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Start End Worker Most Recent Nutr Medicaid Program Provider Location Client ID Client Name Status Enrollment Enrollment Worker Active Score Number
O3C2 1036 0000 4062379505 Test Name ACTV 11192012 CIRTS20804 Y 5
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Start End Worker Most Recent Nutr Medicaid Program Provider Location Client ID Client Name Status Enrollment Enrollment Worker Active Score Number
O3C2 1036 0000 4062401063 Test Name ACTV 10162013 CIRTS20804 Y 3
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Provider Location Client ID Client Name Program Status
Start Enrollment
End Enrollment Worker
Worker Active
Most Recent Nutr Score
Medicaid Number
O3C2 1036 0000 4062538939 ACTV 12082000 CIRTS20388 Y Test Name
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All Enrollments Counts During Date Range PSA ALL Start Date 01012017 End Date Location 0000 Provider Program Program Status
12312017 ALL PROVIDERS
ACTV
Group By Program Provider Location
Program Provider Location Client Count O3C1 1036 0000 45
1951 0000 3
O3C2 1036 0000 113
OA3E 1821 0000 2
OA3ES 1821 0000 1
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C1 1036 0000 4061950299 Test Name ACTV 04072011 CIRTS23407 N 11
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C1 1036 4062586019 Test Name ACTV 12292008 CIRTS23407 N 1
Total for Location 45
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C1 1951 0000 4062452921 Test Name ACTV 03301989 CIRTS22695 N 10
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4062786256 Test Name ACTV 09232013 CIRTS20804 Y 4 1
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4062380426 Test Name ACTV 04112012 CIRTS23407 N 55 2
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4061608826 Test Name ACTV 08102011 CIRTS18634 Y 7 3
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4062615533 Test Name ACTV 10032013 CIRTS20804 Y 6 3
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start Enrollment
End Enrollment Worker
Worker Active
Medicaid Number
Most Recent Nutr Score Rank
O3C2 1036 4062466582 Test Name ACTV 10262010 CIRTS23407 N 105 2
Total for Location 113
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PSA
APCL Clients With No Services ALL Owner All Owners Provider ALL PROVIDERS
Start Date 01012017 End Date 12312017
Includes Clients Receiving Only CM INSC SCAS CA REFE Services
PSA Client ID Client Name Owner Provider Program
Count 0
Unduplicated Clients Count 0
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APCL Clients With Services PSA ALL Owner All Owners Provider ALL PROVIDERS Start Date 01012017 End Date 12312017
Exclude CM CA INSC REFE SCAS
PSA Client ID Name Owner Provider Program 10 4062527553 Test Name 1539 1929 CCE
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APCL Clients With Services PSA ALL Owner All Owners Provider ALL PROVIDERS Start Date 01012017 End Date 12312017
Exclude CM CA INSC REFE SCAS
PSA Client ID Name Owner Provider Program 11 4062732638 Test Name 1177 1177 LTCC
Total 21067
Unduplicated clients count 12460
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APS Assessments PSA ALL Risk Level ALL Owner All Owners Referral Date From 01012017 To 12312017
Order by Referral Date and Owner ID
PSA 03
Ref Date Owner ID Client ID Client Name Risk Level Asmt Type Asmt Date
03032017 1390 4062058415 L 701A 03302018 Test Name
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APS Assessments PSA ALL Risk Level ALL Owner All Owners Referral Date From 01012017 To 12312017
Order by Referral Date and Owner ID
12042017 1980 4061617559 H 701B 12072017 Test Name
Assessment Count for the PSA 52
PSA 04A
Ref Date Owner ID Client ID
09102017 4062308458
Client Name
Test Name
Risk Level
H
Asmt Type
O
Asmt Date
09162017
Assessment Count for the PSA 2
Risk Level H
M
L
Count of Assessments 138
23
21
Total Count of Assessments 182
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APS Repeat Referrals in a Time Range
PSA ALL Owner All Owners
Start Date 01012017 End Date 12312017
Current DOEA CIRTS Cirts SSN if Risk Date Created PSA Owner Abuse No different than DCF DCF SSN Name County Level Date of Birth Date Sent by DCF
Count 0
Unduplicated Client Count by PSA
PSA Count SSN
Total
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Assessed Prioritized Consumer List PSA ALL Provider ALL PROVIDERS Program AC County ALL COUNTIES
County Program Consumer Name Client ID
Total Count 0
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Assessment Due Report PSA 01 Start Date 01012017 End Date 08312018 Owner ALL PROVIDERS Worker ALL WORKERS Program Status ACTV and APCL Assessment Type Needed ALL
Overdue and missing assessments are always listed
Owner ID 1065
Client ID Client Name
Owner Assessor ID
Date of Birth
06281928
CIRTS28099
County of Service
GULF
Worker Name HARPER KENNY
Zip Assessment PSA Date
32534 01 01022014
Type
701A
Active Y
Nutr PriorityScore Score
11 58
Rank
5
Due Date
01022015
Status
701S OVERDUE
LTCC APPL Start Date
03252014 4062235673 Test name
Total Clients for Worker 1
Total Clients for Owner 1
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Assessment Due Report PSA 01 Start Date 01012017 End Date 08312018 Owner ALL PROVIDERS Worker ALL WORKERS Program Status ACTV and APCL Assessment Type Needed ALL
Overdue and missing assessments are always listed
Summary by PSA
PSA 01 701A Overdue 1
701B Overdue 213
701C Overdue 0
701S Overdue 157
No 701A 0
No 701B 2
No 701C 0
No 701S 0
701A Not Overdue 0
701B Not Overdue 0
701C Not Overdue 0
701S Not Overdue 0
701S Optional 0
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CIC Service Units and Costs Projections County SummaryPSA 99 Program CCE
Start Date 01012017 End Date 12312017
County LEON
Total Total Total Avg Max Projected
StateFederal Projected Reimbursement Provider Unduplicated Provider Service Share Service Units Unit Rate Cost Per Unit Client Count
Report Total
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CIC Service Units and Costs Projections Provider SummaryPSA ALL Provider ALL PROVIDERS Program FEDERALLY FUNDED (0101 TO 1231) Year 2017 From 01012017 To 12312017
PSA County Program Service Total State
Federal Share
Total Projected
Service Units
Avg Reimbursement
Unit Rate
Max Provider
Cost Per Unit
Total Projected Unduplicated Client Count
02 FRANKLIN O3C1 CONGREGATE MEALS $810300 1710 15
Program Total
County Total
$810300
$810300
GULF O3C1 CONGREGATE MEALS $25205 3 5
Program Total $25205
O3C2 HOME DELIVERED MEALS $25205 3 6
Program Total
County Total
$25205
$50411
LEON O3C1 CONGREGATE MEALS $621300 1311 15
CONGREGATE MEALS GUEST
CONGREGATE MEALS VOLUNTEERS
$252055
$277260
25
30
2
5
Program Total $1150615
O3C2 HOME DELIVERED MEAL GUEST $252055 25 3
Program Total $252055
OA3D PEARLS (SESSION 5)
PEARLS (SESSION 6)
PEARLS (SESSION 7)
PEARLS (SESSION 8)
$10247
$10247
$10247
$10247
10
10
10
10
3
3
3
3
Program Total $40988
OA3E RESPITE IN-HOME $200 2 2
Program Total
County Total
$200
$1443858
WAKULLA O3C2 EMERGENCY HOME DELIVERED SHELF MEALS
$8065604 14899 90
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CIC Service Units and Costs Projections - PSA Summary
PSA ALL Program CCE
Strat Date 01012017 End Date 12312017
Total
PSA County Provider Service
Total State Federal
Share
Total Projected
Service Units
Avg Reimbursement
Unit Rate
Max Projected Provider Unduplicated
Cost Per Unit Client Count
02 LEON SOUTHERN SERVICE CASE MANAGEMENT PROVIDER EMERGENCY HOME DELIVERED SHELF MEALS
$2175533
$602000
483
689
32
20
HOME DELIVERED MEALS $530262 993 5
MATERIAL AID $1994536 199
Provider Total $5302331
CountyTotal $5302331
WAKULLA SOUTHERN SERVICE CASE MANAGEMENT PROVIDER EMERGENCY HOME DELIVERED SHELF MEALS
$2175533
$1240200
483
689
32
5
MATERIAL AID $1994536 199
Provider Total $5410269
CountyTotal $5410269
PSA Total $10712599
05 PINELLAS BURSTEIN-APPLEBEE ADULT DAY CARE $000 0 $900 $1000 0
COUNSELING (MENTAL HEALTH COUNSELINGSCREENING) - INDIVIDUAL
Provider Total
$000
$000
0 $6600 $7700 0
CountyTotal $000
PSA Total $000
Report Total $10712599
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CID Service Units and Costs Projections - PSA SummaryPSA ALL Program CCE
Start Date 01012017 End Date 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
PSA County Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
02 LEON CASE MANAGEMENT $2175533 483
EMERGENCY HOME $602000 689DELIVERED SHELF MEALS HOME DELIVERED MEALS $530262 993
MATERIAL AID $1994536 199
County Total $5302331 2364
WAKULLA CASE MANAGEMENT $2175533 483
EMERGENCY HOME $1240200 689DELIVERED SHELF MEALS MATERIAL AID $1994536 199
County Total $5410269 1371
PSA Total $10712599 3735
05 PINELLAS ADULT DAY CARE $000 0
COUNSELING (MENTAL $000 0 HEALTH COUNSELINGSCREENING) - INDIVIDUAL
County Total $000 0
PSA Total $000 0
Report Total $10712599 3735
$900 $900 $900 $1000 $1000 $1000
$6600 $6600 $6600 $7700 $7700 $7700
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CID Service Units and Costs Projections County SummaryPSA 99
Program CCE County LEON
Start Date 01012017 End Date 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
Report Total
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CIE Service Units and Costs Projections - PSA Summary - All Programs
PSA 99 Program FEDERALLY FUNDED (0101 TO 1231) Year 2017 From 01012017 To 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
Program Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
Report Total
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CIE Service Units and Costs Projections - PSA Summary
PSA ALL Program CCE
Start Date 01012017 End Date 12312017
Avg High Low Total Total Avg High Low Provider Provider Provider
StateFederal Projected Reimbursement Reimbursement Reimbursement Cost Cost CostPSA
02
Service
CASE MANAGEMENT
Share
$4351066
Service Units
966
Unit Rate Unit Rate Unit Rate Per Unit Per Unit Per Unit
EMERGENCY HOME DELIVERED SHELF MEALS $1842200 1378
HOME DELIVERED MEALS $530262 993
MATERIAL AID $3989071 398
PSA Total $10712599 3735
05 ADULT DAY CARE $000 0 $900 $900 $900 $1000 $1000 $1000
COUNSELING (MENTAL HEALTH $000 0 $6600 $6600 $6600 $7700 $7700 $7700 COUNSELINGSCREENING) - INDIVIDUAL
PSA Total $000 0
Report Total $10712599 3735
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CAREGIVER SEARCH REPORT
SEARCH RESULTS FOR CONSUMERS
Criteria First Name Last Name SSN PSA ALL
Client Name Client SSN Caregiver Name Caregiver SSN
000000000 000000000 Test Name Test Name
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CARES Referrals in a Time Range PSA ALL
Start Date 01012017 End Date 12312017
Referred to ALL REFERRALS
Referring PSA Employee Name Client Name Client ID
Referral Imminent NH Admit Aging Date Risk Date Referred To Cares Provider Name Received Date
03A 4061561263 Test Name Test Name 09242017 Y 05292017 ARC or ADRC 09252017
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CARES Referrals in a Time Range PSA ALL
Start Date 01012017 End Date 12312017
Referred to ALL REFERRALS
Referring PSA Employee Name Client Name Client ID
Referral Date
Imminent Risk
NH Admit Date Referred To Cares Provider Name
Aging Received Date
04B Test Name Test Name 4061738075 04082017 N ARC or ADRC Test Name 04082017
Total Clients 110
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CARES Referrals not acknowledged by the Aging Network PSA ALL For Referrals after 01012017 Owner ID ALL Owners
Unduplicated Client count Cares Office Total Clients Count
Report Total
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
CIRTS Issue PSA Client ID Client Name Program
Program Status Start Provider Enrollment ID Provider Name
APCL CLIENT WITH DATE OF DEATH 08 4061759417 Test Name OA3B APCL 07232013 1141 WESTERN WORLD RADIO
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
Program Start Provider CIRTS Issue PSA Client ID Client Name Program Status Enrollment ID Provider Name
06 LTCC APCL 01242014 1514 4061713685 Test Name APCL CLIENT WITH DATE OF DEATH CENTRAL THE ORIGINAL HOUSE OF PIES
Count 503
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Civil Rights PSA ALL Provider ALL PROVIDERS Program AC Start Date 01012017 End Date 12312017 The Poverty Level for Single is The Poverty Level for Couple is Sort by County
County Unduplicated Count
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Client Information Report Start Date 01012017 End Date 12312017
Client ID 1001141246
Emergency
Client Name Test Name
Telephone () - Address 78 TEST STREET TALLAHASSEE FL 32399
Most Recent Caregiver Information Date Updated
Doctor
Comments
Client Demographic Information
Birth Date 06041940 Race W
Owner ID Ethnicity O
Most Recent Income Information
Ind Mon Inc Cpl Mon Inc
Ind Assets Couple Assets
Most Recent Assessment Information
Asmt Date Ref Risk Lvl
Asmt Site Spec Shel
AsmtType Spec Reg
Ref Date Primary CG
Ref Source Living Sit
Enrollment Information
Sex
Marital Status
F
S
Medicaid Number
ADL Score
ADL Count
IADL Score
IADL Count
Memory Score
Priority Score
Env Score
Nutr Score
Risk Score
Social Score
Rank
Provider Location Program Program Status Worker Start Date End Date
Care Plan Service Needed
Date Service Units Type Frq End Date
Care Plan Service Planned
Program Service Units Type Frq Start Date End Date
Services Received between 01012017 and 12312017
Service Billed Provider Location Worker Program Service Date Units Unit Type Amount
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Provider N
Client Service Units Report PSA ALL Provider ALL PROVIDERS Location 0000
Program ALL PROGRAMS Service ALL SERVICES Worker ALL WORKERS
City ALL CITIES Include Zero Unit N Include Aggregate N Calculated Amount equals the number of Units Provided times Fixed Cost if it existsService Start Date 01012017 Service End Date 12312017 If Fixed Cost does not exist Calculated
Group by PSA Provider Location Client Name County Worker Amount equals Billed Amount
Unduplicated Client Count 0 Grand Total 000 $000
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Clients In Common PSA All Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 County All Counties Worker All Workers
County JEFFERSON
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
MIAMI-DADE
0 0 0 0 0 0 0 0 0
4061539538 Test NameCounty Count
County
0 01
X
0 1
X
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
4061650856 Test Name X 4061486560 Test Name X 4062452921 Test Name X
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Clients Served Not Enrolled PSA ALL Start Date 01012017 End Date 12312017 Locations 0000 Provider All Providers
Service Service Min Serv Max Serv Program Start End Enrollment PSA Provider Location Program Consumer Name Client ID Service Date Date Status Enrollment Enrollment Provider
Count 0
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
4061472791 04
09
1092
1291
0072
0042
LTCC
LTCC
APCL
APCL
4062714543 06
06
1514
1762
0072
5006
LTCC
LTCC
APCL
APPL
4061802246 11
06
1177
1514
0179
0072
LTCC
LTCC
APCL
APCL
4061563719 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062644312 06
08
1514
1771
0072
0896
LTCC
LTCC
APCL
APCL
1001141670 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
1001141671 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
4062375003 07
05
05
07
1263
1755
1638
1263
0368
0072
0072
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062155124 06
06
1762
1514
0072
0072
LTCC
LTCC
APPL
APCL
4061743886 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0369
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4061499927 06
06
1514
1762
0072
5005
LTCC
LTCC
APCL
APPL
4061583524 08
06
1144
1514
0896
0072
LTCC
LTCC
APCL
APCL
4062694843 06
03
1514
1922
0072
0179
LTCC
LTCC
APCL
APCL
4062744517 07
06
1263
1514
0369
0072
LTCC
LTCC
APCL
APCL
4062005488 10
11
10
11
1929
1177
1164
1177
0072
0073
0179
0179
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
Total Count 15
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CODE DESCRIPTIONS Category ALL STATE TABLES
Code Description Active Available To Code Category
0 UNKNOWN Y CARES SUBJECTIVE_HEALTH_EVALUATION
01 ALACHUA Y COMMON COUNTIES
02 BAKER Y COMMON COUNTIES
03 BAY Y COMMON COUNTIES
04 BRADFORD Y COMMON COUNTIES
05 BREVARD Y COMMON COUNTIES
06 BROWARD Y COMMON COUNTIES
07 CALHOUN Y COMMON COUNTIES
08 CHARLOTTE Y COMMON COUNTIES
09 CITRUS Y COMMON COUNTIES
1 EXCELLENT Y CARES SUBJECTIVE_HEALTH_EVALUATION
10 CLAY Y COMMON COUNTIES
11 COLLIER Y COMMON COUNTIES
12 COLUMBIA Y COMMON COUNTIES
13 MIAMI-DADE Y COMMON COUNTIES
14 DESOTO Y COMMON COUNTIES
15 DIXIE Y COMMON COUNTIES
16 DUVAL Y COMMON COUNTIES
17 ESCAMBIA Y COMMON COUNTIES
18 FLAGLER Y COMMON COUNTIES
19 FRANKLIN Y COMMON COUNTIES
2 GOOD Y CARES SUBJECTIVE_HEALTH_EVALUATION
20 GADSDEN Y COMMON COUNTIES
21 GILCHRIST Y COMMON COUNTIES
22 GLADES Y COMMON COUNTIES
23 GULF Y COMMON COUNTIES
24 HAMILTON Y COMMON COUNTIES
25 HARDEE Y COMMON COUNTIES
26 HENDRY Y COMMON COUNTIES
27 HERNANDO Y COMMON COUNTIES
28 HIGHLANDS Y COMMON COUNTIES
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CONSUMER AGE VERIFICATION REPORT PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Program AC
Age at Start
Enroll or Start Enroll Provider Program Description Consumer Name Client ID DOB Svc date or Svc Date
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Contract Budget Information PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Program Service Provider Location County Served Provider Contract
Projected Service
Units Unit Measure
Projected Unduplicated
State Federal Share Client Count Begin Date End Date
Row Count 0 Amount Total
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Start Enroll Latest Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Date Asmt Date Worker
O3C1 1036 000 4061653427 Test CENTRAL 34982 W M 07091930 09102013 09102013 CIRTS20804 0 Name
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Start Enroll Date
Latest Asmt Date Worker
4061593624 Test Name CENTRAL 34946 B F 11261940 12012011 12312013 CIRTS23407
Count 164
Unduplicated Client Count 163
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Assessments After DOD Report
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Owner 1025
The shaded records indicate clients who have different DOBs andor different names
Assemt Current PSA Owner Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Owner Assessor
Provider Assessor
Assemt Date
Assemt Type
Unduplicated Count Total 0
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Open Enrollments
The Vital Statistics Data for 07192002 - 09112014PSA ALL Provider ALL Program Status ACTV Include MLTC ACTVS N
The shaded records indicate clients who have different DOBs andor different names
Enroll PSA
Enrollment Provider Loc Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Enroll Program Status
Enroll Program
Current Owner ID
02 1065 0072 4062244026 Test Name Test Name 10222004 03231917 03231917 ACTV CCE 1065
Count of enrollments for the Provider 1
Count of enrollments for the PSA 1
Count of enrollments for the Report 1
Unduplicated Count of Individuals with open enrollments and DOD PSA Total Clients Count
02 1
Total 1
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Unduplicated count of individuals with Services after DOD
PSA Total Clients Count
Report Total
Report run on 08312018 0207 PM Page 2 of 3 vs_servicesrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
List of Clients with PSA table entry for SERVICES_AFTER_DOD
Unduplicated Count Total 0
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Age
Provider
Total
Age lt 60 Age 60 - 64 Age 65 - 74 Age 75 - 84 Age 85+ Total Clients Avg Age
Total
Avg Age
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Ethnicity
Provider Hispanic Other Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Race
American Indian Native Hawaiian Other Provider Asian Alaska Native Black Pacific Islander Minority White Multiple Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Gender
Provider Male Female Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Monthly Income
Provider 0 - - Higher than Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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None
Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Total Persons Served 0
Age lt 60 Years 0 0
Age 60 - 64 0 0
Age 65 - 74 0 0
Age 75 - 84 0 0
Age 85+ 0 0
Total Age 0 0
Average 000
Ethnicity Hispanic 0 0
Other Ethnicity 0 0
Unknown Ethnicity 0 0
Total 0 0
Race Asian 0 0
American Indian Alaska Native 0 0
Black 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority 0 0
White 0 0
Multiple 0 0
Unknown 0 0
Total 0 0
Sex Male 0 0
Female 0 0
Unknown Sex 0 0
Total 0 0
Monthly Income 0 - 0 0
- 0 0
Higher than 0 0
Unknown 0 0
Total 0 0
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Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Client ID Date Of Birth Ethnicity Race Sex Individual Monthly Income
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Demographics of Clients OAA Registered Served Only PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 City All Cities Program All Programs Service All Services County ALL COUNTIES Table OAA Registered Services Only Low Income Medium Income
Total Persons Served 0
Agelt 60 Years
Age 60 - 64
Age 65 - 74
Age 75 - 84
Age 85+
0
0
0
0
0
0
0
0
0
0
Monthly Income
0 -
-Higher than
Unknown
0
0
0
0
0
0
0
0
Total
Average
0
000
0 Total 0 0
Ethnicity Hispanic
Other
Unknown
0
0
0
0
0
0
Living Situation
Alone
Null
Policy Change
0
0
0
0
0
0
Total 0 0 Unknown
With Caregiver
0
0
0
0
Race Asian 0 0
With Other
With Other Caregiver
0
0
0
0
American Indian Alaska Native
Black
0
0
0
0Total Living Situation 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority
White
0
0
0
0 Limited English Proficiency
Multiple
Unknown
Total Race
0
0
0
0
0
0
Yes
No
Unknown
0
0
0
0
0
0
Total 0 0
Sex Male
Female
Unknown
0
0
0
0
0
0
Total 0 0
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Disaster Assistance Clients for a Provider PSA ALL Provider All Providers Location 0000 Worker All Workers City All Cities Zip Code All Zip Codes Sort By ZIP
Provider 1036 Provider Name Location 0000 Worker CIRTS18634
Need Care Client Name Address City Zip County Phone Asst Reg Situation Relat Care phone Care Name
34946 N WO DA 000 SAINT JAMES DRIVE CENTRAL (025) 101-0620 Test NameTest Name SAINT LUCIE (005) 100-0369 Y
Client is active and no assessment information is available Special Shelter and Special Registry are unknown
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
Total by PSA 0
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
ALACH BAKER BAY BRADF BREVA BROWA CALHO CHARL CITRUS CLAY COLLIE COLUM DESOT DIXIE DUVAL ESCAM FLAGL FRANK GADSDAssisted Household Report UA ORD RD RD UN OTTE R BIA O BIA ER LIN EN
1 of Household Assisted 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Households AssistedWith Gross Income
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C 100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D 125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
3 Households with at leastOne member
A 60 Years or older 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B Disabled 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C Age 5 years or under 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D Under 60 Years Old 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Undup Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Assisted
Applicant Household Report
of Applicant Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Energy Assisted Household Report
County of Assisted
Households
Households Assisted By Poverty Level
Under 75 75 - 100 101 - 125 126 - 150 Over 150 60 Years or older
At least one member who is
Age 5 years Age 2 years Age 3 years Disabled or younger and younger through 5
Under 60 Years Old
Undup Households
Assisted
Energy Assistance Total
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Unduplicated Total 0 0
County of Assisted
Households Under 75 75 - 100
Households Assisted By Poverty Level
101 - 125 126 - 150 Over 150 60 Years or older Disabled
Age 5 years or younger
Age 2 years and younger
Age 3 years through 5
Under 60 Years Old
At least one member who is
Undup Households
Assisted
Other Assisted Household Report
Other Assistance Total
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Applicant Household Report
County of Applicant
Households Under 75 75 - 100 101 - 125 126 - 150 Over 150 Income data
unavailable
Total 0
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01
Enrollment Active Consumer Count by Program PSA ALL Provider ALL PROVIDERS
County Description Program Count of Clients
BREVARD
ADI
CCE
HCE
LSP
NDP
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
MLTC
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
31
57
44
5
62
123
141
26
9
7
5
40
5
50
67
129
2
19
42
29
1
233
79
63
8
2
14
3
37
14
47
3
3
33
127
10
02
03
04
ALACHUA
BAKER
BAY
BRADFORD
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Enrollment Terminations with Reasons PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 Program All Programs Program Status ALL Program Status Worker ALL WORKERS
Last First Program Medicaid Provider Start End Name Name Client ID Status Description Worker Number Program Location Enrollment Enrollment
Count 0
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Enrollments with Care Plan Report
PSA ALL Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTIVE STATUS Care Plan Service ALL SERVICES Care Plan Start 01012017 Care Plan End 12312017
Care Plan Care Plan Care Plan Client Name
Unduplicated Client Count 0
Client ID Program Status Worker Start Date End Date Service
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PSA CLIENT_ID CLIENT_NAME OWNER PROVIDER_ID ASSESSMENT_DATE ASSESSOR_NAME MEDICAID_NUMBER CAREGIVER_CHANGE ENVIRONMENT_CHANGE HEALTH_CHANGE INCOME_CHANGE SITUATION_CHANGE INITIAL_ASSM ANNUAL_ASSM SSN REFERRAL_SOURCE 1114 N N N N Y N 771771777 SELFFAMILY 812017 JANE CASEWORKER 2 1001141633 TEST TEST N
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Fixed Service Costs List PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Provider Location County Program Service Reimbursement Unit Rate Provider Cost Per Unit Begin Valid End Valid
Count 0
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Aging Network Provider Information Report PSA ALL
Address PSA Provider Loc Provider Name Type Provider Address Telephone
01 1147 B
1147
0072 Provider Name
0073 Provider Name B
1147
1147
0100 Provider Name
0179 Provider Name B
1271 B
1271 B
1271
0000 Provider Name
0001 Provider Name
0002 Provider Name B
1271 B
1271
0003 Provider Name
0004 Provider Name B
1271 B
1271
0072 Provider Name
0073 Provider Name B
1271 0100 Provider Name B
1271 B
1271 B
1271 B
1271 B
1271
0101 Provider Name
0138 Provider Name
0179 Provider Name
0286 Provider Name
0287 Provider Name B
123 Provider CALICO DRIVE STAYTON FL 59255
123 Provider TERRA COTTA STREET DARRINGTON
FL 57399
123 Provider LANGTOWN ROAD DARRINGTON FL 57399
123 Provider POINTE LANE Bonum integritas corporis misDARRINGTON FL 58398
123 Provider OAK DRIVE SUNNYVALE MO 83407
123 Provider HOTT STREET DARRINGTON FL 58398
123 Provider GRASSELLI STREET DARRINGTON FL 68396
123 Provider HEAVENS WAY MORRISONS CROSSROADS AL 33165
123 Provider GOOSETOWN DRIVE MIDVILLE
FL 93176
123 Provider PIKE STREET BELLOWS FALLS
FL 48405
123 Provider GLENVIEW DRIVE SUSSEX FL
123 Provider JONES AVENUE BLYTHEVILLE
FL 14027
123 Provider HENERY STREET SUSSEX FL
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Aging Network Provider Information Report PSA ALL
PSA Provider Loc Provider Name Address Type Provider Address Telephone
11 1952 B
1952 B
1952 B
1952 B
1952 B
1952 B
1952 B
123 Test Street ELLSINORE FL 38234 3789 WHITE
123 Test Street OHATCHEE FL 45235 3408 NORMA
123 Test Street WHITE CLOUD FL 46226
123 Test Street NEOSHO FL 06231
123 Test Street WHITE CLOUD FL 16168 3678 OLD
123 Test StreetWHITE CLOUD FL 06231 184 GRANT
123 Test Street WHITE CLOUD FL 93236
1952
1955
1956
B 3123 Test Street Quid censes in Latino fore IaWHITE CLOUD FL 70226
1957
0Provider Name
0Provider Name
0Provider Name
0Provider Name
0Provider Name
0Provider Name
0Provider Name
0Provider Name
0Provider Name
0Provider Name
0Provider Name B 123 Test Street Sed ad rem redeamus ComprehenWHITE CLOUD FL 38227
1957
1958
Count
0474 Provider Name
0072 Provider Name
427
B 123 Test Street BRANCH ROAD Quid ergo hoc loco intellegit WHITE CLOUD FL 25224
Count Total 3117
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Aging Network Providers Report PSA ALL
PSA 01
Provider 1271 Provider Name Provider Name
Location 0000 Location Name Provider Name
Location Business Address 3123 Test Drive DARRINGTON FL 58398
County Served OKALOOSA Phone Fax Location Contact
Provider Director Provider Profit Status Non-Profit
ACCESS_PT CCE_LA N HCE OAA OTHER
ADI EHEAP LSP RELF
CCE Y FOCAL_PT NSIP SR_CTR
Provider 1271 Provider Name Provider Name
Location 0001 Location Name Provider Name
Location Business Address 1234 Test OAK DRIVE SUNNYVALE MO 83407
Phone Fax Location Contact County Served OKALOOSA
Provider Director Provider Profit Status Non-Profit
ACCESS_PT CCE_LA N HCE OAA OTHER
ADI EHEAP LSP RELF
CCE Y FOCAL_PT NSIP SR_CTR
Provider 1271 Provider Name Provider Name
Location 0004 Location Name Provider Name
Location Business Address 1123 Test HEAVENS WAY MORRISONS CROSSROADS AL
33165 Phone County Served OKALOOSA Fax Location Contact
Provider Director Provider Profit Status Non-Profit
ACCESS_PT CCE_LA N HCE Y OAA OTHER
ADI EHEAP LSP RELF
CCE FOCAL_PT NSIP SR_CTR
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Start End Worker Most Recent Nutr Medicaid Program Provider Location Client ID Client Name Status Enrollment Enrollment Worker Active Score Number
O3C1 1036 0000 4061653427 Test Name ACTV 09102013 CIRTS20804 Y 1
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Start End Worker Most Recent Nutr Medicaid Program Provider Location Client ID Client Name Status Enrollment Enrollment Worker Active Score Number
O3C1 1036 0000 4061638016 Test Name ACTV 09122013 CIRTS20804 Y 2
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Start End Worker Most Recent Nutr Medicaid Program Provider Location Client ID Client Name Status Enrollment Enrollment Worker Active Score Number
O3C2 1036 0000 4062000152 Test Name ACTV 02072011 CIRTS23407 N 3
1036 0000 4061594062 ISAACS HATTIE ACTV 11192012 CIRTS20804 Y 5
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Start End Worker Most Recent Nutr Medicaid Program Provider Location Client ID Client Name Status Enrollment Enrollment Worker Active Score Number
O3C2 1036 0000 4062379505 Test Name ACTV 11192012 CIRTS20804 Y 5
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Start End Worker Most Recent Nutr Medicaid Program Provider Location Client ID Client Name Status Enrollment Enrollment Worker Active Score Number
O3C2 1036 0000 4062401063 Test Name ACTV 10162013 CIRTS20804 Y 3
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Provider Location Client ID Client Name Program Status
Start Enrollment
End Enrollment Worker
Worker Active
Most Recent Nutr Score
Medicaid Number
O3C2 1036 0000 4062538939 ACTV 12082000 CIRTS20388 Y Test Name
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All Enrollments Counts During Date Range PSA ALL Start Date 01012017 End Date Location 0000 Provider Program Program Status
12312017 ALL PROVIDERS
ACTV
Group By Program Provider Location
Program Provider Location Client Count O3C1 1036 0000 45
1951 0000 3
O3C2 1036 0000 113
OA3E 1821 0000 2
OA3ES 1821 0000 1
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C1 1036 0000 4061950299 Test Name ACTV 04072011 CIRTS23407 N 11
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C1 1036 4062586019 Test Name ACTV 12292008 CIRTS23407 N 1
Total for Location 45
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C1 1951 0000 4062452921 Test Name ACTV 03301989 CIRTS22695 N 10
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4062786256 Test Name ACTV 09232013 CIRTS20804 Y 4 1
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4062380426 Test Name ACTV 04112012 CIRTS23407 N 55 2
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4061608826 Test Name ACTV 08102011 CIRTS18634 Y 7 3
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4062615533 Test Name ACTV 10032013 CIRTS20804 Y 6 3
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start Enrollment
End Enrollment Worker
Worker Active
Medicaid Number
Most Recent Nutr Score Rank
O3C2 1036 4062466582 Test Name ACTV 10262010 CIRTS23407 N 105 2
Total for Location 113
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PSA
APCL Clients With No Services ALL Owner All Owners Provider ALL PROVIDERS
Start Date 01012017 End Date 12312017
Includes Clients Receiving Only CM INSC SCAS CA REFE Services
PSA Client ID Client Name Owner Provider Program
Count 0
Unduplicated Clients Count 0
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APCL Clients With Services PSA ALL Owner All Owners Provider ALL PROVIDERS Start Date 01012017 End Date 12312017
Exclude CM CA INSC REFE SCAS
PSA Client ID Name Owner Provider Program 10 4062527553 Test Name 1539 1929 CCE
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APCL Clients With Services PSA ALL Owner All Owners Provider ALL PROVIDERS Start Date 01012017 End Date 12312017
Exclude CM CA INSC REFE SCAS
PSA Client ID Name Owner Provider Program 11 4062732638 Test Name 1177 1177 LTCC
Total 21067
Unduplicated clients count 12460
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APS Assessments PSA ALL Risk Level ALL Owner All Owners Referral Date From 01012017 To 12312017
Order by Referral Date and Owner ID
PSA 03
Ref Date Owner ID Client ID Client Name Risk Level Asmt Type Asmt Date
03032017 1390 4062058415 L 701A 03302018 Test Name
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APS Assessments PSA ALL Risk Level ALL Owner All Owners Referral Date From 01012017 To 12312017
Order by Referral Date and Owner ID
12042017 1980 4061617559 H 701B 12072017 Test Name
Assessment Count for the PSA 52
PSA 04A
Ref Date Owner ID Client ID
09102017 4062308458
Client Name
Test Name
Risk Level
H
Asmt Type
O
Asmt Date
09162017
Assessment Count for the PSA 2
Risk Level H
M
L
Count of Assessments 138
23
21
Total Count of Assessments 182
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APS Repeat Referrals in a Time Range
PSA ALL Owner All Owners
Start Date 01012017 End Date 12312017
Current DOEA CIRTS Cirts SSN if Risk Date Created PSA Owner Abuse No different than DCF DCF SSN Name County Level Date of Birth Date Sent by DCF
Count 0
Unduplicated Client Count by PSA
PSA Count SSN
Total
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Assessed Prioritized Consumer List PSA ALL Provider ALL PROVIDERS Program AC County ALL COUNTIES
County Program Consumer Name Client ID
Total Count 0
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Assessment Due Report PSA 01 Start Date 01012017 End Date 08312018 Owner ALL PROVIDERS Worker ALL WORKERS Program Status ACTV and APCL Assessment Type Needed ALL
Overdue and missing assessments are always listed
Owner ID 1065
Client ID Client Name
Owner Assessor ID
Date of Birth
06281928
CIRTS28099
County of Service
GULF
Worker Name HARPER KENNY
Zip Assessment PSA Date
32534 01 01022014
Type
701A
Active Y
Nutr PriorityScore Score
11 58
Rank
5
Due Date
01022015
Status
701S OVERDUE
LTCC APPL Start Date
03252014 4062235673 Test name
Total Clients for Worker 1
Total Clients for Owner 1
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Assessment Due Report PSA 01 Start Date 01012017 End Date 08312018 Owner ALL PROVIDERS Worker ALL WORKERS Program Status ACTV and APCL Assessment Type Needed ALL
Overdue and missing assessments are always listed
Summary by PSA
PSA 01 701A Overdue 1
701B Overdue 213
701C Overdue 0
701S Overdue 157
No 701A 0
No 701B 2
No 701C 0
No 701S 0
701A Not Overdue 0
701B Not Overdue 0
701C Not Overdue 0
701S Not Overdue 0
701S Optional 0
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CIC Service Units and Costs Projections County SummaryPSA 99 Program CCE
Start Date 01012017 End Date 12312017
County LEON
Total Total Total Avg Max Projected
StateFederal Projected Reimbursement Provider Unduplicated Provider Service Share Service Units Unit Rate Cost Per Unit Client Count
Report Total
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CIC Service Units and Costs Projections Provider SummaryPSA ALL Provider ALL PROVIDERS Program FEDERALLY FUNDED (0101 TO 1231) Year 2017 From 01012017 To 12312017
PSA County Program Service Total State
Federal Share
Total Projected
Service Units
Avg Reimbursement
Unit Rate
Max Provider
Cost Per Unit
Total Projected Unduplicated Client Count
02 FRANKLIN O3C1 CONGREGATE MEALS $810300 1710 15
Program Total
County Total
$810300
$810300
GULF O3C1 CONGREGATE MEALS $25205 3 5
Program Total $25205
O3C2 HOME DELIVERED MEALS $25205 3 6
Program Total
County Total
$25205
$50411
LEON O3C1 CONGREGATE MEALS $621300 1311 15
CONGREGATE MEALS GUEST
CONGREGATE MEALS VOLUNTEERS
$252055
$277260
25
30
2
5
Program Total $1150615
O3C2 HOME DELIVERED MEAL GUEST $252055 25 3
Program Total $252055
OA3D PEARLS (SESSION 5)
PEARLS (SESSION 6)
PEARLS (SESSION 7)
PEARLS (SESSION 8)
$10247
$10247
$10247
$10247
10
10
10
10
3
3
3
3
Program Total $40988
OA3E RESPITE IN-HOME $200 2 2
Program Total
County Total
$200
$1443858
WAKULLA O3C2 EMERGENCY HOME DELIVERED SHELF MEALS
$8065604 14899 90
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CIC Service Units and Costs Projections - PSA Summary
PSA ALL Program CCE
Strat Date 01012017 End Date 12312017
Total
PSA County Provider Service
Total State Federal
Share
Total Projected
Service Units
Avg Reimbursement
Unit Rate
Max Projected Provider Unduplicated
Cost Per Unit Client Count
02 LEON SOUTHERN SERVICE CASE MANAGEMENT PROVIDER EMERGENCY HOME DELIVERED SHELF MEALS
$2175533
$602000
483
689
32
20
HOME DELIVERED MEALS $530262 993 5
MATERIAL AID $1994536 199
Provider Total $5302331
CountyTotal $5302331
WAKULLA SOUTHERN SERVICE CASE MANAGEMENT PROVIDER EMERGENCY HOME DELIVERED SHELF MEALS
$2175533
$1240200
483
689
32
5
MATERIAL AID $1994536 199
Provider Total $5410269
CountyTotal $5410269
PSA Total $10712599
05 PINELLAS BURSTEIN-APPLEBEE ADULT DAY CARE $000 0 $900 $1000 0
COUNSELING (MENTAL HEALTH COUNSELINGSCREENING) - INDIVIDUAL
Provider Total
$000
$000
0 $6600 $7700 0
CountyTotal $000
PSA Total $000
Report Total $10712599
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CID Service Units and Costs Projections - PSA SummaryPSA ALL Program CCE
Start Date 01012017 End Date 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
PSA County Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
02 LEON CASE MANAGEMENT $2175533 483
EMERGENCY HOME $602000 689DELIVERED SHELF MEALS HOME DELIVERED MEALS $530262 993
MATERIAL AID $1994536 199
County Total $5302331 2364
WAKULLA CASE MANAGEMENT $2175533 483
EMERGENCY HOME $1240200 689DELIVERED SHELF MEALS MATERIAL AID $1994536 199
County Total $5410269 1371
PSA Total $10712599 3735
05 PINELLAS ADULT DAY CARE $000 0
COUNSELING (MENTAL $000 0 HEALTH COUNSELINGSCREENING) - INDIVIDUAL
County Total $000 0
PSA Total $000 0
Report Total $10712599 3735
$900 $900 $900 $1000 $1000 $1000
$6600 $6600 $6600 $7700 $7700 $7700
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CID Service Units and Costs Projections County SummaryPSA 99
Program CCE County LEON
Start Date 01012017 End Date 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
Report Total
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CIE Service Units and Costs Projections - PSA Summary - All Programs
PSA 99 Program FEDERALLY FUNDED (0101 TO 1231) Year 2017 From 01012017 To 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
Program Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
Report Total
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CIE Service Units and Costs Projections - PSA Summary
PSA ALL Program CCE
Start Date 01012017 End Date 12312017
Avg High Low Total Total Avg High Low Provider Provider Provider
StateFederal Projected Reimbursement Reimbursement Reimbursement Cost Cost CostPSA
02
Service
CASE MANAGEMENT
Share
$4351066
Service Units
966
Unit Rate Unit Rate Unit Rate Per Unit Per Unit Per Unit
EMERGENCY HOME DELIVERED SHELF MEALS $1842200 1378
HOME DELIVERED MEALS $530262 993
MATERIAL AID $3989071 398
PSA Total $10712599 3735
05 ADULT DAY CARE $000 0 $900 $900 $900 $1000 $1000 $1000
COUNSELING (MENTAL HEALTH $000 0 $6600 $6600 $6600 $7700 $7700 $7700 COUNSELINGSCREENING) - INDIVIDUAL
PSA Total $000 0
Report Total $10712599 3735
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CAREGIVER SEARCH REPORT
SEARCH RESULTS FOR CONSUMERS
Criteria First Name Last Name SSN PSA ALL
Client Name Client SSN Caregiver Name Caregiver SSN
000000000 000000000 Test Name Test Name
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CARES Referrals in a Time Range PSA ALL
Start Date 01012017 End Date 12312017
Referred to ALL REFERRALS
Referring PSA Employee Name Client Name Client ID
Referral Imminent NH Admit Aging Date Risk Date Referred To Cares Provider Name Received Date
03A 4061561263 Test Name Test Name 09242017 Y 05292017 ARC or ADRC 09252017
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CARES Referrals in a Time Range PSA ALL
Start Date 01012017 End Date 12312017
Referred to ALL REFERRALS
Referring PSA Employee Name Client Name Client ID
Referral Date
Imminent Risk
NH Admit Date Referred To Cares Provider Name
Aging Received Date
04B Test Name Test Name 4061738075 04082017 N ARC or ADRC Test Name 04082017
Total Clients 110
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CARES Referrals not acknowledged by the Aging Network PSA ALL For Referrals after 01012017 Owner ID ALL Owners
Unduplicated Client count Cares Office Total Clients Count
Report Total
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
CIRTS Issue PSA Client ID Client Name Program
Program Status Start Provider Enrollment ID Provider Name
APCL CLIENT WITH DATE OF DEATH 08 4061759417 Test Name OA3B APCL 07232013 1141 WESTERN WORLD RADIO
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
Program Start Provider CIRTS Issue PSA Client ID Client Name Program Status Enrollment ID Provider Name
06 LTCC APCL 01242014 1514 4061713685 Test Name APCL CLIENT WITH DATE OF DEATH CENTRAL THE ORIGINAL HOUSE OF PIES
Count 503
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Civil Rights PSA ALL Provider ALL PROVIDERS Program AC Start Date 01012017 End Date 12312017 The Poverty Level for Single is The Poverty Level for Couple is Sort by County
County Unduplicated Count
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Client Information Report Start Date 01012017 End Date 12312017
Client ID 1001141246
Emergency
Client Name Test Name
Telephone () - Address 78 TEST STREET TALLAHASSEE FL 32399
Most Recent Caregiver Information Date Updated
Doctor
Comments
Client Demographic Information
Birth Date 06041940 Race W
Owner ID Ethnicity O
Most Recent Income Information
Ind Mon Inc Cpl Mon Inc
Ind Assets Couple Assets
Most Recent Assessment Information
Asmt Date Ref Risk Lvl
Asmt Site Spec Shel
AsmtType Spec Reg
Ref Date Primary CG
Ref Source Living Sit
Enrollment Information
Sex
Marital Status
F
S
Medicaid Number
ADL Score
ADL Count
IADL Score
IADL Count
Memory Score
Priority Score
Env Score
Nutr Score
Risk Score
Social Score
Rank
Provider Location Program Program Status Worker Start Date End Date
Care Plan Service Needed
Date Service Units Type Frq End Date
Care Plan Service Planned
Program Service Units Type Frq Start Date End Date
Services Received between 01012017 and 12312017
Service Billed Provider Location Worker Program Service Date Units Unit Type Amount
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Provider N
Client Service Units Report PSA ALL Provider ALL PROVIDERS Location 0000
Program ALL PROGRAMS Service ALL SERVICES Worker ALL WORKERS
City ALL CITIES Include Zero Unit N Include Aggregate N Calculated Amount equals the number of Units Provided times Fixed Cost if it existsService Start Date 01012017 Service End Date 12312017 If Fixed Cost does not exist Calculated
Group by PSA Provider Location Client Name County Worker Amount equals Billed Amount
Unduplicated Client Count 0 Grand Total 000 $000
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Clients In Common PSA All Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 County All Counties Worker All Workers
County JEFFERSON
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
MIAMI-DADE
0 0 0 0 0 0 0 0 0
4061539538 Test NameCounty Count
County
0 01
X
0 1
X
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
4061650856 Test Name X 4061486560 Test Name X 4062452921 Test Name X
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Clients Served Not Enrolled PSA ALL Start Date 01012017 End Date 12312017 Locations 0000 Provider All Providers
Service Service Min Serv Max Serv Program Start End Enrollment PSA Provider Location Program Consumer Name Client ID Service Date Date Status Enrollment Enrollment Provider
Count 0
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
4061472791 04
09
1092
1291
0072
0042
LTCC
LTCC
APCL
APCL
4062714543 06
06
1514
1762
0072
5006
LTCC
LTCC
APCL
APPL
4061802246 11
06
1177
1514
0179
0072
LTCC
LTCC
APCL
APCL
4061563719 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062644312 06
08
1514
1771
0072
0896
LTCC
LTCC
APCL
APCL
1001141670 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
1001141671 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
4062375003 07
05
05
07
1263
1755
1638
1263
0368
0072
0072
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062155124 06
06
1762
1514
0072
0072
LTCC
LTCC
APPL
APCL
4061743886 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0369
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4061499927 06
06
1514
1762
0072
5005
LTCC
LTCC
APCL
APPL
4061583524 08
06
1144
1514
0896
0072
LTCC
LTCC
APCL
APCL
4062694843 06
03
1514
1922
0072
0179
LTCC
LTCC
APCL
APCL
4062744517 07
06
1263
1514
0369
0072
LTCC
LTCC
APCL
APCL
4062005488 10
11
10
11
1929
1177
1164
1177
0072
0073
0179
0179
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
Total Count 15
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CODE DESCRIPTIONS Category ALL STATE TABLES
Code Description Active Available To Code Category
0 UNKNOWN Y CARES SUBJECTIVE_HEALTH_EVALUATION
01 ALACHUA Y COMMON COUNTIES
02 BAKER Y COMMON COUNTIES
03 BAY Y COMMON COUNTIES
04 BRADFORD Y COMMON COUNTIES
05 BREVARD Y COMMON COUNTIES
06 BROWARD Y COMMON COUNTIES
07 CALHOUN Y COMMON COUNTIES
08 CHARLOTTE Y COMMON COUNTIES
09 CITRUS Y COMMON COUNTIES
1 EXCELLENT Y CARES SUBJECTIVE_HEALTH_EVALUATION
10 CLAY Y COMMON COUNTIES
11 COLLIER Y COMMON COUNTIES
12 COLUMBIA Y COMMON COUNTIES
13 MIAMI-DADE Y COMMON COUNTIES
14 DESOTO Y COMMON COUNTIES
15 DIXIE Y COMMON COUNTIES
16 DUVAL Y COMMON COUNTIES
17 ESCAMBIA Y COMMON COUNTIES
18 FLAGLER Y COMMON COUNTIES
19 FRANKLIN Y COMMON COUNTIES
2 GOOD Y CARES SUBJECTIVE_HEALTH_EVALUATION
20 GADSDEN Y COMMON COUNTIES
21 GILCHRIST Y COMMON COUNTIES
22 GLADES Y COMMON COUNTIES
23 GULF Y COMMON COUNTIES
24 HAMILTON Y COMMON COUNTIES
25 HARDEE Y COMMON COUNTIES
26 HENDRY Y COMMON COUNTIES
27 HERNANDO Y COMMON COUNTIES
28 HIGHLANDS Y COMMON COUNTIES
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CONSUMER AGE VERIFICATION REPORT PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Program AC
Age at Start
Enroll or Start Enroll Provider Program Description Consumer Name Client ID DOB Svc date or Svc Date
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Contract Budget Information PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Program Service Provider Location County Served Provider Contract
Projected Service
Units Unit Measure
Projected Unduplicated
State Federal Share Client Count Begin Date End Date
Row Count 0 Amount Total
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Start Enroll Latest Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Date Asmt Date Worker
O3C1 1036 000 4061653427 Test CENTRAL 34982 W M 07091930 09102013 09102013 CIRTS20804 0 Name
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Start Enroll Date
Latest Asmt Date Worker
4061593624 Test Name CENTRAL 34946 B F 11261940 12012011 12312013 CIRTS23407
Count 164
Unduplicated Client Count 163
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Assessments After DOD Report
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Owner 1025
The shaded records indicate clients who have different DOBs andor different names
Assemt Current PSA Owner Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Owner Assessor
Provider Assessor
Assemt Date
Assemt Type
Unduplicated Count Total 0
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Open Enrollments
The Vital Statistics Data for 07192002 - 09112014PSA ALL Provider ALL Program Status ACTV Include MLTC ACTVS N
The shaded records indicate clients who have different DOBs andor different names
Enroll PSA
Enrollment Provider Loc Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Enroll Program Status
Enroll Program
Current Owner ID
02 1065 0072 4062244026 Test Name Test Name 10222004 03231917 03231917 ACTV CCE 1065
Count of enrollments for the Provider 1
Count of enrollments for the PSA 1
Count of enrollments for the Report 1
Unduplicated Count of Individuals with open enrollments and DOD PSA Total Clients Count
02 1
Total 1
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Unduplicated count of individuals with Services after DOD
PSA Total Clients Count
Report Total
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
List of Clients with PSA table entry for SERVICES_AFTER_DOD
Unduplicated Count Total 0
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Age
Provider
Total
Age lt 60 Age 60 - 64 Age 65 - 74 Age 75 - 84 Age 85+ Total Clients Avg Age
Total
Avg Age
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 1 of 5 demo_all_prvrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Ethnicity
Provider Hispanic Other Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Race
American Indian Native Hawaiian Other Provider Asian Alaska Native Black Pacific Islander Minority White Multiple Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Gender
Provider Male Female Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 4 of 5 demo_all_prvrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Monthly Income
Provider 0 - - Higher than Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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None
Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Total Persons Served 0
Age lt 60 Years 0 0
Age 60 - 64 0 0
Age 65 - 74 0 0
Age 75 - 84 0 0
Age 85+ 0 0
Total Age 0 0
Average 000
Ethnicity Hispanic 0 0
Other Ethnicity 0 0
Unknown Ethnicity 0 0
Total 0 0
Race Asian 0 0
American Indian Alaska Native 0 0
Black 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority 0 0
White 0 0
Multiple 0 0
Unknown 0 0
Total 0 0
Sex Male 0 0
Female 0 0
Unknown Sex 0 0
Total 0 0
Monthly Income 0 - 0 0
- 0 0
Higher than 0 0
Unknown 0 0
Total 0 0
Report run on 08312018 1058 AM Page 1 of 2 demo_by_prov_detrdf Report run byRSHQALL Dispose of this report so that it can not be read or reconstructed
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Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Client ID Date Of Birth Ethnicity Race Sex Individual Monthly Income
Report run on 08312018 1058 AM Page 2 of 2 demo_by_prov_detrdf Report run byRSHQALL Dispose of this report so that it can not be read or reconstructed
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Demographics of Clients OAA Registered Served Only PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 City All Cities Program All Programs Service All Services County ALL COUNTIES Table OAA Registered Services Only Low Income Medium Income
Total Persons Served 0
Agelt 60 Years
Age 60 - 64
Age 65 - 74
Age 75 - 84
Age 85+
0
0
0
0
0
0
0
0
0
0
Monthly Income
0 -
-Higher than
Unknown
0
0
0
0
0
0
0
0
Total
Average
0
000
0 Total 0 0
Ethnicity Hispanic
Other
Unknown
0
0
0
0
0
0
Living Situation
Alone
Null
Policy Change
0
0
0
0
0
0
Total 0 0 Unknown
With Caregiver
0
0
0
0
Race Asian 0 0
With Other
With Other Caregiver
0
0
0
0
American Indian Alaska Native
Black
0
0
0
0Total Living Situation 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority
White
0
0
0
0 Limited English Proficiency
Multiple
Unknown
Total Race
0
0
0
0
0
0
Yes
No
Unknown
0
0
0
0
0
0
Total 0 0
Sex Male
Female
Unknown
0
0
0
0
0
0
Total 0 0
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Disaster Assistance Clients for a Provider PSA ALL Provider All Providers Location 0000 Worker All Workers City All Cities Zip Code All Zip Codes Sort By ZIP
Provider 1036 Provider Name Location 0000 Worker CIRTS18634
Need Care Client Name Address City Zip County Phone Asst Reg Situation Relat Care phone Care Name
34946 N WO DA 000 SAINT JAMES DRIVE CENTRAL (025) 101-0620 Test NameTest Name SAINT LUCIE (005) 100-0369 Y
Client is active and no assessment information is available Special Shelter and Special Registry are unknown
Report run on 08312018 1102 AM Page 1 of 8 disaster_by_provrdf
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
Total by PSA 0
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
ALACH BAKER BAY BRADF BREVA BROWA CALHO CHARL CITRUS CLAY COLLIE COLUM DESOT DIXIE DUVAL ESCAM FLAGL FRANK GADSDAssisted Household Report UA ORD RD RD UN OTTE R BIA O BIA ER LIN EN
1 of Household Assisted 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Households AssistedWith Gross Income
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C 100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D 125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
3 Households with at leastOne member
A 60 Years or older 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B Disabled 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C Age 5 years or under 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D Under 60 Years Old 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Undup Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Assisted
Applicant Household Report
of Applicant Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Energy Assisted Household Report
County of Assisted
Households
Households Assisted By Poverty Level
Under 75 75 - 100 101 - 125 126 - 150 Over 150 60 Years or older
At least one member who is
Age 5 years Age 2 years Age 3 years Disabled or younger and younger through 5
Under 60 Years Old
Undup Households
Assisted
Energy Assistance Total
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Unduplicated Total 0 0
County of Assisted
Households Under 75 75 - 100
Households Assisted By Poverty Level
101 - 125 126 - 150 Over 150 60 Years or older Disabled
Age 5 years or younger
Age 2 years and younger
Age 3 years through 5
Under 60 Years Old
At least one member who is
Undup Households
Assisted
Other Assisted Household Report
Other Assistance Total
Report run on 08312018 1107 AM Page 2 of 3 eheap_summaryrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Applicant Household Report
County of Applicant
Households Under 75 75 - 100 101 - 125 126 - 150 Over 150 Income data
unavailable
Total 0
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01
Enrollment Active Consumer Count by Program PSA ALL Provider ALL PROVIDERS
County Description Program Count of Clients
BREVARD
ADI
CCE
HCE
LSP
NDP
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
MLTC
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
31
57
44
5
62
123
141
26
9
7
5
40
5
50
67
129
2
19
42
29
1
233
79
63
8
2
14
3
37
14
47
3
3
33
127
10
02
03
04
ALACHUA
BAKER
BAY
BRADFORD
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05
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Enrollment Terminations with Reasons PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 Program All Programs Program Status ALL Program Status Worker ALL WORKERS
Last First Program Medicaid Provider Start End Name Name Client ID Status Description Worker Number Program Location Enrollment Enrollment
Count 0
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Enrollments with Care Plan Report
PSA ALL Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTIVE STATUS Care Plan Service ALL SERVICES Care Plan Start 01012017 Care Plan End 12312017
Care Plan Care Plan Care Plan Client Name
Unduplicated Client Count 0
Client ID Program Status Worker Start Date End Date Service
Report run on 08312018 1054 AM Page 1 of 1 enroll_careplrdf Report run by RSHQALL Dispose of this report so that it cannot be read or reconstructed
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PSA CLIENT_ID CLIENT_NAME OWNER PROVIDER_ID ASSESSMENT_DATE ASSESSOR_NAME MEDICAID_NUMBER CAREGIVER_CHANGE ENVIRONMENT_CHANGE HEALTH_CHANGE INCOME_CHANGE SITUATION_CHANGE INITIAL_ASSM ANNUAL_ASSM SSN REFERRAL_SOURCE 1114 N N N N Y N 771771777 SELFFAMILY 812017 JANE CASEWORKER 2 1001141633 TEST TEST N
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Fixed Service Costs List PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Provider Location County Program Service Reimbursement Unit Rate Provider Cost Per Unit Begin Valid End Valid
Count 0
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Aging Network Provider Information Report PSA ALL
PSA Provider Loc Provider Name Address Type Provider Address Telephone
11 1952 B
1952 B
1952 B
1952 B
1952 B
1952 B
1952 B
123 Test Street ELLSINORE FL 38234 3789 WHITE
123 Test Street OHATCHEE FL 45235 3408 NORMA
123 Test Street WHITE CLOUD FL 46226
123 Test Street NEOSHO FL 06231
123 Test Street WHITE CLOUD FL 16168 3678 OLD
123 Test StreetWHITE CLOUD FL 06231 184 GRANT
123 Test Street WHITE CLOUD FL 93236
1952
1955
1956
B 3123 Test Street Quid censes in Latino fore IaWHITE CLOUD FL 70226
1957
0Provider Name
0Provider Name
0Provider Name
0Provider Name
0Provider Name
0Provider Name
0Provider Name
0Provider Name
0Provider Name
0Provider Name
0Provider Name B 123 Test Street Sed ad rem redeamus ComprehenWHITE CLOUD FL 38227
1957
1958
Count
0474 Provider Name
0072 Provider Name
427
B 123 Test Street BRANCH ROAD Quid ergo hoc loco intellegit WHITE CLOUD FL 25224
Count Total 3117
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Aging Network Providers Report PSA ALL
PSA 01
Provider 1271 Provider Name Provider Name
Location 0000 Location Name Provider Name
Location Business Address 3123 Test Drive DARRINGTON FL 58398
County Served OKALOOSA Phone Fax Location Contact
Provider Director Provider Profit Status Non-Profit
ACCESS_PT CCE_LA N HCE OAA OTHER
ADI EHEAP LSP RELF
CCE Y FOCAL_PT NSIP SR_CTR
Provider 1271 Provider Name Provider Name
Location 0001 Location Name Provider Name
Location Business Address 1234 Test OAK DRIVE SUNNYVALE MO 83407
Phone Fax Location Contact County Served OKALOOSA
Provider Director Provider Profit Status Non-Profit
ACCESS_PT CCE_LA N HCE OAA OTHER
ADI EHEAP LSP RELF
CCE Y FOCAL_PT NSIP SR_CTR
Provider 1271 Provider Name Provider Name
Location 0004 Location Name Provider Name
Location Business Address 1123 Test HEAVENS WAY MORRISONS CROSSROADS AL
33165 Phone County Served OKALOOSA Fax Location Contact
Provider Director Provider Profit Status Non-Profit
ACCESS_PT CCE_LA N HCE Y OAA OTHER
ADI EHEAP LSP RELF
CCE FOCAL_PT NSIP SR_CTR
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Start End Worker Most Recent Nutr Medicaid Program Provider Location Client ID Client Name Status Enrollment Enrollment Worker Active Score Number
O3C1 1036 0000 4061653427 Test Name ACTV 09102013 CIRTS20804 Y 1
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Start End Worker Most Recent Nutr Medicaid Program Provider Location Client ID Client Name Status Enrollment Enrollment Worker Active Score Number
O3C1 1036 0000 4061638016 Test Name ACTV 09122013 CIRTS20804 Y 2
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Start End Worker Most Recent Nutr Medicaid Program Provider Location Client ID Client Name Status Enrollment Enrollment Worker Active Score Number
O3C2 1036 0000 4062000152 Test Name ACTV 02072011 CIRTS23407 N 3
1036 0000 4061594062 ISAACS HATTIE ACTV 11192012 CIRTS20804 Y 5
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Start End Worker Most Recent Nutr Medicaid Program Provider Location Client ID Client Name Status Enrollment Enrollment Worker Active Score Number
O3C2 1036 0000 4062379505 Test Name ACTV 11192012 CIRTS20804 Y 5
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Start End Worker Most Recent Nutr Medicaid Program Provider Location Client ID Client Name Status Enrollment Enrollment Worker Active Score Number
O3C2 1036 0000 4062401063 Test Name ACTV 10162013 CIRTS20804 Y 3
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Provider Location Client ID Client Name Program Status
Start Enrollment
End Enrollment Worker
Worker Active
Most Recent Nutr Score
Medicaid Number
O3C2 1036 0000 4062538939 ACTV 12082000 CIRTS20388 Y Test Name
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All Enrollments Counts During Date Range PSA ALL Start Date 01012017 End Date Location 0000 Provider Program Program Status
12312017 ALL PROVIDERS
ACTV
Group By Program Provider Location
Program Provider Location Client Count O3C1 1036 0000 45
1951 0000 3
O3C2 1036 0000 113
OA3E 1821 0000 2
OA3ES 1821 0000 1
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C1 1036 0000 4061950299 Test Name ACTV 04072011 CIRTS23407 N 11
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C1 1036 4062586019 Test Name ACTV 12292008 CIRTS23407 N 1
Total for Location 45
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C1 1951 0000 4062452921 Test Name ACTV 03301989 CIRTS22695 N 10
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4062786256 Test Name ACTV 09232013 CIRTS20804 Y 4 1
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4062380426 Test Name ACTV 04112012 CIRTS23407 N 55 2
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4061608826 Test Name ACTV 08102011 CIRTS18634 Y 7 3
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4062615533 Test Name ACTV 10032013 CIRTS20804 Y 6 3
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start Enrollment
End Enrollment Worker
Worker Active
Medicaid Number
Most Recent Nutr Score Rank
O3C2 1036 4062466582 Test Name ACTV 10262010 CIRTS23407 N 105 2
Total for Location 113
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PSA
APCL Clients With No Services ALL Owner All Owners Provider ALL PROVIDERS
Start Date 01012017 End Date 12312017
Includes Clients Receiving Only CM INSC SCAS CA REFE Services
PSA Client ID Client Name Owner Provider Program
Count 0
Unduplicated Clients Count 0
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APCL Clients With Services PSA ALL Owner All Owners Provider ALL PROVIDERS Start Date 01012017 End Date 12312017
Exclude CM CA INSC REFE SCAS
PSA Client ID Name Owner Provider Program 10 4062527553 Test Name 1539 1929 CCE
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APCL Clients With Services PSA ALL Owner All Owners Provider ALL PROVIDERS Start Date 01012017 End Date 12312017
Exclude CM CA INSC REFE SCAS
PSA Client ID Name Owner Provider Program 11 4062732638 Test Name 1177 1177 LTCC
Total 21067
Unduplicated clients count 12460
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APS Assessments PSA ALL Risk Level ALL Owner All Owners Referral Date From 01012017 To 12312017
Order by Referral Date and Owner ID
PSA 03
Ref Date Owner ID Client ID Client Name Risk Level Asmt Type Asmt Date
03032017 1390 4062058415 L 701A 03302018 Test Name
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APS Assessments PSA ALL Risk Level ALL Owner All Owners Referral Date From 01012017 To 12312017
Order by Referral Date and Owner ID
12042017 1980 4061617559 H 701B 12072017 Test Name
Assessment Count for the PSA 52
PSA 04A
Ref Date Owner ID Client ID
09102017 4062308458
Client Name
Test Name
Risk Level
H
Asmt Type
O
Asmt Date
09162017
Assessment Count for the PSA 2
Risk Level H
M
L
Count of Assessments 138
23
21
Total Count of Assessments 182
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APS Repeat Referrals in a Time Range
PSA ALL Owner All Owners
Start Date 01012017 End Date 12312017
Current DOEA CIRTS Cirts SSN if Risk Date Created PSA Owner Abuse No different than DCF DCF SSN Name County Level Date of Birth Date Sent by DCF
Count 0
Unduplicated Client Count by PSA
PSA Count SSN
Total
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Assessed Prioritized Consumer List PSA ALL Provider ALL PROVIDERS Program AC County ALL COUNTIES
County Program Consumer Name Client ID
Total Count 0
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Assessment Due Report PSA 01 Start Date 01012017 End Date 08312018 Owner ALL PROVIDERS Worker ALL WORKERS Program Status ACTV and APCL Assessment Type Needed ALL
Overdue and missing assessments are always listed
Owner ID 1065
Client ID Client Name
Owner Assessor ID
Date of Birth
06281928
CIRTS28099
County of Service
GULF
Worker Name HARPER KENNY
Zip Assessment PSA Date
32534 01 01022014
Type
701A
Active Y
Nutr PriorityScore Score
11 58
Rank
5
Due Date
01022015
Status
701S OVERDUE
LTCC APPL Start Date
03252014 4062235673 Test name
Total Clients for Worker 1
Total Clients for Owner 1
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Assessment Due Report PSA 01 Start Date 01012017 End Date 08312018 Owner ALL PROVIDERS Worker ALL WORKERS Program Status ACTV and APCL Assessment Type Needed ALL
Overdue and missing assessments are always listed
Summary by PSA
PSA 01 701A Overdue 1
701B Overdue 213
701C Overdue 0
701S Overdue 157
No 701A 0
No 701B 2
No 701C 0
No 701S 0
701A Not Overdue 0
701B Not Overdue 0
701C Not Overdue 0
701S Not Overdue 0
701S Optional 0
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CIC Service Units and Costs Projections County SummaryPSA 99 Program CCE
Start Date 01012017 End Date 12312017
County LEON
Total Total Total Avg Max Projected
StateFederal Projected Reimbursement Provider Unduplicated Provider Service Share Service Units Unit Rate Cost Per Unit Client Count
Report Total
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CIC Service Units and Costs Projections Provider SummaryPSA ALL Provider ALL PROVIDERS Program FEDERALLY FUNDED (0101 TO 1231) Year 2017 From 01012017 To 12312017
PSA County Program Service Total State
Federal Share
Total Projected
Service Units
Avg Reimbursement
Unit Rate
Max Provider
Cost Per Unit
Total Projected Unduplicated Client Count
02 FRANKLIN O3C1 CONGREGATE MEALS $810300 1710 15
Program Total
County Total
$810300
$810300
GULF O3C1 CONGREGATE MEALS $25205 3 5
Program Total $25205
O3C2 HOME DELIVERED MEALS $25205 3 6
Program Total
County Total
$25205
$50411
LEON O3C1 CONGREGATE MEALS $621300 1311 15
CONGREGATE MEALS GUEST
CONGREGATE MEALS VOLUNTEERS
$252055
$277260
25
30
2
5
Program Total $1150615
O3C2 HOME DELIVERED MEAL GUEST $252055 25 3
Program Total $252055
OA3D PEARLS (SESSION 5)
PEARLS (SESSION 6)
PEARLS (SESSION 7)
PEARLS (SESSION 8)
$10247
$10247
$10247
$10247
10
10
10
10
3
3
3
3
Program Total $40988
OA3E RESPITE IN-HOME $200 2 2
Program Total
County Total
$200
$1443858
WAKULLA O3C2 EMERGENCY HOME DELIVERED SHELF MEALS
$8065604 14899 90
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CIC Service Units and Costs Projections - PSA Summary
PSA ALL Program CCE
Strat Date 01012017 End Date 12312017
Total
PSA County Provider Service
Total State Federal
Share
Total Projected
Service Units
Avg Reimbursement
Unit Rate
Max Projected Provider Unduplicated
Cost Per Unit Client Count
02 LEON SOUTHERN SERVICE CASE MANAGEMENT PROVIDER EMERGENCY HOME DELIVERED SHELF MEALS
$2175533
$602000
483
689
32
20
HOME DELIVERED MEALS $530262 993 5
MATERIAL AID $1994536 199
Provider Total $5302331
CountyTotal $5302331
WAKULLA SOUTHERN SERVICE CASE MANAGEMENT PROVIDER EMERGENCY HOME DELIVERED SHELF MEALS
$2175533
$1240200
483
689
32
5
MATERIAL AID $1994536 199
Provider Total $5410269
CountyTotal $5410269
PSA Total $10712599
05 PINELLAS BURSTEIN-APPLEBEE ADULT DAY CARE $000 0 $900 $1000 0
COUNSELING (MENTAL HEALTH COUNSELINGSCREENING) - INDIVIDUAL
Provider Total
$000
$000
0 $6600 $7700 0
CountyTotal $000
PSA Total $000
Report Total $10712599
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CID Service Units and Costs Projections - PSA SummaryPSA ALL Program CCE
Start Date 01012017 End Date 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
PSA County Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
02 LEON CASE MANAGEMENT $2175533 483
EMERGENCY HOME $602000 689DELIVERED SHELF MEALS HOME DELIVERED MEALS $530262 993
MATERIAL AID $1994536 199
County Total $5302331 2364
WAKULLA CASE MANAGEMENT $2175533 483
EMERGENCY HOME $1240200 689DELIVERED SHELF MEALS MATERIAL AID $1994536 199
County Total $5410269 1371
PSA Total $10712599 3735
05 PINELLAS ADULT DAY CARE $000 0
COUNSELING (MENTAL $000 0 HEALTH COUNSELINGSCREENING) - INDIVIDUAL
County Total $000 0
PSA Total $000 0
Report Total $10712599 3735
$900 $900 $900 $1000 $1000 $1000
$6600 $6600 $6600 $7700 $7700 $7700
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CID Service Units and Costs Projections County SummaryPSA 99
Program CCE County LEON
Start Date 01012017 End Date 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
Report Total
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CIE Service Units and Costs Projections - PSA Summary - All Programs
PSA 99 Program FEDERALLY FUNDED (0101 TO 1231) Year 2017 From 01012017 To 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
Program Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
Report Total
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CIE Service Units and Costs Projections - PSA Summary
PSA ALL Program CCE
Start Date 01012017 End Date 12312017
Avg High Low Total Total Avg High Low Provider Provider Provider
StateFederal Projected Reimbursement Reimbursement Reimbursement Cost Cost CostPSA
02
Service
CASE MANAGEMENT
Share
$4351066
Service Units
966
Unit Rate Unit Rate Unit Rate Per Unit Per Unit Per Unit
EMERGENCY HOME DELIVERED SHELF MEALS $1842200 1378
HOME DELIVERED MEALS $530262 993
MATERIAL AID $3989071 398
PSA Total $10712599 3735
05 ADULT DAY CARE $000 0 $900 $900 $900 $1000 $1000 $1000
COUNSELING (MENTAL HEALTH $000 0 $6600 $6600 $6600 $7700 $7700 $7700 COUNSELINGSCREENING) - INDIVIDUAL
PSA Total $000 0
Report Total $10712599 3735
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CAREGIVER SEARCH REPORT
SEARCH RESULTS FOR CONSUMERS
Criteria First Name Last Name SSN PSA ALL
Client Name Client SSN Caregiver Name Caregiver SSN
000000000 000000000 Test Name Test Name
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CARES Referrals in a Time Range PSA ALL
Start Date 01012017 End Date 12312017
Referred to ALL REFERRALS
Referring PSA Employee Name Client Name Client ID
Referral Imminent NH Admit Aging Date Risk Date Referred To Cares Provider Name Received Date
03A 4061561263 Test Name Test Name 09242017 Y 05292017 ARC or ADRC 09252017
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CARES Referrals in a Time Range PSA ALL
Start Date 01012017 End Date 12312017
Referred to ALL REFERRALS
Referring PSA Employee Name Client Name Client ID
Referral Date
Imminent Risk
NH Admit Date Referred To Cares Provider Name
Aging Received Date
04B Test Name Test Name 4061738075 04082017 N ARC or ADRC Test Name 04082017
Total Clients 110
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CARES Referrals not acknowledged by the Aging Network PSA ALL For Referrals after 01012017 Owner ID ALL Owners
Unduplicated Client count Cares Office Total Clients Count
Report Total
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
CIRTS Issue PSA Client ID Client Name Program
Program Status Start Provider Enrollment ID Provider Name
APCL CLIENT WITH DATE OF DEATH 08 4061759417 Test Name OA3B APCL 07232013 1141 WESTERN WORLD RADIO
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
Program Start Provider CIRTS Issue PSA Client ID Client Name Program Status Enrollment ID Provider Name
06 LTCC APCL 01242014 1514 4061713685 Test Name APCL CLIENT WITH DATE OF DEATH CENTRAL THE ORIGINAL HOUSE OF PIES
Count 503
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Civil Rights PSA ALL Provider ALL PROVIDERS Program AC Start Date 01012017 End Date 12312017 The Poverty Level for Single is The Poverty Level for Couple is Sort by County
County Unduplicated Count
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Client Information Report Start Date 01012017 End Date 12312017
Client ID 1001141246
Emergency
Client Name Test Name
Telephone () - Address 78 TEST STREET TALLAHASSEE FL 32399
Most Recent Caregiver Information Date Updated
Doctor
Comments
Client Demographic Information
Birth Date 06041940 Race W
Owner ID Ethnicity O
Most Recent Income Information
Ind Mon Inc Cpl Mon Inc
Ind Assets Couple Assets
Most Recent Assessment Information
Asmt Date Ref Risk Lvl
Asmt Site Spec Shel
AsmtType Spec Reg
Ref Date Primary CG
Ref Source Living Sit
Enrollment Information
Sex
Marital Status
F
S
Medicaid Number
ADL Score
ADL Count
IADL Score
IADL Count
Memory Score
Priority Score
Env Score
Nutr Score
Risk Score
Social Score
Rank
Provider Location Program Program Status Worker Start Date End Date
Care Plan Service Needed
Date Service Units Type Frq End Date
Care Plan Service Planned
Program Service Units Type Frq Start Date End Date
Services Received between 01012017 and 12312017
Service Billed Provider Location Worker Program Service Date Units Unit Type Amount
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Provider N
Client Service Units Report PSA ALL Provider ALL PROVIDERS Location 0000
Program ALL PROGRAMS Service ALL SERVICES Worker ALL WORKERS
City ALL CITIES Include Zero Unit N Include Aggregate N Calculated Amount equals the number of Units Provided times Fixed Cost if it existsService Start Date 01012017 Service End Date 12312017 If Fixed Cost does not exist Calculated
Group by PSA Provider Location Client Name County Worker Amount equals Billed Amount
Unduplicated Client Count 0 Grand Total 000 $000
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Clients In Common PSA All Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 County All Counties Worker All Workers
County JEFFERSON
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
MIAMI-DADE
0 0 0 0 0 0 0 0 0
4061539538 Test NameCounty Count
County
0 01
X
0 1
X
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
4061650856 Test Name X 4061486560 Test Name X 4062452921 Test Name X
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Clients Served Not Enrolled PSA ALL Start Date 01012017 End Date 12312017 Locations 0000 Provider All Providers
Service Service Min Serv Max Serv Program Start End Enrollment PSA Provider Location Program Consumer Name Client ID Service Date Date Status Enrollment Enrollment Provider
Count 0
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
4061472791 04
09
1092
1291
0072
0042
LTCC
LTCC
APCL
APCL
4062714543 06
06
1514
1762
0072
5006
LTCC
LTCC
APCL
APPL
4061802246 11
06
1177
1514
0179
0072
LTCC
LTCC
APCL
APCL
4061563719 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062644312 06
08
1514
1771
0072
0896
LTCC
LTCC
APCL
APCL
1001141670 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
1001141671 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
4062375003 07
05
05
07
1263
1755
1638
1263
0368
0072
0072
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062155124 06
06
1762
1514
0072
0072
LTCC
LTCC
APPL
APCL
4061743886 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0369
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4061499927 06
06
1514
1762
0072
5005
LTCC
LTCC
APCL
APPL
4061583524 08
06
1144
1514
0896
0072
LTCC
LTCC
APCL
APCL
4062694843 06
03
1514
1922
0072
0179
LTCC
LTCC
APCL
APCL
4062744517 07
06
1263
1514
0369
0072
LTCC
LTCC
APCL
APCL
4062005488 10
11
10
11
1929
1177
1164
1177
0072
0073
0179
0179
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
Total Count 15
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CODE DESCRIPTIONS Category ALL STATE TABLES
Code Description Active Available To Code Category
0 UNKNOWN Y CARES SUBJECTIVE_HEALTH_EVALUATION
01 ALACHUA Y COMMON COUNTIES
02 BAKER Y COMMON COUNTIES
03 BAY Y COMMON COUNTIES
04 BRADFORD Y COMMON COUNTIES
05 BREVARD Y COMMON COUNTIES
06 BROWARD Y COMMON COUNTIES
07 CALHOUN Y COMMON COUNTIES
08 CHARLOTTE Y COMMON COUNTIES
09 CITRUS Y COMMON COUNTIES
1 EXCELLENT Y CARES SUBJECTIVE_HEALTH_EVALUATION
10 CLAY Y COMMON COUNTIES
11 COLLIER Y COMMON COUNTIES
12 COLUMBIA Y COMMON COUNTIES
13 MIAMI-DADE Y COMMON COUNTIES
14 DESOTO Y COMMON COUNTIES
15 DIXIE Y COMMON COUNTIES
16 DUVAL Y COMMON COUNTIES
17 ESCAMBIA Y COMMON COUNTIES
18 FLAGLER Y COMMON COUNTIES
19 FRANKLIN Y COMMON COUNTIES
2 GOOD Y CARES SUBJECTIVE_HEALTH_EVALUATION
20 GADSDEN Y COMMON COUNTIES
21 GILCHRIST Y COMMON COUNTIES
22 GLADES Y COMMON COUNTIES
23 GULF Y COMMON COUNTIES
24 HAMILTON Y COMMON COUNTIES
25 HARDEE Y COMMON COUNTIES
26 HENDRY Y COMMON COUNTIES
27 HERNANDO Y COMMON COUNTIES
28 HIGHLANDS Y COMMON COUNTIES
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CONSUMER AGE VERIFICATION REPORT PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Program AC
Age at Start
Enroll or Start Enroll Provider Program Description Consumer Name Client ID DOB Svc date or Svc Date
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Contract Budget Information PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Program Service Provider Location County Served Provider Contract
Projected Service
Units Unit Measure
Projected Unduplicated
State Federal Share Client Count Begin Date End Date
Row Count 0 Amount Total
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Start Enroll Latest Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Date Asmt Date Worker
O3C1 1036 000 4061653427 Test CENTRAL 34982 W M 07091930 09102013 09102013 CIRTS20804 0 Name
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Start Enroll Date
Latest Asmt Date Worker
4061593624 Test Name CENTRAL 34946 B F 11261940 12012011 12312013 CIRTS23407
Count 164
Unduplicated Client Count 163
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Assessments After DOD Report
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Owner 1025
The shaded records indicate clients who have different DOBs andor different names
Assemt Current PSA Owner Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Owner Assessor
Provider Assessor
Assemt Date
Assemt Type
Unduplicated Count Total 0
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Open Enrollments
The Vital Statistics Data for 07192002 - 09112014PSA ALL Provider ALL Program Status ACTV Include MLTC ACTVS N
The shaded records indicate clients who have different DOBs andor different names
Enroll PSA
Enrollment Provider Loc Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Enroll Program Status
Enroll Program
Current Owner ID
02 1065 0072 4062244026 Test Name Test Name 10222004 03231917 03231917 ACTV CCE 1065
Count of enrollments for the Provider 1
Count of enrollments for the PSA 1
Count of enrollments for the Report 1
Unduplicated Count of Individuals with open enrollments and DOD PSA Total Clients Count
02 1
Total 1
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Unduplicated count of individuals with Services after DOD
PSA Total Clients Count
Report Total
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
List of Clients with PSA table entry for SERVICES_AFTER_DOD
Unduplicated Count Total 0
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Age
Provider
Total
Age lt 60 Age 60 - 64 Age 65 - 74 Age 75 - 84 Age 85+ Total Clients Avg Age
Total
Avg Age
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Ethnicity
Provider Hispanic Other Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Race
American Indian Native Hawaiian Other Provider Asian Alaska Native Black Pacific Islander Minority White Multiple Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Gender
Provider Male Female Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Monthly Income
Provider 0 - - Higher than Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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None
Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Total Persons Served 0
Age lt 60 Years 0 0
Age 60 - 64 0 0
Age 65 - 74 0 0
Age 75 - 84 0 0
Age 85+ 0 0
Total Age 0 0
Average 000
Ethnicity Hispanic 0 0
Other Ethnicity 0 0
Unknown Ethnicity 0 0
Total 0 0
Race Asian 0 0
American Indian Alaska Native 0 0
Black 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority 0 0
White 0 0
Multiple 0 0
Unknown 0 0
Total 0 0
Sex Male 0 0
Female 0 0
Unknown Sex 0 0
Total 0 0
Monthly Income 0 - 0 0
- 0 0
Higher than 0 0
Unknown 0 0
Total 0 0
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Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Client ID Date Of Birth Ethnicity Race Sex Individual Monthly Income
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Demographics of Clients OAA Registered Served Only PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 City All Cities Program All Programs Service All Services County ALL COUNTIES Table OAA Registered Services Only Low Income Medium Income
Total Persons Served 0
Agelt 60 Years
Age 60 - 64
Age 65 - 74
Age 75 - 84
Age 85+
0
0
0
0
0
0
0
0
0
0
Monthly Income
0 -
-Higher than
Unknown
0
0
0
0
0
0
0
0
Total
Average
0
000
0 Total 0 0
Ethnicity Hispanic
Other
Unknown
0
0
0
0
0
0
Living Situation
Alone
Null
Policy Change
0
0
0
0
0
0
Total 0 0 Unknown
With Caregiver
0
0
0
0
Race Asian 0 0
With Other
With Other Caregiver
0
0
0
0
American Indian Alaska Native
Black
0
0
0
0Total Living Situation 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority
White
0
0
0
0 Limited English Proficiency
Multiple
Unknown
Total Race
0
0
0
0
0
0
Yes
No
Unknown
0
0
0
0
0
0
Total 0 0
Sex Male
Female
Unknown
0
0
0
0
0
0
Total 0 0
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Disaster Assistance Clients for a Provider PSA ALL Provider All Providers Location 0000 Worker All Workers City All Cities Zip Code All Zip Codes Sort By ZIP
Provider 1036 Provider Name Location 0000 Worker CIRTS18634
Need Care Client Name Address City Zip County Phone Asst Reg Situation Relat Care phone Care Name
34946 N WO DA 000 SAINT JAMES DRIVE CENTRAL (025) 101-0620 Test NameTest Name SAINT LUCIE (005) 100-0369 Y
Client is active and no assessment information is available Special Shelter and Special Registry are unknown
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
Total by PSA 0
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
ALACH BAKER BAY BRADF BREVA BROWA CALHO CHARL CITRUS CLAY COLLIE COLUM DESOT DIXIE DUVAL ESCAM FLAGL FRANK GADSDAssisted Household Report UA ORD RD RD UN OTTE R BIA O BIA ER LIN EN
1 of Household Assisted 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Households AssistedWith Gross Income
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C 100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D 125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
3 Households with at leastOne member
A 60 Years or older 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B Disabled 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C Age 5 years or under 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D Under 60 Years Old 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Undup Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Assisted
Applicant Household Report
of Applicant Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Energy Assisted Household Report
County of Assisted
Households
Households Assisted By Poverty Level
Under 75 75 - 100 101 - 125 126 - 150 Over 150 60 Years or older
At least one member who is
Age 5 years Age 2 years Age 3 years Disabled or younger and younger through 5
Under 60 Years Old
Undup Households
Assisted
Energy Assistance Total
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Unduplicated Total 0 0
County of Assisted
Households Under 75 75 - 100
Households Assisted By Poverty Level
101 - 125 126 - 150 Over 150 60 Years or older Disabled
Age 5 years or younger
Age 2 years and younger
Age 3 years through 5
Under 60 Years Old
At least one member who is
Undup Households
Assisted
Other Assisted Household Report
Other Assistance Total
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Applicant Household Report
County of Applicant
Households Under 75 75 - 100 101 - 125 126 - 150 Over 150 Income data
unavailable
Total 0
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01
Enrollment Active Consumer Count by Program PSA ALL Provider ALL PROVIDERS
County Description Program Count of Clients
BREVARD
ADI
CCE
HCE
LSP
NDP
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
MLTC
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
31
57
44
5
62
123
141
26
9
7
5
40
5
50
67
129
2
19
42
29
1
233
79
63
8
2
14
3
37
14
47
3
3
33
127
10
02
03
04
ALACHUA
BAKER
BAY
BRADFORD
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Enrollment Terminations with Reasons PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 Program All Programs Program Status ALL Program Status Worker ALL WORKERS
Last First Program Medicaid Provider Start End Name Name Client ID Status Description Worker Number Program Location Enrollment Enrollment
Count 0
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Enrollments with Care Plan Report
PSA ALL Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTIVE STATUS Care Plan Service ALL SERVICES Care Plan Start 01012017 Care Plan End 12312017
Care Plan Care Plan Care Plan Client Name
Unduplicated Client Count 0
Client ID Program Status Worker Start Date End Date Service
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PSA CLIENT_ID CLIENT_NAME OWNER PROVIDER_ID ASSESSMENT_DATE ASSESSOR_NAME MEDICAID_NUMBER CAREGIVER_CHANGE ENVIRONMENT_CHANGE HEALTH_CHANGE INCOME_CHANGE SITUATION_CHANGE INITIAL_ASSM ANNUAL_ASSM SSN REFERRAL_SOURCE 1114 N N N N Y N 771771777 SELFFAMILY 812017 JANE CASEWORKER 2 1001141633 TEST TEST N
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Fixed Service Costs List PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Provider Location County Program Service Reimbursement Unit Rate Provider Cost Per Unit Begin Valid End Valid
Count 0
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Aging Network Providers Report PSA ALL
PSA 01
Provider 1271 Provider Name Provider Name
Location 0000 Location Name Provider Name
Location Business Address 3123 Test Drive DARRINGTON FL 58398
County Served OKALOOSA Phone Fax Location Contact
Provider Director Provider Profit Status Non-Profit
ACCESS_PT CCE_LA N HCE OAA OTHER
ADI EHEAP LSP RELF
CCE Y FOCAL_PT NSIP SR_CTR
Provider 1271 Provider Name Provider Name
Location 0001 Location Name Provider Name
Location Business Address 1234 Test OAK DRIVE SUNNYVALE MO 83407
Phone Fax Location Contact County Served OKALOOSA
Provider Director Provider Profit Status Non-Profit
ACCESS_PT CCE_LA N HCE OAA OTHER
ADI EHEAP LSP RELF
CCE Y FOCAL_PT NSIP SR_CTR
Provider 1271 Provider Name Provider Name
Location 0004 Location Name Provider Name
Location Business Address 1123 Test HEAVENS WAY MORRISONS CROSSROADS AL
33165 Phone County Served OKALOOSA Fax Location Contact
Provider Director Provider Profit Status Non-Profit
ACCESS_PT CCE_LA N HCE Y OAA OTHER
ADI EHEAP LSP RELF
CCE FOCAL_PT NSIP SR_CTR
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Start End Worker Most Recent Nutr Medicaid Program Provider Location Client ID Client Name Status Enrollment Enrollment Worker Active Score Number
O3C1 1036 0000 4061653427 Test Name ACTV 09102013 CIRTS20804 Y 1
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Start End Worker Most Recent Nutr Medicaid Program Provider Location Client ID Client Name Status Enrollment Enrollment Worker Active Score Number
O3C1 1036 0000 4061638016 Test Name ACTV 09122013 CIRTS20804 Y 2
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Start End Worker Most Recent Nutr Medicaid Program Provider Location Client ID Client Name Status Enrollment Enrollment Worker Active Score Number
O3C2 1036 0000 4062000152 Test Name ACTV 02072011 CIRTS23407 N 3
1036 0000 4061594062 ISAACS HATTIE ACTV 11192012 CIRTS20804 Y 5
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Start End Worker Most Recent Nutr Medicaid Program Provider Location Client ID Client Name Status Enrollment Enrollment Worker Active Score Number
O3C2 1036 0000 4062379505 Test Name ACTV 11192012 CIRTS20804 Y 5
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Start End Worker Most Recent Nutr Medicaid Program Provider Location Client ID Client Name Status Enrollment Enrollment Worker Active Score Number
O3C2 1036 0000 4062401063 Test Name ACTV 10162013 CIRTS20804 Y 3
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Provider Location Client ID Client Name Program Status
Start Enrollment
End Enrollment Worker
Worker Active
Most Recent Nutr Score
Medicaid Number
O3C2 1036 0000 4062538939 ACTV 12082000 CIRTS20388 Y Test Name
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All Enrollments Counts During Date Range PSA ALL Start Date 01012017 End Date Location 0000 Provider Program Program Status
12312017 ALL PROVIDERS
ACTV
Group By Program Provider Location
Program Provider Location Client Count O3C1 1036 0000 45
1951 0000 3
O3C2 1036 0000 113
OA3E 1821 0000 2
OA3ES 1821 0000 1
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C1 1036 0000 4061950299 Test Name ACTV 04072011 CIRTS23407 N 11
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C1 1036 4062586019 Test Name ACTV 12292008 CIRTS23407 N 1
Total for Location 45
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C1 1951 0000 4062452921 Test Name ACTV 03301989 CIRTS22695 N 10
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4062786256 Test Name ACTV 09232013 CIRTS20804 Y 4 1
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4062380426 Test Name ACTV 04112012 CIRTS23407 N 55 2
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4061608826 Test Name ACTV 08102011 CIRTS18634 Y 7 3
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4062615533 Test Name ACTV 10032013 CIRTS20804 Y 6 3
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start Enrollment
End Enrollment Worker
Worker Active
Medicaid Number
Most Recent Nutr Score Rank
O3C2 1036 4062466582 Test Name ACTV 10262010 CIRTS23407 N 105 2
Total for Location 113
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PSA
APCL Clients With No Services ALL Owner All Owners Provider ALL PROVIDERS
Start Date 01012017 End Date 12312017
Includes Clients Receiving Only CM INSC SCAS CA REFE Services
PSA Client ID Client Name Owner Provider Program
Count 0
Unduplicated Clients Count 0
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APCL Clients With Services PSA ALL Owner All Owners Provider ALL PROVIDERS Start Date 01012017 End Date 12312017
Exclude CM CA INSC REFE SCAS
PSA Client ID Name Owner Provider Program 10 4062527553 Test Name 1539 1929 CCE
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APCL Clients With Services PSA ALL Owner All Owners Provider ALL PROVIDERS Start Date 01012017 End Date 12312017
Exclude CM CA INSC REFE SCAS
PSA Client ID Name Owner Provider Program 11 4062732638 Test Name 1177 1177 LTCC
Total 21067
Unduplicated clients count 12460
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APS Assessments PSA ALL Risk Level ALL Owner All Owners Referral Date From 01012017 To 12312017
Order by Referral Date and Owner ID
PSA 03
Ref Date Owner ID Client ID Client Name Risk Level Asmt Type Asmt Date
03032017 1390 4062058415 L 701A 03302018 Test Name
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APS Assessments PSA ALL Risk Level ALL Owner All Owners Referral Date From 01012017 To 12312017
Order by Referral Date and Owner ID
12042017 1980 4061617559 H 701B 12072017 Test Name
Assessment Count for the PSA 52
PSA 04A
Ref Date Owner ID Client ID
09102017 4062308458
Client Name
Test Name
Risk Level
H
Asmt Type
O
Asmt Date
09162017
Assessment Count for the PSA 2
Risk Level H
M
L
Count of Assessments 138
23
21
Total Count of Assessments 182
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APS Repeat Referrals in a Time Range
PSA ALL Owner All Owners
Start Date 01012017 End Date 12312017
Current DOEA CIRTS Cirts SSN if Risk Date Created PSA Owner Abuse No different than DCF DCF SSN Name County Level Date of Birth Date Sent by DCF
Count 0
Unduplicated Client Count by PSA
PSA Count SSN
Total
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Assessed Prioritized Consumer List PSA ALL Provider ALL PROVIDERS Program AC County ALL COUNTIES
County Program Consumer Name Client ID
Total Count 0
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Assessment Due Report PSA 01 Start Date 01012017 End Date 08312018 Owner ALL PROVIDERS Worker ALL WORKERS Program Status ACTV and APCL Assessment Type Needed ALL
Overdue and missing assessments are always listed
Owner ID 1065
Client ID Client Name
Owner Assessor ID
Date of Birth
06281928
CIRTS28099
County of Service
GULF
Worker Name HARPER KENNY
Zip Assessment PSA Date
32534 01 01022014
Type
701A
Active Y
Nutr PriorityScore Score
11 58
Rank
5
Due Date
01022015
Status
701S OVERDUE
LTCC APPL Start Date
03252014 4062235673 Test name
Total Clients for Worker 1
Total Clients for Owner 1
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Assessment Due Report PSA 01 Start Date 01012017 End Date 08312018 Owner ALL PROVIDERS Worker ALL WORKERS Program Status ACTV and APCL Assessment Type Needed ALL
Overdue and missing assessments are always listed
Summary by PSA
PSA 01 701A Overdue 1
701B Overdue 213
701C Overdue 0
701S Overdue 157
No 701A 0
No 701B 2
No 701C 0
No 701S 0
701A Not Overdue 0
701B Not Overdue 0
701C Not Overdue 0
701S Not Overdue 0
701S Optional 0
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CIC Service Units and Costs Projections County SummaryPSA 99 Program CCE
Start Date 01012017 End Date 12312017
County LEON
Total Total Total Avg Max Projected
StateFederal Projected Reimbursement Provider Unduplicated Provider Service Share Service Units Unit Rate Cost Per Unit Client Count
Report Total
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CIC Service Units and Costs Projections Provider SummaryPSA ALL Provider ALL PROVIDERS Program FEDERALLY FUNDED (0101 TO 1231) Year 2017 From 01012017 To 12312017
PSA County Program Service Total State
Federal Share
Total Projected
Service Units
Avg Reimbursement
Unit Rate
Max Provider
Cost Per Unit
Total Projected Unduplicated Client Count
02 FRANKLIN O3C1 CONGREGATE MEALS $810300 1710 15
Program Total
County Total
$810300
$810300
GULF O3C1 CONGREGATE MEALS $25205 3 5
Program Total $25205
O3C2 HOME DELIVERED MEALS $25205 3 6
Program Total
County Total
$25205
$50411
LEON O3C1 CONGREGATE MEALS $621300 1311 15
CONGREGATE MEALS GUEST
CONGREGATE MEALS VOLUNTEERS
$252055
$277260
25
30
2
5
Program Total $1150615
O3C2 HOME DELIVERED MEAL GUEST $252055 25 3
Program Total $252055
OA3D PEARLS (SESSION 5)
PEARLS (SESSION 6)
PEARLS (SESSION 7)
PEARLS (SESSION 8)
$10247
$10247
$10247
$10247
10
10
10
10
3
3
3
3
Program Total $40988
OA3E RESPITE IN-HOME $200 2 2
Program Total
County Total
$200
$1443858
WAKULLA O3C2 EMERGENCY HOME DELIVERED SHELF MEALS
$8065604 14899 90
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CIC Service Units and Costs Projections - PSA Summary
PSA ALL Program CCE
Strat Date 01012017 End Date 12312017
Total
PSA County Provider Service
Total State Federal
Share
Total Projected
Service Units
Avg Reimbursement
Unit Rate
Max Projected Provider Unduplicated
Cost Per Unit Client Count
02 LEON SOUTHERN SERVICE CASE MANAGEMENT PROVIDER EMERGENCY HOME DELIVERED SHELF MEALS
$2175533
$602000
483
689
32
20
HOME DELIVERED MEALS $530262 993 5
MATERIAL AID $1994536 199
Provider Total $5302331
CountyTotal $5302331
WAKULLA SOUTHERN SERVICE CASE MANAGEMENT PROVIDER EMERGENCY HOME DELIVERED SHELF MEALS
$2175533
$1240200
483
689
32
5
MATERIAL AID $1994536 199
Provider Total $5410269
CountyTotal $5410269
PSA Total $10712599
05 PINELLAS BURSTEIN-APPLEBEE ADULT DAY CARE $000 0 $900 $1000 0
COUNSELING (MENTAL HEALTH COUNSELINGSCREENING) - INDIVIDUAL
Provider Total
$000
$000
0 $6600 $7700 0
CountyTotal $000
PSA Total $000
Report Total $10712599
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CID Service Units and Costs Projections - PSA SummaryPSA ALL Program CCE
Start Date 01012017 End Date 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
PSA County Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
02 LEON CASE MANAGEMENT $2175533 483
EMERGENCY HOME $602000 689DELIVERED SHELF MEALS HOME DELIVERED MEALS $530262 993
MATERIAL AID $1994536 199
County Total $5302331 2364
WAKULLA CASE MANAGEMENT $2175533 483
EMERGENCY HOME $1240200 689DELIVERED SHELF MEALS MATERIAL AID $1994536 199
County Total $5410269 1371
PSA Total $10712599 3735
05 PINELLAS ADULT DAY CARE $000 0
COUNSELING (MENTAL $000 0 HEALTH COUNSELINGSCREENING) - INDIVIDUAL
County Total $000 0
PSA Total $000 0
Report Total $10712599 3735
$900 $900 $900 $1000 $1000 $1000
$6600 $6600 $6600 $7700 $7700 $7700
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CID Service Units and Costs Projections County SummaryPSA 99
Program CCE County LEON
Start Date 01012017 End Date 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
Report Total
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CIE Service Units and Costs Projections - PSA Summary - All Programs
PSA 99 Program FEDERALLY FUNDED (0101 TO 1231) Year 2017 From 01012017 To 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
Program Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
Report Total
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CIE Service Units and Costs Projections - PSA Summary
PSA ALL Program CCE
Start Date 01012017 End Date 12312017
Avg High Low Total Total Avg High Low Provider Provider Provider
StateFederal Projected Reimbursement Reimbursement Reimbursement Cost Cost CostPSA
02
Service
CASE MANAGEMENT
Share
$4351066
Service Units
966
Unit Rate Unit Rate Unit Rate Per Unit Per Unit Per Unit
EMERGENCY HOME DELIVERED SHELF MEALS $1842200 1378
HOME DELIVERED MEALS $530262 993
MATERIAL AID $3989071 398
PSA Total $10712599 3735
05 ADULT DAY CARE $000 0 $900 $900 $900 $1000 $1000 $1000
COUNSELING (MENTAL HEALTH $000 0 $6600 $6600 $6600 $7700 $7700 $7700 COUNSELINGSCREENING) - INDIVIDUAL
PSA Total $000 0
Report Total $10712599 3735
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CAREGIVER SEARCH REPORT
SEARCH RESULTS FOR CONSUMERS
Criteria First Name Last Name SSN PSA ALL
Client Name Client SSN Caregiver Name Caregiver SSN
000000000 000000000 Test Name Test Name
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CARES Referrals in a Time Range PSA ALL
Start Date 01012017 End Date 12312017
Referred to ALL REFERRALS
Referring PSA Employee Name Client Name Client ID
Referral Imminent NH Admit Aging Date Risk Date Referred To Cares Provider Name Received Date
03A 4061561263 Test Name Test Name 09242017 Y 05292017 ARC or ADRC 09252017
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CARES Referrals in a Time Range PSA ALL
Start Date 01012017 End Date 12312017
Referred to ALL REFERRALS
Referring PSA Employee Name Client Name Client ID
Referral Date
Imminent Risk
NH Admit Date Referred To Cares Provider Name
Aging Received Date
04B Test Name Test Name 4061738075 04082017 N ARC or ADRC Test Name 04082017
Total Clients 110
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CARES Referrals not acknowledged by the Aging Network PSA ALL For Referrals after 01012017 Owner ID ALL Owners
Unduplicated Client count Cares Office Total Clients Count
Report Total
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
CIRTS Issue PSA Client ID Client Name Program
Program Status Start Provider Enrollment ID Provider Name
APCL CLIENT WITH DATE OF DEATH 08 4061759417 Test Name OA3B APCL 07232013 1141 WESTERN WORLD RADIO
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
Program Start Provider CIRTS Issue PSA Client ID Client Name Program Status Enrollment ID Provider Name
06 LTCC APCL 01242014 1514 4061713685 Test Name APCL CLIENT WITH DATE OF DEATH CENTRAL THE ORIGINAL HOUSE OF PIES
Count 503
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Civil Rights PSA ALL Provider ALL PROVIDERS Program AC Start Date 01012017 End Date 12312017 The Poverty Level for Single is The Poverty Level for Couple is Sort by County
County Unduplicated Count
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Client Information Report Start Date 01012017 End Date 12312017
Client ID 1001141246
Emergency
Client Name Test Name
Telephone () - Address 78 TEST STREET TALLAHASSEE FL 32399
Most Recent Caregiver Information Date Updated
Doctor
Comments
Client Demographic Information
Birth Date 06041940 Race W
Owner ID Ethnicity O
Most Recent Income Information
Ind Mon Inc Cpl Mon Inc
Ind Assets Couple Assets
Most Recent Assessment Information
Asmt Date Ref Risk Lvl
Asmt Site Spec Shel
AsmtType Spec Reg
Ref Date Primary CG
Ref Source Living Sit
Enrollment Information
Sex
Marital Status
F
S
Medicaid Number
ADL Score
ADL Count
IADL Score
IADL Count
Memory Score
Priority Score
Env Score
Nutr Score
Risk Score
Social Score
Rank
Provider Location Program Program Status Worker Start Date End Date
Care Plan Service Needed
Date Service Units Type Frq End Date
Care Plan Service Planned
Program Service Units Type Frq Start Date End Date
Services Received between 01012017 and 12312017
Service Billed Provider Location Worker Program Service Date Units Unit Type Amount
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Provider N
Client Service Units Report PSA ALL Provider ALL PROVIDERS Location 0000
Program ALL PROGRAMS Service ALL SERVICES Worker ALL WORKERS
City ALL CITIES Include Zero Unit N Include Aggregate N Calculated Amount equals the number of Units Provided times Fixed Cost if it existsService Start Date 01012017 Service End Date 12312017 If Fixed Cost does not exist Calculated
Group by PSA Provider Location Client Name County Worker Amount equals Billed Amount
Unduplicated Client Count 0 Grand Total 000 $000
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Clients In Common PSA All Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 County All Counties Worker All Workers
County JEFFERSON
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
MIAMI-DADE
0 0 0 0 0 0 0 0 0
4061539538 Test NameCounty Count
County
0 01
X
0 1
X
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
4061650856 Test Name X 4061486560 Test Name X 4062452921 Test Name X
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Clients Served Not Enrolled PSA ALL Start Date 01012017 End Date 12312017 Locations 0000 Provider All Providers
Service Service Min Serv Max Serv Program Start End Enrollment PSA Provider Location Program Consumer Name Client ID Service Date Date Status Enrollment Enrollment Provider
Count 0
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
4061472791 04
09
1092
1291
0072
0042
LTCC
LTCC
APCL
APCL
4062714543 06
06
1514
1762
0072
5006
LTCC
LTCC
APCL
APPL
4061802246 11
06
1177
1514
0179
0072
LTCC
LTCC
APCL
APCL
4061563719 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062644312 06
08
1514
1771
0072
0896
LTCC
LTCC
APCL
APCL
1001141670 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
1001141671 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
4062375003 07
05
05
07
1263
1755
1638
1263
0368
0072
0072
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062155124 06
06
1762
1514
0072
0072
LTCC
LTCC
APPL
APCL
4061743886 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0369
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4061499927 06
06
1514
1762
0072
5005
LTCC
LTCC
APCL
APPL
4061583524 08
06
1144
1514
0896
0072
LTCC
LTCC
APCL
APCL
4062694843 06
03
1514
1922
0072
0179
LTCC
LTCC
APCL
APCL
4062744517 07
06
1263
1514
0369
0072
LTCC
LTCC
APCL
APCL
4062005488 10
11
10
11
1929
1177
1164
1177
0072
0073
0179
0179
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
Total Count 15
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CODE DESCRIPTIONS Category ALL STATE TABLES
Code Description Active Available To Code Category
0 UNKNOWN Y CARES SUBJECTIVE_HEALTH_EVALUATION
01 ALACHUA Y COMMON COUNTIES
02 BAKER Y COMMON COUNTIES
03 BAY Y COMMON COUNTIES
04 BRADFORD Y COMMON COUNTIES
05 BREVARD Y COMMON COUNTIES
06 BROWARD Y COMMON COUNTIES
07 CALHOUN Y COMMON COUNTIES
08 CHARLOTTE Y COMMON COUNTIES
09 CITRUS Y COMMON COUNTIES
1 EXCELLENT Y CARES SUBJECTIVE_HEALTH_EVALUATION
10 CLAY Y COMMON COUNTIES
11 COLLIER Y COMMON COUNTIES
12 COLUMBIA Y COMMON COUNTIES
13 MIAMI-DADE Y COMMON COUNTIES
14 DESOTO Y COMMON COUNTIES
15 DIXIE Y COMMON COUNTIES
16 DUVAL Y COMMON COUNTIES
17 ESCAMBIA Y COMMON COUNTIES
18 FLAGLER Y COMMON COUNTIES
19 FRANKLIN Y COMMON COUNTIES
2 GOOD Y CARES SUBJECTIVE_HEALTH_EVALUATION
20 GADSDEN Y COMMON COUNTIES
21 GILCHRIST Y COMMON COUNTIES
22 GLADES Y COMMON COUNTIES
23 GULF Y COMMON COUNTIES
24 HAMILTON Y COMMON COUNTIES
25 HARDEE Y COMMON COUNTIES
26 HENDRY Y COMMON COUNTIES
27 HERNANDO Y COMMON COUNTIES
28 HIGHLANDS Y COMMON COUNTIES
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CONSUMER AGE VERIFICATION REPORT PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Program AC
Age at Start
Enroll or Start Enroll Provider Program Description Consumer Name Client ID DOB Svc date or Svc Date
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Contract Budget Information PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Program Service Provider Location County Served Provider Contract
Projected Service
Units Unit Measure
Projected Unduplicated
State Federal Share Client Count Begin Date End Date
Row Count 0 Amount Total
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Start Enroll Latest Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Date Asmt Date Worker
O3C1 1036 000 4061653427 Test CENTRAL 34982 W M 07091930 09102013 09102013 CIRTS20804 0 Name
Report run on 08312018 1133 AM Page 1 of 6 actv_by_progrdf
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Start Enroll Date
Latest Asmt Date Worker
4061593624 Test Name CENTRAL 34946 B F 11261940 12012011 12312013 CIRTS23407
Count 164
Unduplicated Client Count 163
Report run on 08312018 1133 AM Page 6 of 6 actv_by_progrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Assessments After DOD Report
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Owner 1025
The shaded records indicate clients who have different DOBs andor different names
Assemt Current PSA Owner Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Owner Assessor
Provider Assessor
Assemt Date
Assemt Type
Unduplicated Count Total 0
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Open Enrollments
The Vital Statistics Data for 07192002 - 09112014PSA ALL Provider ALL Program Status ACTV Include MLTC ACTVS N
The shaded records indicate clients who have different DOBs andor different names
Enroll PSA
Enrollment Provider Loc Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Enroll Program Status
Enroll Program
Current Owner ID
02 1065 0072 4062244026 Test Name Test Name 10222004 03231917 03231917 ACTV CCE 1065
Count of enrollments for the Provider 1
Count of enrollments for the PSA 1
Count of enrollments for the Report 1
Unduplicated Count of Individuals with open enrollments and DOD PSA Total Clients Count
02 1
Total 1
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Unduplicated count of individuals with Services after DOD
PSA Total Clients Count
Report Total
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
List of Clients with PSA table entry for SERVICES_AFTER_DOD
Unduplicated Count Total 0
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Age
Provider
Total
Age lt 60 Age 60 - 64 Age 65 - 74 Age 75 - 84 Age 85+ Total Clients Avg Age
Total
Avg Age
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Ethnicity
Provider Hispanic Other Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Race
American Indian Native Hawaiian Other Provider Asian Alaska Native Black Pacific Islander Minority White Multiple Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Gender
Provider Male Female Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Monthly Income
Provider 0 - - Higher than Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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None
Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Total Persons Served 0
Age lt 60 Years 0 0
Age 60 - 64 0 0
Age 65 - 74 0 0
Age 75 - 84 0 0
Age 85+ 0 0
Total Age 0 0
Average 000
Ethnicity Hispanic 0 0
Other Ethnicity 0 0
Unknown Ethnicity 0 0
Total 0 0
Race Asian 0 0
American Indian Alaska Native 0 0
Black 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority 0 0
White 0 0
Multiple 0 0
Unknown 0 0
Total 0 0
Sex Male 0 0
Female 0 0
Unknown Sex 0 0
Total 0 0
Monthly Income 0 - 0 0
- 0 0
Higher than 0 0
Unknown 0 0
Total 0 0
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Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Client ID Date Of Birth Ethnicity Race Sex Individual Monthly Income
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Demographics of Clients OAA Registered Served Only PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 City All Cities Program All Programs Service All Services County ALL COUNTIES Table OAA Registered Services Only Low Income Medium Income
Total Persons Served 0
Agelt 60 Years
Age 60 - 64
Age 65 - 74
Age 75 - 84
Age 85+
0
0
0
0
0
0
0
0
0
0
Monthly Income
0 -
-Higher than
Unknown
0
0
0
0
0
0
0
0
Total
Average
0
000
0 Total 0 0
Ethnicity Hispanic
Other
Unknown
0
0
0
0
0
0
Living Situation
Alone
Null
Policy Change
0
0
0
0
0
0
Total 0 0 Unknown
With Caregiver
0
0
0
0
Race Asian 0 0
With Other
With Other Caregiver
0
0
0
0
American Indian Alaska Native
Black
0
0
0
0Total Living Situation 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority
White
0
0
0
0 Limited English Proficiency
Multiple
Unknown
Total Race
0
0
0
0
0
0
Yes
No
Unknown
0
0
0
0
0
0
Total 0 0
Sex Male
Female
Unknown
0
0
0
0
0
0
Total 0 0
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Disaster Assistance Clients for a Provider PSA ALL Provider All Providers Location 0000 Worker All Workers City All Cities Zip Code All Zip Codes Sort By ZIP
Provider 1036 Provider Name Location 0000 Worker CIRTS18634
Need Care Client Name Address City Zip County Phone Asst Reg Situation Relat Care phone Care Name
34946 N WO DA 000 SAINT JAMES DRIVE CENTRAL (025) 101-0620 Test NameTest Name SAINT LUCIE (005) 100-0369 Y
Client is active and no assessment information is available Special Shelter and Special Registry are unknown
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
Total by PSA 0
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
ALACH BAKER BAY BRADF BREVA BROWA CALHO CHARL CITRUS CLAY COLLIE COLUM DESOT DIXIE DUVAL ESCAM FLAGL FRANK GADSDAssisted Household Report UA ORD RD RD UN OTTE R BIA O BIA ER LIN EN
1 of Household Assisted 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Households AssistedWith Gross Income
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C 100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D 125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
3 Households with at leastOne member
A 60 Years or older 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B Disabled 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C Age 5 years or under 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D Under 60 Years Old 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Undup Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Assisted
Applicant Household Report
of Applicant Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Energy Assisted Household Report
County of Assisted
Households
Households Assisted By Poverty Level
Under 75 75 - 100 101 - 125 126 - 150 Over 150 60 Years or older
At least one member who is
Age 5 years Age 2 years Age 3 years Disabled or younger and younger through 5
Under 60 Years Old
Undup Households
Assisted
Energy Assistance Total
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Unduplicated Total 0 0
County of Assisted
Households Under 75 75 - 100
Households Assisted By Poverty Level
101 - 125 126 - 150 Over 150 60 Years or older Disabled
Age 5 years or younger
Age 2 years and younger
Age 3 years through 5
Under 60 Years Old
At least one member who is
Undup Households
Assisted
Other Assisted Household Report
Other Assistance Total
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Applicant Household Report
County of Applicant
Households Under 75 75 - 100 101 - 125 126 - 150 Over 150 Income data
unavailable
Total 0
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01
Enrollment Active Consumer Count by Program PSA ALL Provider ALL PROVIDERS
County Description Program Count of Clients
BREVARD
ADI
CCE
HCE
LSP
NDP
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
MLTC
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
31
57
44
5
62
123
141
26
9
7
5
40
5
50
67
129
2
19
42
29
1
233
79
63
8
2
14
3
37
14
47
3
3
33
127
10
02
03
04
ALACHUA
BAKER
BAY
BRADFORD
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Enrollment Terminations with Reasons PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 Program All Programs Program Status ALL Program Status Worker ALL WORKERS
Last First Program Medicaid Provider Start End Name Name Client ID Status Description Worker Number Program Location Enrollment Enrollment
Count 0
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Enrollments with Care Plan Report
PSA ALL Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTIVE STATUS Care Plan Service ALL SERVICES Care Plan Start 01012017 Care Plan End 12312017
Care Plan Care Plan Care Plan Client Name
Unduplicated Client Count 0
Client ID Program Status Worker Start Date End Date Service
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PSA CLIENT_ID CLIENT_NAME OWNER PROVIDER_ID ASSESSMENT_DATE ASSESSOR_NAME MEDICAID_NUMBER CAREGIVER_CHANGE ENVIRONMENT_CHANGE HEALTH_CHANGE INCOME_CHANGE SITUATION_CHANGE INITIAL_ASSM ANNUAL_ASSM SSN REFERRAL_SOURCE 1114 N N N N Y N 771771777 SELFFAMILY 812017 JANE CASEWORKER 2 1001141633 TEST TEST N
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Fixed Service Costs List PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Provider Location County Program Service Reimbursement Unit Rate Provider Cost Per Unit Begin Valid End Valid
Count 0
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Start End Worker Most Recent Nutr Medicaid Program Provider Location Client ID Client Name Status Enrollment Enrollment Worker Active Score Number
O3C1 1036 0000 4061653427 Test Name ACTV 09102013 CIRTS20804 Y 1
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Start End Worker Most Recent Nutr Medicaid Program Provider Location Client ID Client Name Status Enrollment Enrollment Worker Active Score Number
O3C1 1036 0000 4061638016 Test Name ACTV 09122013 CIRTS20804 Y 2
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Start End Worker Most Recent Nutr Medicaid Program Provider Location Client ID Client Name Status Enrollment Enrollment Worker Active Score Number
O3C2 1036 0000 4062000152 Test Name ACTV 02072011 CIRTS23407 N 3
1036 0000 4061594062 ISAACS HATTIE ACTV 11192012 CIRTS20804 Y 5
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Start End Worker Most Recent Nutr Medicaid Program Provider Location Client ID Client Name Status Enrollment Enrollment Worker Active Score Number
O3C2 1036 0000 4062379505 Test Name ACTV 11192012 CIRTS20804 Y 5
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Start End Worker Most Recent Nutr Medicaid Program Provider Location Client ID Client Name Status Enrollment Enrollment Worker Active Score Number
O3C2 1036 0000 4062401063 Test Name ACTV 10162013 CIRTS20804 Y 3
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Provider Location Client ID Client Name Program Status
Start Enrollment
End Enrollment Worker
Worker Active
Most Recent Nutr Score
Medicaid Number
O3C2 1036 0000 4062538939 ACTV 12082000 CIRTS20388 Y Test Name
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All Enrollments Counts During Date Range PSA ALL Start Date 01012017 End Date Location 0000 Provider Program Program Status
12312017 ALL PROVIDERS
ACTV
Group By Program Provider Location
Program Provider Location Client Count O3C1 1036 0000 45
1951 0000 3
O3C2 1036 0000 113
OA3E 1821 0000 2
OA3ES 1821 0000 1
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C1 1036 0000 4061950299 Test Name ACTV 04072011 CIRTS23407 N 11
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C1 1036 4062586019 Test Name ACTV 12292008 CIRTS23407 N 1
Total for Location 45
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C1 1951 0000 4062452921 Test Name ACTV 03301989 CIRTS22695 N 10
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4062786256 Test Name ACTV 09232013 CIRTS20804 Y 4 1
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4062380426 Test Name ACTV 04112012 CIRTS23407 N 55 2
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4061608826 Test Name ACTV 08102011 CIRTS18634 Y 7 3
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4062615533 Test Name ACTV 10032013 CIRTS20804 Y 6 3
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start Enrollment
End Enrollment Worker
Worker Active
Medicaid Number
Most Recent Nutr Score Rank
O3C2 1036 4062466582 Test Name ACTV 10262010 CIRTS23407 N 105 2
Total for Location 113
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PSA
APCL Clients With No Services ALL Owner All Owners Provider ALL PROVIDERS
Start Date 01012017 End Date 12312017
Includes Clients Receiving Only CM INSC SCAS CA REFE Services
PSA Client ID Client Name Owner Provider Program
Count 0
Unduplicated Clients Count 0
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APCL Clients With Services PSA ALL Owner All Owners Provider ALL PROVIDERS Start Date 01012017 End Date 12312017
Exclude CM CA INSC REFE SCAS
PSA Client ID Name Owner Provider Program 10 4062527553 Test Name 1539 1929 CCE
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APCL Clients With Services PSA ALL Owner All Owners Provider ALL PROVIDERS Start Date 01012017 End Date 12312017
Exclude CM CA INSC REFE SCAS
PSA Client ID Name Owner Provider Program 11 4062732638 Test Name 1177 1177 LTCC
Total 21067
Unduplicated clients count 12460
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APS Assessments PSA ALL Risk Level ALL Owner All Owners Referral Date From 01012017 To 12312017
Order by Referral Date and Owner ID
PSA 03
Ref Date Owner ID Client ID Client Name Risk Level Asmt Type Asmt Date
03032017 1390 4062058415 L 701A 03302018 Test Name
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APS Assessments PSA ALL Risk Level ALL Owner All Owners Referral Date From 01012017 To 12312017
Order by Referral Date and Owner ID
12042017 1980 4061617559 H 701B 12072017 Test Name
Assessment Count for the PSA 52
PSA 04A
Ref Date Owner ID Client ID
09102017 4062308458
Client Name
Test Name
Risk Level
H
Asmt Type
O
Asmt Date
09162017
Assessment Count for the PSA 2
Risk Level H
M
L
Count of Assessments 138
23
21
Total Count of Assessments 182
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APS Repeat Referrals in a Time Range
PSA ALL Owner All Owners
Start Date 01012017 End Date 12312017
Current DOEA CIRTS Cirts SSN if Risk Date Created PSA Owner Abuse No different than DCF DCF SSN Name County Level Date of Birth Date Sent by DCF
Count 0
Unduplicated Client Count by PSA
PSA Count SSN
Total
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Assessed Prioritized Consumer List PSA ALL Provider ALL PROVIDERS Program AC County ALL COUNTIES
County Program Consumer Name Client ID
Total Count 0
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Assessment Due Report PSA 01 Start Date 01012017 End Date 08312018 Owner ALL PROVIDERS Worker ALL WORKERS Program Status ACTV and APCL Assessment Type Needed ALL
Overdue and missing assessments are always listed
Owner ID 1065
Client ID Client Name
Owner Assessor ID
Date of Birth
06281928
CIRTS28099
County of Service
GULF
Worker Name HARPER KENNY
Zip Assessment PSA Date
32534 01 01022014
Type
701A
Active Y
Nutr PriorityScore Score
11 58
Rank
5
Due Date
01022015
Status
701S OVERDUE
LTCC APPL Start Date
03252014 4062235673 Test name
Total Clients for Worker 1
Total Clients for Owner 1
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Assessment Due Report PSA 01 Start Date 01012017 End Date 08312018 Owner ALL PROVIDERS Worker ALL WORKERS Program Status ACTV and APCL Assessment Type Needed ALL
Overdue and missing assessments are always listed
Summary by PSA
PSA 01 701A Overdue 1
701B Overdue 213
701C Overdue 0
701S Overdue 157
No 701A 0
No 701B 2
No 701C 0
No 701S 0
701A Not Overdue 0
701B Not Overdue 0
701C Not Overdue 0
701S Not Overdue 0
701S Optional 0
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CIC Service Units and Costs Projections County SummaryPSA 99 Program CCE
Start Date 01012017 End Date 12312017
County LEON
Total Total Total Avg Max Projected
StateFederal Projected Reimbursement Provider Unduplicated Provider Service Share Service Units Unit Rate Cost Per Unit Client Count
Report Total
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CIC Service Units and Costs Projections Provider SummaryPSA ALL Provider ALL PROVIDERS Program FEDERALLY FUNDED (0101 TO 1231) Year 2017 From 01012017 To 12312017
PSA County Program Service Total State
Federal Share
Total Projected
Service Units
Avg Reimbursement
Unit Rate
Max Provider
Cost Per Unit
Total Projected Unduplicated Client Count
02 FRANKLIN O3C1 CONGREGATE MEALS $810300 1710 15
Program Total
County Total
$810300
$810300
GULF O3C1 CONGREGATE MEALS $25205 3 5
Program Total $25205
O3C2 HOME DELIVERED MEALS $25205 3 6
Program Total
County Total
$25205
$50411
LEON O3C1 CONGREGATE MEALS $621300 1311 15
CONGREGATE MEALS GUEST
CONGREGATE MEALS VOLUNTEERS
$252055
$277260
25
30
2
5
Program Total $1150615
O3C2 HOME DELIVERED MEAL GUEST $252055 25 3
Program Total $252055
OA3D PEARLS (SESSION 5)
PEARLS (SESSION 6)
PEARLS (SESSION 7)
PEARLS (SESSION 8)
$10247
$10247
$10247
$10247
10
10
10
10
3
3
3
3
Program Total $40988
OA3E RESPITE IN-HOME $200 2 2
Program Total
County Total
$200
$1443858
WAKULLA O3C2 EMERGENCY HOME DELIVERED SHELF MEALS
$8065604 14899 90
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CIC Service Units and Costs Projections - PSA Summary
PSA ALL Program CCE
Strat Date 01012017 End Date 12312017
Total
PSA County Provider Service
Total State Federal
Share
Total Projected
Service Units
Avg Reimbursement
Unit Rate
Max Projected Provider Unduplicated
Cost Per Unit Client Count
02 LEON SOUTHERN SERVICE CASE MANAGEMENT PROVIDER EMERGENCY HOME DELIVERED SHELF MEALS
$2175533
$602000
483
689
32
20
HOME DELIVERED MEALS $530262 993 5
MATERIAL AID $1994536 199
Provider Total $5302331
CountyTotal $5302331
WAKULLA SOUTHERN SERVICE CASE MANAGEMENT PROVIDER EMERGENCY HOME DELIVERED SHELF MEALS
$2175533
$1240200
483
689
32
5
MATERIAL AID $1994536 199
Provider Total $5410269
CountyTotal $5410269
PSA Total $10712599
05 PINELLAS BURSTEIN-APPLEBEE ADULT DAY CARE $000 0 $900 $1000 0
COUNSELING (MENTAL HEALTH COUNSELINGSCREENING) - INDIVIDUAL
Provider Total
$000
$000
0 $6600 $7700 0
CountyTotal $000
PSA Total $000
Report Total $10712599
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CID Service Units and Costs Projections - PSA SummaryPSA ALL Program CCE
Start Date 01012017 End Date 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
PSA County Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
02 LEON CASE MANAGEMENT $2175533 483
EMERGENCY HOME $602000 689DELIVERED SHELF MEALS HOME DELIVERED MEALS $530262 993
MATERIAL AID $1994536 199
County Total $5302331 2364
WAKULLA CASE MANAGEMENT $2175533 483
EMERGENCY HOME $1240200 689DELIVERED SHELF MEALS MATERIAL AID $1994536 199
County Total $5410269 1371
PSA Total $10712599 3735
05 PINELLAS ADULT DAY CARE $000 0
COUNSELING (MENTAL $000 0 HEALTH COUNSELINGSCREENING) - INDIVIDUAL
County Total $000 0
PSA Total $000 0
Report Total $10712599 3735
$900 $900 $900 $1000 $1000 $1000
$6600 $6600 $6600 $7700 $7700 $7700
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CID Service Units and Costs Projections County SummaryPSA 99
Program CCE County LEON
Start Date 01012017 End Date 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
Report Total
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CIE Service Units and Costs Projections - PSA Summary - All Programs
PSA 99 Program FEDERALLY FUNDED (0101 TO 1231) Year 2017 From 01012017 To 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
Program Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
Report Total
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CIE Service Units and Costs Projections - PSA Summary
PSA ALL Program CCE
Start Date 01012017 End Date 12312017
Avg High Low Total Total Avg High Low Provider Provider Provider
StateFederal Projected Reimbursement Reimbursement Reimbursement Cost Cost CostPSA
02
Service
CASE MANAGEMENT
Share
$4351066
Service Units
966
Unit Rate Unit Rate Unit Rate Per Unit Per Unit Per Unit
EMERGENCY HOME DELIVERED SHELF MEALS $1842200 1378
HOME DELIVERED MEALS $530262 993
MATERIAL AID $3989071 398
PSA Total $10712599 3735
05 ADULT DAY CARE $000 0 $900 $900 $900 $1000 $1000 $1000
COUNSELING (MENTAL HEALTH $000 0 $6600 $6600 $6600 $7700 $7700 $7700 COUNSELINGSCREENING) - INDIVIDUAL
PSA Total $000 0
Report Total $10712599 3735
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CAREGIVER SEARCH REPORT
SEARCH RESULTS FOR CONSUMERS
Criteria First Name Last Name SSN PSA ALL
Client Name Client SSN Caregiver Name Caregiver SSN
000000000 000000000 Test Name Test Name
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CARES Referrals in a Time Range PSA ALL
Start Date 01012017 End Date 12312017
Referred to ALL REFERRALS
Referring PSA Employee Name Client Name Client ID
Referral Imminent NH Admit Aging Date Risk Date Referred To Cares Provider Name Received Date
03A 4061561263 Test Name Test Name 09242017 Y 05292017 ARC or ADRC 09252017
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CARES Referrals in a Time Range PSA ALL
Start Date 01012017 End Date 12312017
Referred to ALL REFERRALS
Referring PSA Employee Name Client Name Client ID
Referral Date
Imminent Risk
NH Admit Date Referred To Cares Provider Name
Aging Received Date
04B Test Name Test Name 4061738075 04082017 N ARC or ADRC Test Name 04082017
Total Clients 110
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CARES Referrals not acknowledged by the Aging Network PSA ALL For Referrals after 01012017 Owner ID ALL Owners
Unduplicated Client count Cares Office Total Clients Count
Report Total
Report run on 08312018 0158 PM Page 1 of 1 cares_not_ackrdf
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
CIRTS Issue PSA Client ID Client Name Program
Program Status Start Provider Enrollment ID Provider Name
APCL CLIENT WITH DATE OF DEATH 08 4061759417 Test Name OA3B APCL 07232013 1141 WESTERN WORLD RADIO
Report run on 08312018 0224 PM
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
Program Start Provider CIRTS Issue PSA Client ID Client Name Program Status Enrollment ID Provider Name
06 LTCC APCL 01242014 1514 4061713685 Test Name APCL CLIENT WITH DATE OF DEATH CENTRAL THE ORIGINAL HOUSE OF PIES
Count 503
Report run on 08312018 0224 PM Page 22 of 22 data_cleanuprdf Report run by RSHQALL Dispose of this report so that it can not be read or reconstructed
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Civil Rights PSA ALL Provider ALL PROVIDERS Program AC Start Date 01012017 End Date 12312017 The Poverty Level for Single is The Poverty Level for Couple is Sort by County
County Unduplicated Count
Report run on 08312018 1055 AM Page 1 of 1 civil_rightsrdf
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Client Information Report Start Date 01012017 End Date 12312017
Client ID 1001141246
Emergency
Client Name Test Name
Telephone () - Address 78 TEST STREET TALLAHASSEE FL 32399
Most Recent Caregiver Information Date Updated
Doctor
Comments
Client Demographic Information
Birth Date 06041940 Race W
Owner ID Ethnicity O
Most Recent Income Information
Ind Mon Inc Cpl Mon Inc
Ind Assets Couple Assets
Most Recent Assessment Information
Asmt Date Ref Risk Lvl
Asmt Site Spec Shel
AsmtType Spec Reg
Ref Date Primary CG
Ref Source Living Sit
Enrollment Information
Sex
Marital Status
F
S
Medicaid Number
ADL Score
ADL Count
IADL Score
IADL Count
Memory Score
Priority Score
Env Score
Nutr Score
Risk Score
Social Score
Rank
Provider Location Program Program Status Worker Start Date End Date
Care Plan Service Needed
Date Service Units Type Frq End Date
Care Plan Service Planned
Program Service Units Type Frq Start Date End Date
Services Received between 01012017 and 12312017
Service Billed Provider Location Worker Program Service Date Units Unit Type Amount
Report run on 08312018 0159 PM Page 1 of 1 client_info_formrdf
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Provider N
Client Service Units Report PSA ALL Provider ALL PROVIDERS Location 0000
Program ALL PROGRAMS Service ALL SERVICES Worker ALL WORKERS
City ALL CITIES Include Zero Unit N Include Aggregate N Calculated Amount equals the number of Units Provided times Fixed Cost if it existsService Start Date 01012017 Service End Date 12312017 If Fixed Cost does not exist Calculated
Group by PSA Provider Location Client Name County Worker Amount equals Billed Amount
Unduplicated Client Count 0 Grand Total 000 $000
Report run on 08312018 0234 PM Page 1 of 1 clnt_serv_unitsrdf
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Clients In Common PSA All Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 County All Counties Worker All Workers
County JEFFERSON
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
MIAMI-DADE
0 0 0 0 0 0 0 0 0
4061539538 Test NameCounty Count
County
0 01
X
0 1
X
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
4061650856 Test Name X 4061486560 Test Name X 4062452921 Test Name X
Report run on 08312018 1148 AM clients_commonrdfPage 1 of 4 Report run by RSHQALL Dispose of this Report so that it can not be read or reconstructed
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Clients Served Not Enrolled PSA ALL Start Date 01012017 End Date 12312017 Locations 0000 Provider All Providers
Service Service Min Serv Max Serv Program Start End Enrollment PSA Provider Location Program Consumer Name Client ID Service Date Date Status Enrollment Enrollment Provider
Count 0
Report run on 08312018 0201 PM Page 1 of 1 clnts_serv_no_enrrdf
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
4061472791 04
09
1092
1291
0072
0042
LTCC
LTCC
APCL
APCL
4062714543 06
06
1514
1762
0072
5006
LTCC
LTCC
APCL
APPL
4061802246 11
06
1177
1514
0179
0072
LTCC
LTCC
APCL
APCL
4061563719 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062644312 06
08
1514
1771
0072
0896
LTCC
LTCC
APCL
APCL
1001141670 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
1001141671 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
4062375003 07
05
05
07
1263
1755
1638
1263
0368
0072
0072
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062155124 06
06
1762
1514
0072
0072
LTCC
LTCC
APPL
APCL
4061743886 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0369
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4061499927 06
06
1514
1762
0072
5005
LTCC
LTCC
APCL
APPL
4061583524 08
06
1144
1514
0896
0072
LTCC
LTCC
APCL
APCL
4062694843 06
03
1514
1922
0072
0179
LTCC
LTCC
APCL
APCL
4062744517 07
06
1263
1514
0369
0072
LTCC
LTCC
APCL
APCL
4062005488 10
11
10
11
1929
1177
1164
1177
0072
0073
0179
0179
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
Report run on 08312018 0200 PM Page 1 of 2 clnts_mult_enrollrdf
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
Total Count 15
Report run on 08312018 0200 PM Page 2 of 2 clnts_mult_enrollrdf
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CODE DESCRIPTIONS Category ALL STATE TABLES
Code Description Active Available To Code Category
0 UNKNOWN Y CARES SUBJECTIVE_HEALTH_EVALUATION
01 ALACHUA Y COMMON COUNTIES
02 BAKER Y COMMON COUNTIES
03 BAY Y COMMON COUNTIES
04 BRADFORD Y COMMON COUNTIES
05 BREVARD Y COMMON COUNTIES
06 BROWARD Y COMMON COUNTIES
07 CALHOUN Y COMMON COUNTIES
08 CHARLOTTE Y COMMON COUNTIES
09 CITRUS Y COMMON COUNTIES
1 EXCELLENT Y CARES SUBJECTIVE_HEALTH_EVALUATION
10 CLAY Y COMMON COUNTIES
11 COLLIER Y COMMON COUNTIES
12 COLUMBIA Y COMMON COUNTIES
13 MIAMI-DADE Y COMMON COUNTIES
14 DESOTO Y COMMON COUNTIES
15 DIXIE Y COMMON COUNTIES
16 DUVAL Y COMMON COUNTIES
17 ESCAMBIA Y COMMON COUNTIES
18 FLAGLER Y COMMON COUNTIES
19 FRANKLIN Y COMMON COUNTIES
2 GOOD Y CARES SUBJECTIVE_HEALTH_EVALUATION
20 GADSDEN Y COMMON COUNTIES
21 GILCHRIST Y COMMON COUNTIES
22 GLADES Y COMMON COUNTIES
23 GULF Y COMMON COUNTIES
24 HAMILTON Y COMMON COUNTIES
25 HARDEE Y COMMON COUNTIES
26 HENDRY Y COMMON COUNTIES
27 HERNANDO Y COMMON COUNTIES
28 HIGHLANDS Y COMMON COUNTIES
Report run on 08312018 0140 PM Page 1 of 45 state_codesrdf Report run by RSHQALL Dispose of this report so that it cannot be read or reconstructed
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CONSUMER AGE VERIFICATION REPORT PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Program AC
Age at Start
Enroll or Start Enroll Provider Program Description Consumer Name Client ID DOB Svc date or Svc Date
Report run on 08312018 0203 PM Page 1 of 1 age_verifyrdf
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Contract Budget Information PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Program Service Provider Location County Served Provider Contract
Projected Service
Units Unit Measure
Projected Unduplicated
State Federal Share Client Count Begin Date End Date
Row Count 0 Amount Total
Report run on 08312018 0233 PM Page 1 of 1 contract_budgetrdf
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Start Enroll Latest Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Date Asmt Date Worker
O3C1 1036 000 4061653427 Test CENTRAL 34982 W M 07091930 09102013 09102013 CIRTS20804 0 Name
Report run on 08312018 1133 AM Page 1 of 6 actv_by_progrdf
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Start Enroll Date
Latest Asmt Date Worker
4061593624 Test Name CENTRAL 34946 B F 11261940 12012011 12312013 CIRTS23407
Count 164
Unduplicated Client Count 163
Report run on 08312018 1133 AM Page 6 of 6 actv_by_progrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Assessments After DOD Report
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Owner 1025
The shaded records indicate clients who have different DOBs andor different names
Assemt Current PSA Owner Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Owner Assessor
Provider Assessor
Assemt Date
Assemt Type
Unduplicated Count Total 0
Report run on 08312018 0206 PM Page 1 of 1 vs_assmrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Open Enrollments
The Vital Statistics Data for 07192002 - 09112014PSA ALL Provider ALL Program Status ACTV Include MLTC ACTVS N
The shaded records indicate clients who have different DOBs andor different names
Enroll PSA
Enrollment Provider Loc Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Enroll Program Status
Enroll Program
Current Owner ID
02 1065 0072 4062244026 Test Name Test Name 10222004 03231917 03231917 ACTV CCE 1065
Count of enrollments for the Provider 1
Count of enrollments for the PSA 1
Count of enrollments for the Report 1
Unduplicated Count of Individuals with open enrollments and DOD PSA Total Clients Count
02 1
Total 1
Report run on 08312018 0205 PM Page 1 of 1 vs_open_enrollrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Report run on 08312018 0207 PM Page 1 of 3 vs_servicesrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Unduplicated count of individuals with Services after DOD
PSA Total Clients Count
Report Total
Report run on 08312018 0207 PM Page 2 of 3 vs_servicesrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
List of Clients with PSA table entry for SERVICES_AFTER_DOD
Unduplicated Count Total 0
Report run on 08312018 0207 PM Page 3 of 3 vs_servicesrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Age
Provider
Total
Age lt 60 Age 60 - 64 Age 65 - 74 Age 75 - 84 Age 85+ Total Clients Avg Age
Total
Avg Age
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 1 of 5 demo_all_prvrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Ethnicity
Provider Hispanic Other Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Race
American Indian Native Hawaiian Other Provider Asian Alaska Native Black Pacific Islander Minority White Multiple Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Gender
Provider Male Female Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 4 of 5 demo_all_prvrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Monthly Income
Provider 0 - - Higher than Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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None
Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Total Persons Served 0
Age lt 60 Years 0 0
Age 60 - 64 0 0
Age 65 - 74 0 0
Age 75 - 84 0 0
Age 85+ 0 0
Total Age 0 0
Average 000
Ethnicity Hispanic 0 0
Other Ethnicity 0 0
Unknown Ethnicity 0 0
Total 0 0
Race Asian 0 0
American Indian Alaska Native 0 0
Black 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority 0 0
White 0 0
Multiple 0 0
Unknown 0 0
Total 0 0
Sex Male 0 0
Female 0 0
Unknown Sex 0 0
Total 0 0
Monthly Income 0 - 0 0
- 0 0
Higher than 0 0
Unknown 0 0
Total 0 0
Report run on 08312018 1058 AM Page 1 of 2 demo_by_prov_detrdf Report run byRSHQALL Dispose of this report so that it can not be read or reconstructed
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Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Client ID Date Of Birth Ethnicity Race Sex Individual Monthly Income
Report run on 08312018 1058 AM Page 2 of 2 demo_by_prov_detrdf Report run byRSHQALL Dispose of this report so that it can not be read or reconstructed
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Demographics of Clients OAA Registered Served Only PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 City All Cities Program All Programs Service All Services County ALL COUNTIES Table OAA Registered Services Only Low Income Medium Income
Total Persons Served 0
Agelt 60 Years
Age 60 - 64
Age 65 - 74
Age 75 - 84
Age 85+
0
0
0
0
0
0
0
0
0
0
Monthly Income
0 -
-Higher than
Unknown
0
0
0
0
0
0
0
0
Total
Average
0
000
0 Total 0 0
Ethnicity Hispanic
Other
Unknown
0
0
0
0
0
0
Living Situation
Alone
Null
Policy Change
0
0
0
0
0
0
Total 0 0 Unknown
With Caregiver
0
0
0
0
Race Asian 0 0
With Other
With Other Caregiver
0
0
0
0
American Indian Alaska Native
Black
0
0
0
0Total Living Situation 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority
White
0
0
0
0 Limited English Proficiency
Multiple
Unknown
Total Race
0
0
0
0
0
0
Yes
No
Unknown
0
0
0
0
0
0
Total 0 0
Sex Male
Female
Unknown
0
0
0
0
0
0
Total 0 0
Report run on 08312018 1056 AM Page 1 of 1 demo_by_provrdf
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Disaster Assistance Clients for a Provider PSA ALL Provider All Providers Location 0000 Worker All Workers City All Cities Zip Code All Zip Codes Sort By ZIP
Provider 1036 Provider Name Location 0000 Worker CIRTS18634
Need Care Client Name Address City Zip County Phone Asst Reg Situation Relat Care phone Care Name
34946 N WO DA 000 SAINT JAMES DRIVE CENTRAL (025) 101-0620 Test NameTest Name SAINT LUCIE (005) 100-0369 Y
Client is active and no assessment information is available Special Shelter and Special Registry are unknown
Report run on 08312018 1102 AM Page 1 of 8 disaster_by_provrdf
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
Total by PSA 0
Report run on 08312018 1111 AM Page 1 of 5 eheap_exceptionsrdf
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
ALACH BAKER BAY BRADF BREVA BROWA CALHO CHARL CITRUS CLAY COLLIE COLUM DESOT DIXIE DUVAL ESCAM FLAGL FRANK GADSDAssisted Household Report UA ORD RD RD UN OTTE R BIA O BIA ER LIN EN
1 of Household Assisted 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Households AssistedWith Gross Income
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C 100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D 125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
3 Households with at leastOne member
A 60 Years or older 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B Disabled 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C Age 5 years or under 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D Under 60 Years Old 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Undup Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Assisted
Applicant Household Report
of Applicant Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
Report run on 08312018 1111 AM Page 2 of 5 eheap_exceptionsrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Energy Assisted Household Report
County of Assisted
Households
Households Assisted By Poverty Level
Under 75 75 - 100 101 - 125 126 - 150 Over 150 60 Years or older
At least one member who is
Age 5 years Age 2 years Age 3 years Disabled or younger and younger through 5
Under 60 Years Old
Undup Households
Assisted
Energy Assistance Total
Report run on 08312018 1107 AM Page 1 of 3 eheap_summaryrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Unduplicated Total 0 0
County of Assisted
Households Under 75 75 - 100
Households Assisted By Poverty Level
101 - 125 126 - 150 Over 150 60 Years or older Disabled
Age 5 years or younger
Age 2 years and younger
Age 3 years through 5
Under 60 Years Old
At least one member who is
Undup Households
Assisted
Other Assisted Household Report
Other Assistance Total
Report run on 08312018 1107 AM Page 2 of 3 eheap_summaryrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Applicant Household Report
County of Applicant
Households Under 75 75 - 100 101 - 125 126 - 150 Over 150 Income data
unavailable
Total 0
Report run on 08312018 1107 AM Page 3 of 3 eheap_summaryrdf
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01
Enrollment Active Consumer Count by Program PSA ALL Provider ALL PROVIDERS
County Description Program Count of Clients
BREVARD
ADI
CCE
HCE
LSP
NDP
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
MLTC
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
31
57
44
5
62
123
141
26
9
7
5
40
5
50
67
129
2
19
42
29
1
233
79
63
8
2
14
3
37
14
47
3
3
33
127
10
02
03
04
ALACHUA
BAKER
BAY
BRADFORD
Report run on 08312018 1148 AM Page 1 of 18 actv_countrdf
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Enrollment Terminations with Reasons PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 Program All Programs Program Status ALL Program Status Worker ALL WORKERS
Last First Program Medicaid Provider Start End Name Name Client ID Status Description Worker Number Program Location Enrollment Enrollment
Count 0
Report run on 08312018 1150 AM Page 1 of 1 enroll_term_reasonrdf
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Enrollments with Care Plan Report
PSA ALL Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTIVE STATUS Care Plan Service ALL SERVICES Care Plan Start 01012017 Care Plan End 12312017
Care Plan Care Plan Care Plan Client Name
Unduplicated Client Count 0
Client ID Program Status Worker Start Date End Date Service
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PSA CLIENT_ID CLIENT_NAME OWNER PROVIDER_ID ASSESSMENT_DATE ASSESSOR_NAME MEDICAID_NUMBER CAREGIVER_CHANGE ENVIRONMENT_CHANGE HEALTH_CHANGE INCOME_CHANGE SITUATION_CHANGE INITIAL_ASSM ANNUAL_ASSM SSN REFERRAL_SOURCE 1114 N N N N Y N 771771777 SELFFAMILY 812017 JANE CASEWORKER 2 1001141633 TEST TEST N
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Fixed Service Costs List PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Provider Location County Program Service Reimbursement Unit Rate Provider Cost Per Unit Begin Valid End Valid
Count 0
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Start End Worker Most Recent Nutr Medicaid Program Provider Location Client ID Client Name Status Enrollment Enrollment Worker Active Score Number
O3C1 1036 0000 4061638016 Test Name ACTV 09122013 CIRTS20804 Y 2
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Start End Worker Most Recent Nutr Medicaid Program Provider Location Client ID Client Name Status Enrollment Enrollment Worker Active Score Number
O3C2 1036 0000 4062000152 Test Name ACTV 02072011 CIRTS23407 N 3
1036 0000 4061594062 ISAACS HATTIE ACTV 11192012 CIRTS20804 Y 5
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Start End Worker Most Recent Nutr Medicaid Program Provider Location Client ID Client Name Status Enrollment Enrollment Worker Active Score Number
O3C2 1036 0000 4062379505 Test Name ACTV 11192012 CIRTS20804 Y 5
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Start End Worker Most Recent Nutr Medicaid Program Provider Location Client ID Client Name Status Enrollment Enrollment Worker Active Score Number
O3C2 1036 0000 4062401063 Test Name ACTV 10162013 CIRTS20804 Y 3
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Provider Location Client ID Client Name Program Status
Start Enrollment
End Enrollment Worker
Worker Active
Most Recent Nutr Score
Medicaid Number
O3C2 1036 0000 4062538939 ACTV 12082000 CIRTS20388 Y Test Name
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All Enrollments Counts During Date Range PSA ALL Start Date 01012017 End Date Location 0000 Provider Program Program Status
12312017 ALL PROVIDERS
ACTV
Group By Program Provider Location
Program Provider Location Client Count O3C1 1036 0000 45
1951 0000 3
O3C2 1036 0000 113
OA3E 1821 0000 2
OA3ES 1821 0000 1
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C1 1036 0000 4061950299 Test Name ACTV 04072011 CIRTS23407 N 11
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C1 1036 4062586019 Test Name ACTV 12292008 CIRTS23407 N 1
Total for Location 45
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C1 1951 0000 4062452921 Test Name ACTV 03301989 CIRTS22695 N 10
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4062786256 Test Name ACTV 09232013 CIRTS20804 Y 4 1
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4062380426 Test Name ACTV 04112012 CIRTS23407 N 55 2
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4061608826 Test Name ACTV 08102011 CIRTS18634 Y 7 3
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4062615533 Test Name ACTV 10032013 CIRTS20804 Y 6 3
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start Enrollment
End Enrollment Worker
Worker Active
Medicaid Number
Most Recent Nutr Score Rank
O3C2 1036 4062466582 Test Name ACTV 10262010 CIRTS23407 N 105 2
Total for Location 113
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PSA
APCL Clients With No Services ALL Owner All Owners Provider ALL PROVIDERS
Start Date 01012017 End Date 12312017
Includes Clients Receiving Only CM INSC SCAS CA REFE Services
PSA Client ID Client Name Owner Provider Program
Count 0
Unduplicated Clients Count 0
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APCL Clients With Services PSA ALL Owner All Owners Provider ALL PROVIDERS Start Date 01012017 End Date 12312017
Exclude CM CA INSC REFE SCAS
PSA Client ID Name Owner Provider Program 10 4062527553 Test Name 1539 1929 CCE
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APCL Clients With Services PSA ALL Owner All Owners Provider ALL PROVIDERS Start Date 01012017 End Date 12312017
Exclude CM CA INSC REFE SCAS
PSA Client ID Name Owner Provider Program 11 4062732638 Test Name 1177 1177 LTCC
Total 21067
Unduplicated clients count 12460
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APS Assessments PSA ALL Risk Level ALL Owner All Owners Referral Date From 01012017 To 12312017
Order by Referral Date and Owner ID
PSA 03
Ref Date Owner ID Client ID Client Name Risk Level Asmt Type Asmt Date
03032017 1390 4062058415 L 701A 03302018 Test Name
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APS Assessments PSA ALL Risk Level ALL Owner All Owners Referral Date From 01012017 To 12312017
Order by Referral Date and Owner ID
12042017 1980 4061617559 H 701B 12072017 Test Name
Assessment Count for the PSA 52
PSA 04A
Ref Date Owner ID Client ID
09102017 4062308458
Client Name
Test Name
Risk Level
H
Asmt Type
O
Asmt Date
09162017
Assessment Count for the PSA 2
Risk Level H
M
L
Count of Assessments 138
23
21
Total Count of Assessments 182
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APS Repeat Referrals in a Time Range
PSA ALL Owner All Owners
Start Date 01012017 End Date 12312017
Current DOEA CIRTS Cirts SSN if Risk Date Created PSA Owner Abuse No different than DCF DCF SSN Name County Level Date of Birth Date Sent by DCF
Count 0
Unduplicated Client Count by PSA
PSA Count SSN
Total
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Assessed Prioritized Consumer List PSA ALL Provider ALL PROVIDERS Program AC County ALL COUNTIES
County Program Consumer Name Client ID
Total Count 0
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Assessment Due Report PSA 01 Start Date 01012017 End Date 08312018 Owner ALL PROVIDERS Worker ALL WORKERS Program Status ACTV and APCL Assessment Type Needed ALL
Overdue and missing assessments are always listed
Owner ID 1065
Client ID Client Name
Owner Assessor ID
Date of Birth
06281928
CIRTS28099
County of Service
GULF
Worker Name HARPER KENNY
Zip Assessment PSA Date
32534 01 01022014
Type
701A
Active Y
Nutr PriorityScore Score
11 58
Rank
5
Due Date
01022015
Status
701S OVERDUE
LTCC APPL Start Date
03252014 4062235673 Test name
Total Clients for Worker 1
Total Clients for Owner 1
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Assessment Due Report PSA 01 Start Date 01012017 End Date 08312018 Owner ALL PROVIDERS Worker ALL WORKERS Program Status ACTV and APCL Assessment Type Needed ALL
Overdue and missing assessments are always listed
Summary by PSA
PSA 01 701A Overdue 1
701B Overdue 213
701C Overdue 0
701S Overdue 157
No 701A 0
No 701B 2
No 701C 0
No 701S 0
701A Not Overdue 0
701B Not Overdue 0
701C Not Overdue 0
701S Not Overdue 0
701S Optional 0
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CIC Service Units and Costs Projections County SummaryPSA 99 Program CCE
Start Date 01012017 End Date 12312017
County LEON
Total Total Total Avg Max Projected
StateFederal Projected Reimbursement Provider Unduplicated Provider Service Share Service Units Unit Rate Cost Per Unit Client Count
Report Total
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CIC Service Units and Costs Projections Provider SummaryPSA ALL Provider ALL PROVIDERS Program FEDERALLY FUNDED (0101 TO 1231) Year 2017 From 01012017 To 12312017
PSA County Program Service Total State
Federal Share
Total Projected
Service Units
Avg Reimbursement
Unit Rate
Max Provider
Cost Per Unit
Total Projected Unduplicated Client Count
02 FRANKLIN O3C1 CONGREGATE MEALS $810300 1710 15
Program Total
County Total
$810300
$810300
GULF O3C1 CONGREGATE MEALS $25205 3 5
Program Total $25205
O3C2 HOME DELIVERED MEALS $25205 3 6
Program Total
County Total
$25205
$50411
LEON O3C1 CONGREGATE MEALS $621300 1311 15
CONGREGATE MEALS GUEST
CONGREGATE MEALS VOLUNTEERS
$252055
$277260
25
30
2
5
Program Total $1150615
O3C2 HOME DELIVERED MEAL GUEST $252055 25 3
Program Total $252055
OA3D PEARLS (SESSION 5)
PEARLS (SESSION 6)
PEARLS (SESSION 7)
PEARLS (SESSION 8)
$10247
$10247
$10247
$10247
10
10
10
10
3
3
3
3
Program Total $40988
OA3E RESPITE IN-HOME $200 2 2
Program Total
County Total
$200
$1443858
WAKULLA O3C2 EMERGENCY HOME DELIVERED SHELF MEALS
$8065604 14899 90
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CIC Service Units and Costs Projections - PSA Summary
PSA ALL Program CCE
Strat Date 01012017 End Date 12312017
Total
PSA County Provider Service
Total State Federal
Share
Total Projected
Service Units
Avg Reimbursement
Unit Rate
Max Projected Provider Unduplicated
Cost Per Unit Client Count
02 LEON SOUTHERN SERVICE CASE MANAGEMENT PROVIDER EMERGENCY HOME DELIVERED SHELF MEALS
$2175533
$602000
483
689
32
20
HOME DELIVERED MEALS $530262 993 5
MATERIAL AID $1994536 199
Provider Total $5302331
CountyTotal $5302331
WAKULLA SOUTHERN SERVICE CASE MANAGEMENT PROVIDER EMERGENCY HOME DELIVERED SHELF MEALS
$2175533
$1240200
483
689
32
5
MATERIAL AID $1994536 199
Provider Total $5410269
CountyTotal $5410269
PSA Total $10712599
05 PINELLAS BURSTEIN-APPLEBEE ADULT DAY CARE $000 0 $900 $1000 0
COUNSELING (MENTAL HEALTH COUNSELINGSCREENING) - INDIVIDUAL
Provider Total
$000
$000
0 $6600 $7700 0
CountyTotal $000
PSA Total $000
Report Total $10712599
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CID Service Units and Costs Projections - PSA SummaryPSA ALL Program CCE
Start Date 01012017 End Date 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
PSA County Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
02 LEON CASE MANAGEMENT $2175533 483
EMERGENCY HOME $602000 689DELIVERED SHELF MEALS HOME DELIVERED MEALS $530262 993
MATERIAL AID $1994536 199
County Total $5302331 2364
WAKULLA CASE MANAGEMENT $2175533 483
EMERGENCY HOME $1240200 689DELIVERED SHELF MEALS MATERIAL AID $1994536 199
County Total $5410269 1371
PSA Total $10712599 3735
05 PINELLAS ADULT DAY CARE $000 0
COUNSELING (MENTAL $000 0 HEALTH COUNSELINGSCREENING) - INDIVIDUAL
County Total $000 0
PSA Total $000 0
Report Total $10712599 3735
$900 $900 $900 $1000 $1000 $1000
$6600 $6600 $6600 $7700 $7700 $7700
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CID Service Units and Costs Projections County SummaryPSA 99
Program CCE County LEON
Start Date 01012017 End Date 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
Report Total
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CIE Service Units and Costs Projections - PSA Summary - All Programs
PSA 99 Program FEDERALLY FUNDED (0101 TO 1231) Year 2017 From 01012017 To 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
Program Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
Report Total
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CIE Service Units and Costs Projections - PSA Summary
PSA ALL Program CCE
Start Date 01012017 End Date 12312017
Avg High Low Total Total Avg High Low Provider Provider Provider
StateFederal Projected Reimbursement Reimbursement Reimbursement Cost Cost CostPSA
02
Service
CASE MANAGEMENT
Share
$4351066
Service Units
966
Unit Rate Unit Rate Unit Rate Per Unit Per Unit Per Unit
EMERGENCY HOME DELIVERED SHELF MEALS $1842200 1378
HOME DELIVERED MEALS $530262 993
MATERIAL AID $3989071 398
PSA Total $10712599 3735
05 ADULT DAY CARE $000 0 $900 $900 $900 $1000 $1000 $1000
COUNSELING (MENTAL HEALTH $000 0 $6600 $6600 $6600 $7700 $7700 $7700 COUNSELINGSCREENING) - INDIVIDUAL
PSA Total $000 0
Report Total $10712599 3735
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CAREGIVER SEARCH REPORT
SEARCH RESULTS FOR CONSUMERS
Criteria First Name Last Name SSN PSA ALL
Client Name Client SSN Caregiver Name Caregiver SSN
000000000 000000000 Test Name Test Name
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CARES Referrals in a Time Range PSA ALL
Start Date 01012017 End Date 12312017
Referred to ALL REFERRALS
Referring PSA Employee Name Client Name Client ID
Referral Imminent NH Admit Aging Date Risk Date Referred To Cares Provider Name Received Date
03A 4061561263 Test Name Test Name 09242017 Y 05292017 ARC or ADRC 09252017
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CARES Referrals in a Time Range PSA ALL
Start Date 01012017 End Date 12312017
Referred to ALL REFERRALS
Referring PSA Employee Name Client Name Client ID
Referral Date
Imminent Risk
NH Admit Date Referred To Cares Provider Name
Aging Received Date
04B Test Name Test Name 4061738075 04082017 N ARC or ADRC Test Name 04082017
Total Clients 110
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CARES Referrals not acknowledged by the Aging Network PSA ALL For Referrals after 01012017 Owner ID ALL Owners
Unduplicated Client count Cares Office Total Clients Count
Report Total
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
CIRTS Issue PSA Client ID Client Name Program
Program Status Start Provider Enrollment ID Provider Name
APCL CLIENT WITH DATE OF DEATH 08 4061759417 Test Name OA3B APCL 07232013 1141 WESTERN WORLD RADIO
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
Program Start Provider CIRTS Issue PSA Client ID Client Name Program Status Enrollment ID Provider Name
06 LTCC APCL 01242014 1514 4061713685 Test Name APCL CLIENT WITH DATE OF DEATH CENTRAL THE ORIGINAL HOUSE OF PIES
Count 503
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Civil Rights PSA ALL Provider ALL PROVIDERS Program AC Start Date 01012017 End Date 12312017 The Poverty Level for Single is The Poverty Level for Couple is Sort by County
County Unduplicated Count
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Client Information Report Start Date 01012017 End Date 12312017
Client ID 1001141246
Emergency
Client Name Test Name
Telephone () - Address 78 TEST STREET TALLAHASSEE FL 32399
Most Recent Caregiver Information Date Updated
Doctor
Comments
Client Demographic Information
Birth Date 06041940 Race W
Owner ID Ethnicity O
Most Recent Income Information
Ind Mon Inc Cpl Mon Inc
Ind Assets Couple Assets
Most Recent Assessment Information
Asmt Date Ref Risk Lvl
Asmt Site Spec Shel
AsmtType Spec Reg
Ref Date Primary CG
Ref Source Living Sit
Enrollment Information
Sex
Marital Status
F
S
Medicaid Number
ADL Score
ADL Count
IADL Score
IADL Count
Memory Score
Priority Score
Env Score
Nutr Score
Risk Score
Social Score
Rank
Provider Location Program Program Status Worker Start Date End Date
Care Plan Service Needed
Date Service Units Type Frq End Date
Care Plan Service Planned
Program Service Units Type Frq Start Date End Date
Services Received between 01012017 and 12312017
Service Billed Provider Location Worker Program Service Date Units Unit Type Amount
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Provider N
Client Service Units Report PSA ALL Provider ALL PROVIDERS Location 0000
Program ALL PROGRAMS Service ALL SERVICES Worker ALL WORKERS
City ALL CITIES Include Zero Unit N Include Aggregate N Calculated Amount equals the number of Units Provided times Fixed Cost if it existsService Start Date 01012017 Service End Date 12312017 If Fixed Cost does not exist Calculated
Group by PSA Provider Location Client Name County Worker Amount equals Billed Amount
Unduplicated Client Count 0 Grand Total 000 $000
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Clients In Common PSA All Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 County All Counties Worker All Workers
County JEFFERSON
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
MIAMI-DADE
0 0 0 0 0 0 0 0 0
4061539538 Test NameCounty Count
County
0 01
X
0 1
X
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
4061650856 Test Name X 4061486560 Test Name X 4062452921 Test Name X
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Clients Served Not Enrolled PSA ALL Start Date 01012017 End Date 12312017 Locations 0000 Provider All Providers
Service Service Min Serv Max Serv Program Start End Enrollment PSA Provider Location Program Consumer Name Client ID Service Date Date Status Enrollment Enrollment Provider
Count 0
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
4061472791 04
09
1092
1291
0072
0042
LTCC
LTCC
APCL
APCL
4062714543 06
06
1514
1762
0072
5006
LTCC
LTCC
APCL
APPL
4061802246 11
06
1177
1514
0179
0072
LTCC
LTCC
APCL
APCL
4061563719 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062644312 06
08
1514
1771
0072
0896
LTCC
LTCC
APCL
APCL
1001141670 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
1001141671 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
4062375003 07
05
05
07
1263
1755
1638
1263
0368
0072
0072
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062155124 06
06
1762
1514
0072
0072
LTCC
LTCC
APPL
APCL
4061743886 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0369
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4061499927 06
06
1514
1762
0072
5005
LTCC
LTCC
APCL
APPL
4061583524 08
06
1144
1514
0896
0072
LTCC
LTCC
APCL
APCL
4062694843 06
03
1514
1922
0072
0179
LTCC
LTCC
APCL
APCL
4062744517 07
06
1263
1514
0369
0072
LTCC
LTCC
APCL
APCL
4062005488 10
11
10
11
1929
1177
1164
1177
0072
0073
0179
0179
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
Report run on 08312018 0200 PM Page 1 of 2 clnts_mult_enrollrdf
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
Total Count 15
Report run on 08312018 0200 PM Page 2 of 2 clnts_mult_enrollrdf
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CODE DESCRIPTIONS Category ALL STATE TABLES
Code Description Active Available To Code Category
0 UNKNOWN Y CARES SUBJECTIVE_HEALTH_EVALUATION
01 ALACHUA Y COMMON COUNTIES
02 BAKER Y COMMON COUNTIES
03 BAY Y COMMON COUNTIES
04 BRADFORD Y COMMON COUNTIES
05 BREVARD Y COMMON COUNTIES
06 BROWARD Y COMMON COUNTIES
07 CALHOUN Y COMMON COUNTIES
08 CHARLOTTE Y COMMON COUNTIES
09 CITRUS Y COMMON COUNTIES
1 EXCELLENT Y CARES SUBJECTIVE_HEALTH_EVALUATION
10 CLAY Y COMMON COUNTIES
11 COLLIER Y COMMON COUNTIES
12 COLUMBIA Y COMMON COUNTIES
13 MIAMI-DADE Y COMMON COUNTIES
14 DESOTO Y COMMON COUNTIES
15 DIXIE Y COMMON COUNTIES
16 DUVAL Y COMMON COUNTIES
17 ESCAMBIA Y COMMON COUNTIES
18 FLAGLER Y COMMON COUNTIES
19 FRANKLIN Y COMMON COUNTIES
2 GOOD Y CARES SUBJECTIVE_HEALTH_EVALUATION
20 GADSDEN Y COMMON COUNTIES
21 GILCHRIST Y COMMON COUNTIES
22 GLADES Y COMMON COUNTIES
23 GULF Y COMMON COUNTIES
24 HAMILTON Y COMMON COUNTIES
25 HARDEE Y COMMON COUNTIES
26 HENDRY Y COMMON COUNTIES
27 HERNANDO Y COMMON COUNTIES
28 HIGHLANDS Y COMMON COUNTIES
Report run on 08312018 0140 PM Page 1 of 45 state_codesrdf Report run by RSHQALL Dispose of this report so that it cannot be read or reconstructed
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CONSUMER AGE VERIFICATION REPORT PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Program AC
Age at Start
Enroll or Start Enroll Provider Program Description Consumer Name Client ID DOB Svc date or Svc Date
Report run on 08312018 0203 PM Page 1 of 1 age_verifyrdf
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Contract Budget Information PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Program Service Provider Location County Served Provider Contract
Projected Service
Units Unit Measure
Projected Unduplicated
State Federal Share Client Count Begin Date End Date
Row Count 0 Amount Total
Report run on 08312018 0233 PM Page 1 of 1 contract_budgetrdf
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Start Enroll Latest Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Date Asmt Date Worker
O3C1 1036 000 4061653427 Test CENTRAL 34982 W M 07091930 09102013 09102013 CIRTS20804 0 Name
Report run on 08312018 1133 AM Page 1 of 6 actv_by_progrdf
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Start Enroll Date
Latest Asmt Date Worker
4061593624 Test Name CENTRAL 34946 B F 11261940 12012011 12312013 CIRTS23407
Count 164
Unduplicated Client Count 163
Report run on 08312018 1133 AM Page 6 of 6 actv_by_progrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Assessments After DOD Report
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Owner 1025
The shaded records indicate clients who have different DOBs andor different names
Assemt Current PSA Owner Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Owner Assessor
Provider Assessor
Assemt Date
Assemt Type
Unduplicated Count Total 0
Report run on 08312018 0206 PM Page 1 of 1 vs_assmrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Open Enrollments
The Vital Statistics Data for 07192002 - 09112014PSA ALL Provider ALL Program Status ACTV Include MLTC ACTVS N
The shaded records indicate clients who have different DOBs andor different names
Enroll PSA
Enrollment Provider Loc Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Enroll Program Status
Enroll Program
Current Owner ID
02 1065 0072 4062244026 Test Name Test Name 10222004 03231917 03231917 ACTV CCE 1065
Count of enrollments for the Provider 1
Count of enrollments for the PSA 1
Count of enrollments for the Report 1
Unduplicated Count of Individuals with open enrollments and DOD PSA Total Clients Count
02 1
Total 1
Report run on 08312018 0205 PM Page 1 of 1 vs_open_enrollrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Report run on 08312018 0207 PM Page 1 of 3 vs_servicesrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Unduplicated count of individuals with Services after DOD
PSA Total Clients Count
Report Total
Report run on 08312018 0207 PM Page 2 of 3 vs_servicesrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
List of Clients with PSA table entry for SERVICES_AFTER_DOD
Unduplicated Count Total 0
Report run on 08312018 0207 PM Page 3 of 3 vs_servicesrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Age
Provider
Total
Age lt 60 Age 60 - 64 Age 65 - 74 Age 75 - 84 Age 85+ Total Clients Avg Age
Total
Avg Age
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 1 of 5 demo_all_prvrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Ethnicity
Provider Hispanic Other Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Race
American Indian Native Hawaiian Other Provider Asian Alaska Native Black Pacific Islander Minority White Multiple Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 3 of 5 demo_all_prvrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Gender
Provider Male Female Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 4 of 5 demo_all_prvrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Monthly Income
Provider 0 - - Higher than Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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None
Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Total Persons Served 0
Age lt 60 Years 0 0
Age 60 - 64 0 0
Age 65 - 74 0 0
Age 75 - 84 0 0
Age 85+ 0 0
Total Age 0 0
Average 000
Ethnicity Hispanic 0 0
Other Ethnicity 0 0
Unknown Ethnicity 0 0
Total 0 0
Race Asian 0 0
American Indian Alaska Native 0 0
Black 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority 0 0
White 0 0
Multiple 0 0
Unknown 0 0
Total 0 0
Sex Male 0 0
Female 0 0
Unknown Sex 0 0
Total 0 0
Monthly Income 0 - 0 0
- 0 0
Higher than 0 0
Unknown 0 0
Total 0 0
Report run on 08312018 1058 AM Page 1 of 2 demo_by_prov_detrdf Report run byRSHQALL Dispose of this report so that it can not be read or reconstructed
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Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Client ID Date Of Birth Ethnicity Race Sex Individual Monthly Income
Report run on 08312018 1058 AM Page 2 of 2 demo_by_prov_detrdf Report run byRSHQALL Dispose of this report so that it can not be read or reconstructed
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Demographics of Clients OAA Registered Served Only PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 City All Cities Program All Programs Service All Services County ALL COUNTIES Table OAA Registered Services Only Low Income Medium Income
Total Persons Served 0
Agelt 60 Years
Age 60 - 64
Age 65 - 74
Age 75 - 84
Age 85+
0
0
0
0
0
0
0
0
0
0
Monthly Income
0 -
-Higher than
Unknown
0
0
0
0
0
0
0
0
Total
Average
0
000
0 Total 0 0
Ethnicity Hispanic
Other
Unknown
0
0
0
0
0
0
Living Situation
Alone
Null
Policy Change
0
0
0
0
0
0
Total 0 0 Unknown
With Caregiver
0
0
0
0
Race Asian 0 0
With Other
With Other Caregiver
0
0
0
0
American Indian Alaska Native
Black
0
0
0
0Total Living Situation 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority
White
0
0
0
0 Limited English Proficiency
Multiple
Unknown
Total Race
0
0
0
0
0
0
Yes
No
Unknown
0
0
0
0
0
0
Total 0 0
Sex Male
Female
Unknown
0
0
0
0
0
0
Total 0 0
Report run on 08312018 1056 AM Page 1 of 1 demo_by_provrdf
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Disaster Assistance Clients for a Provider PSA ALL Provider All Providers Location 0000 Worker All Workers City All Cities Zip Code All Zip Codes Sort By ZIP
Provider 1036 Provider Name Location 0000 Worker CIRTS18634
Need Care Client Name Address City Zip County Phone Asst Reg Situation Relat Care phone Care Name
34946 N WO DA 000 SAINT JAMES DRIVE CENTRAL (025) 101-0620 Test NameTest Name SAINT LUCIE (005) 100-0369 Y
Client is active and no assessment information is available Special Shelter and Special Registry are unknown
Report run on 08312018 1102 AM Page 1 of 8 disaster_by_provrdf
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
Total by PSA 0
Report run on 08312018 1111 AM Page 1 of 5 eheap_exceptionsrdf
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
ALACH BAKER BAY BRADF BREVA BROWA CALHO CHARL CITRUS CLAY COLLIE COLUM DESOT DIXIE DUVAL ESCAM FLAGL FRANK GADSDAssisted Household Report UA ORD RD RD UN OTTE R BIA O BIA ER LIN EN
1 of Household Assisted 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Households AssistedWith Gross Income
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C 100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D 125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
3 Households with at leastOne member
A 60 Years or older 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B Disabled 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C Age 5 years or under 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D Under 60 Years Old 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Undup Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Assisted
Applicant Household Report
of Applicant Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
Report run on 08312018 1111 AM Page 2 of 5 eheap_exceptionsrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Energy Assisted Household Report
County of Assisted
Households
Households Assisted By Poverty Level
Under 75 75 - 100 101 - 125 126 - 150 Over 150 60 Years or older
At least one member who is
Age 5 years Age 2 years Age 3 years Disabled or younger and younger through 5
Under 60 Years Old
Undup Households
Assisted
Energy Assistance Total
Report run on 08312018 1107 AM Page 1 of 3 eheap_summaryrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Unduplicated Total 0 0
County of Assisted
Households Under 75 75 - 100
Households Assisted By Poverty Level
101 - 125 126 - 150 Over 150 60 Years or older Disabled
Age 5 years or younger
Age 2 years and younger
Age 3 years through 5
Under 60 Years Old
At least one member who is
Undup Households
Assisted
Other Assisted Household Report
Other Assistance Total
Report run on 08312018 1107 AM Page 2 of 3 eheap_summaryrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Applicant Household Report
County of Applicant
Households Under 75 75 - 100 101 - 125 126 - 150 Over 150 Income data
unavailable
Total 0
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01
Enrollment Active Consumer Count by Program PSA ALL Provider ALL PROVIDERS
County Description Program Count of Clients
BREVARD
ADI
CCE
HCE
LSP
NDP
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
MLTC
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
31
57
44
5
62
123
141
26
9
7
5
40
5
50
67
129
2
19
42
29
1
233
79
63
8
2
14
3
37
14
47
3
3
33
127
10
02
03
04
ALACHUA
BAKER
BAY
BRADFORD
Report run on 08312018 1148 AM Page 1 of 18 actv_countrdf
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05
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Enrollment Terminations with Reasons PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 Program All Programs Program Status ALL Program Status Worker ALL WORKERS
Last First Program Medicaid Provider Start End Name Name Client ID Status Description Worker Number Program Location Enrollment Enrollment
Count 0
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Enrollments with Care Plan Report
PSA ALL Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTIVE STATUS Care Plan Service ALL SERVICES Care Plan Start 01012017 Care Plan End 12312017
Care Plan Care Plan Care Plan Client Name
Unduplicated Client Count 0
Client ID Program Status Worker Start Date End Date Service
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PSA CLIENT_ID CLIENT_NAME OWNER PROVIDER_ID ASSESSMENT_DATE ASSESSOR_NAME MEDICAID_NUMBER CAREGIVER_CHANGE ENVIRONMENT_CHANGE HEALTH_CHANGE INCOME_CHANGE SITUATION_CHANGE INITIAL_ASSM ANNUAL_ASSM SSN REFERRAL_SOURCE 1114 N N N N Y N 771771777 SELFFAMILY 812017 JANE CASEWORKER 2 1001141633 TEST TEST N
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Fixed Service Costs List PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Provider Location County Program Service Reimbursement Unit Rate Provider Cost Per Unit Begin Valid End Valid
Count 0
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Start End Worker Most Recent Nutr Medicaid Program Provider Location Client ID Client Name Status Enrollment Enrollment Worker Active Score Number
O3C2 1036 0000 4062000152 Test Name ACTV 02072011 CIRTS23407 N 3
1036 0000 4061594062 ISAACS HATTIE ACTV 11192012 CIRTS20804 Y 5
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Start End Worker Most Recent Nutr Medicaid Program Provider Location Client ID Client Name Status Enrollment Enrollment Worker Active Score Number
O3C2 1036 0000 4062379505 Test Name ACTV 11192012 CIRTS20804 Y 5
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Start End Worker Most Recent Nutr Medicaid Program Provider Location Client ID Client Name Status Enrollment Enrollment Worker Active Score Number
O3C2 1036 0000 4062401063 Test Name ACTV 10162013 CIRTS20804 Y 3
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Provider Location Client ID Client Name Program Status
Start Enrollment
End Enrollment Worker
Worker Active
Most Recent Nutr Score
Medicaid Number
O3C2 1036 0000 4062538939 ACTV 12082000 CIRTS20388 Y Test Name
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All Enrollments Counts During Date Range PSA ALL Start Date 01012017 End Date Location 0000 Provider Program Program Status
12312017 ALL PROVIDERS
ACTV
Group By Program Provider Location
Program Provider Location Client Count O3C1 1036 0000 45
1951 0000 3
O3C2 1036 0000 113
OA3E 1821 0000 2
OA3ES 1821 0000 1
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C1 1036 0000 4061950299 Test Name ACTV 04072011 CIRTS23407 N 11
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C1 1036 4062586019 Test Name ACTV 12292008 CIRTS23407 N 1
Total for Location 45
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C1 1951 0000 4062452921 Test Name ACTV 03301989 CIRTS22695 N 10
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4062786256 Test Name ACTV 09232013 CIRTS20804 Y 4 1
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4062380426 Test Name ACTV 04112012 CIRTS23407 N 55 2
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4061608826 Test Name ACTV 08102011 CIRTS18634 Y 7 3
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4062615533 Test Name ACTV 10032013 CIRTS20804 Y 6 3
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start Enrollment
End Enrollment Worker
Worker Active
Medicaid Number
Most Recent Nutr Score Rank
O3C2 1036 4062466582 Test Name ACTV 10262010 CIRTS23407 N 105 2
Total for Location 113
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PSA
APCL Clients With No Services ALL Owner All Owners Provider ALL PROVIDERS
Start Date 01012017 End Date 12312017
Includes Clients Receiving Only CM INSC SCAS CA REFE Services
PSA Client ID Client Name Owner Provider Program
Count 0
Unduplicated Clients Count 0
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APCL Clients With Services PSA ALL Owner All Owners Provider ALL PROVIDERS Start Date 01012017 End Date 12312017
Exclude CM CA INSC REFE SCAS
PSA Client ID Name Owner Provider Program 10 4062527553 Test Name 1539 1929 CCE
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APCL Clients With Services PSA ALL Owner All Owners Provider ALL PROVIDERS Start Date 01012017 End Date 12312017
Exclude CM CA INSC REFE SCAS
PSA Client ID Name Owner Provider Program 11 4062732638 Test Name 1177 1177 LTCC
Total 21067
Unduplicated clients count 12460
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APS Assessments PSA ALL Risk Level ALL Owner All Owners Referral Date From 01012017 To 12312017
Order by Referral Date and Owner ID
PSA 03
Ref Date Owner ID Client ID Client Name Risk Level Asmt Type Asmt Date
03032017 1390 4062058415 L 701A 03302018 Test Name
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APS Assessments PSA ALL Risk Level ALL Owner All Owners Referral Date From 01012017 To 12312017
Order by Referral Date and Owner ID
12042017 1980 4061617559 H 701B 12072017 Test Name
Assessment Count for the PSA 52
PSA 04A
Ref Date Owner ID Client ID
09102017 4062308458
Client Name
Test Name
Risk Level
H
Asmt Type
O
Asmt Date
09162017
Assessment Count for the PSA 2
Risk Level H
M
L
Count of Assessments 138
23
21
Total Count of Assessments 182
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APS Repeat Referrals in a Time Range
PSA ALL Owner All Owners
Start Date 01012017 End Date 12312017
Current DOEA CIRTS Cirts SSN if Risk Date Created PSA Owner Abuse No different than DCF DCF SSN Name County Level Date of Birth Date Sent by DCF
Count 0
Unduplicated Client Count by PSA
PSA Count SSN
Total
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Assessed Prioritized Consumer List PSA ALL Provider ALL PROVIDERS Program AC County ALL COUNTIES
County Program Consumer Name Client ID
Total Count 0
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Assessment Due Report PSA 01 Start Date 01012017 End Date 08312018 Owner ALL PROVIDERS Worker ALL WORKERS Program Status ACTV and APCL Assessment Type Needed ALL
Overdue and missing assessments are always listed
Owner ID 1065
Client ID Client Name
Owner Assessor ID
Date of Birth
06281928
CIRTS28099
County of Service
GULF
Worker Name HARPER KENNY
Zip Assessment PSA Date
32534 01 01022014
Type
701A
Active Y
Nutr PriorityScore Score
11 58
Rank
5
Due Date
01022015
Status
701S OVERDUE
LTCC APPL Start Date
03252014 4062235673 Test name
Total Clients for Worker 1
Total Clients for Owner 1
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Assessment Due Report PSA 01 Start Date 01012017 End Date 08312018 Owner ALL PROVIDERS Worker ALL WORKERS Program Status ACTV and APCL Assessment Type Needed ALL
Overdue and missing assessments are always listed
Summary by PSA
PSA 01 701A Overdue 1
701B Overdue 213
701C Overdue 0
701S Overdue 157
No 701A 0
No 701B 2
No 701C 0
No 701S 0
701A Not Overdue 0
701B Not Overdue 0
701C Not Overdue 0
701S Not Overdue 0
701S Optional 0
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CIC Service Units and Costs Projections County SummaryPSA 99 Program CCE
Start Date 01012017 End Date 12312017
County LEON
Total Total Total Avg Max Projected
StateFederal Projected Reimbursement Provider Unduplicated Provider Service Share Service Units Unit Rate Cost Per Unit Client Count
Report Total
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CIC Service Units and Costs Projections Provider SummaryPSA ALL Provider ALL PROVIDERS Program FEDERALLY FUNDED (0101 TO 1231) Year 2017 From 01012017 To 12312017
PSA County Program Service Total State
Federal Share
Total Projected
Service Units
Avg Reimbursement
Unit Rate
Max Provider
Cost Per Unit
Total Projected Unduplicated Client Count
02 FRANKLIN O3C1 CONGREGATE MEALS $810300 1710 15
Program Total
County Total
$810300
$810300
GULF O3C1 CONGREGATE MEALS $25205 3 5
Program Total $25205
O3C2 HOME DELIVERED MEALS $25205 3 6
Program Total
County Total
$25205
$50411
LEON O3C1 CONGREGATE MEALS $621300 1311 15
CONGREGATE MEALS GUEST
CONGREGATE MEALS VOLUNTEERS
$252055
$277260
25
30
2
5
Program Total $1150615
O3C2 HOME DELIVERED MEAL GUEST $252055 25 3
Program Total $252055
OA3D PEARLS (SESSION 5)
PEARLS (SESSION 6)
PEARLS (SESSION 7)
PEARLS (SESSION 8)
$10247
$10247
$10247
$10247
10
10
10
10
3
3
3
3
Program Total $40988
OA3E RESPITE IN-HOME $200 2 2
Program Total
County Total
$200
$1443858
WAKULLA O3C2 EMERGENCY HOME DELIVERED SHELF MEALS
$8065604 14899 90
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CIC Service Units and Costs Projections - PSA Summary
PSA ALL Program CCE
Strat Date 01012017 End Date 12312017
Total
PSA County Provider Service
Total State Federal
Share
Total Projected
Service Units
Avg Reimbursement
Unit Rate
Max Projected Provider Unduplicated
Cost Per Unit Client Count
02 LEON SOUTHERN SERVICE CASE MANAGEMENT PROVIDER EMERGENCY HOME DELIVERED SHELF MEALS
$2175533
$602000
483
689
32
20
HOME DELIVERED MEALS $530262 993 5
MATERIAL AID $1994536 199
Provider Total $5302331
CountyTotal $5302331
WAKULLA SOUTHERN SERVICE CASE MANAGEMENT PROVIDER EMERGENCY HOME DELIVERED SHELF MEALS
$2175533
$1240200
483
689
32
5
MATERIAL AID $1994536 199
Provider Total $5410269
CountyTotal $5410269
PSA Total $10712599
05 PINELLAS BURSTEIN-APPLEBEE ADULT DAY CARE $000 0 $900 $1000 0
COUNSELING (MENTAL HEALTH COUNSELINGSCREENING) - INDIVIDUAL
Provider Total
$000
$000
0 $6600 $7700 0
CountyTotal $000
PSA Total $000
Report Total $10712599
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CID Service Units and Costs Projections - PSA SummaryPSA ALL Program CCE
Start Date 01012017 End Date 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
PSA County Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
02 LEON CASE MANAGEMENT $2175533 483
EMERGENCY HOME $602000 689DELIVERED SHELF MEALS HOME DELIVERED MEALS $530262 993
MATERIAL AID $1994536 199
County Total $5302331 2364
WAKULLA CASE MANAGEMENT $2175533 483
EMERGENCY HOME $1240200 689DELIVERED SHELF MEALS MATERIAL AID $1994536 199
County Total $5410269 1371
PSA Total $10712599 3735
05 PINELLAS ADULT DAY CARE $000 0
COUNSELING (MENTAL $000 0 HEALTH COUNSELINGSCREENING) - INDIVIDUAL
County Total $000 0
PSA Total $000 0
Report Total $10712599 3735
$900 $900 $900 $1000 $1000 $1000
$6600 $6600 $6600 $7700 $7700 $7700
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CID Service Units and Costs Projections County SummaryPSA 99
Program CCE County LEON
Start Date 01012017 End Date 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
Report Total
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CIE Service Units and Costs Projections - PSA Summary - All Programs
PSA 99 Program FEDERALLY FUNDED (0101 TO 1231) Year 2017 From 01012017 To 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
Program Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
Report Total
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CIE Service Units and Costs Projections - PSA Summary
PSA ALL Program CCE
Start Date 01012017 End Date 12312017
Avg High Low Total Total Avg High Low Provider Provider Provider
StateFederal Projected Reimbursement Reimbursement Reimbursement Cost Cost CostPSA
02
Service
CASE MANAGEMENT
Share
$4351066
Service Units
966
Unit Rate Unit Rate Unit Rate Per Unit Per Unit Per Unit
EMERGENCY HOME DELIVERED SHELF MEALS $1842200 1378
HOME DELIVERED MEALS $530262 993
MATERIAL AID $3989071 398
PSA Total $10712599 3735
05 ADULT DAY CARE $000 0 $900 $900 $900 $1000 $1000 $1000
COUNSELING (MENTAL HEALTH $000 0 $6600 $6600 $6600 $7700 $7700 $7700 COUNSELINGSCREENING) - INDIVIDUAL
PSA Total $000 0
Report Total $10712599 3735
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CAREGIVER SEARCH REPORT
SEARCH RESULTS FOR CONSUMERS
Criteria First Name Last Name SSN PSA ALL
Client Name Client SSN Caregiver Name Caregiver SSN
000000000 000000000 Test Name Test Name
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CARES Referrals in a Time Range PSA ALL
Start Date 01012017 End Date 12312017
Referred to ALL REFERRALS
Referring PSA Employee Name Client Name Client ID
Referral Imminent NH Admit Aging Date Risk Date Referred To Cares Provider Name Received Date
03A 4061561263 Test Name Test Name 09242017 Y 05292017 ARC or ADRC 09252017
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CARES Referrals in a Time Range PSA ALL
Start Date 01012017 End Date 12312017
Referred to ALL REFERRALS
Referring PSA Employee Name Client Name Client ID
Referral Date
Imminent Risk
NH Admit Date Referred To Cares Provider Name
Aging Received Date
04B Test Name Test Name 4061738075 04082017 N ARC or ADRC Test Name 04082017
Total Clients 110
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CARES Referrals not acknowledged by the Aging Network PSA ALL For Referrals after 01012017 Owner ID ALL Owners
Unduplicated Client count Cares Office Total Clients Count
Report Total
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
CIRTS Issue PSA Client ID Client Name Program
Program Status Start Provider Enrollment ID Provider Name
APCL CLIENT WITH DATE OF DEATH 08 4061759417 Test Name OA3B APCL 07232013 1141 WESTERN WORLD RADIO
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
Program Start Provider CIRTS Issue PSA Client ID Client Name Program Status Enrollment ID Provider Name
06 LTCC APCL 01242014 1514 4061713685 Test Name APCL CLIENT WITH DATE OF DEATH CENTRAL THE ORIGINAL HOUSE OF PIES
Count 503
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Civil Rights PSA ALL Provider ALL PROVIDERS Program AC Start Date 01012017 End Date 12312017 The Poverty Level for Single is The Poverty Level for Couple is Sort by County
County Unduplicated Count
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Client Information Report Start Date 01012017 End Date 12312017
Client ID 1001141246
Emergency
Client Name Test Name
Telephone () - Address 78 TEST STREET TALLAHASSEE FL 32399
Most Recent Caregiver Information Date Updated
Doctor
Comments
Client Demographic Information
Birth Date 06041940 Race W
Owner ID Ethnicity O
Most Recent Income Information
Ind Mon Inc Cpl Mon Inc
Ind Assets Couple Assets
Most Recent Assessment Information
Asmt Date Ref Risk Lvl
Asmt Site Spec Shel
AsmtType Spec Reg
Ref Date Primary CG
Ref Source Living Sit
Enrollment Information
Sex
Marital Status
F
S
Medicaid Number
ADL Score
ADL Count
IADL Score
IADL Count
Memory Score
Priority Score
Env Score
Nutr Score
Risk Score
Social Score
Rank
Provider Location Program Program Status Worker Start Date End Date
Care Plan Service Needed
Date Service Units Type Frq End Date
Care Plan Service Planned
Program Service Units Type Frq Start Date End Date
Services Received between 01012017 and 12312017
Service Billed Provider Location Worker Program Service Date Units Unit Type Amount
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Provider N
Client Service Units Report PSA ALL Provider ALL PROVIDERS Location 0000
Program ALL PROGRAMS Service ALL SERVICES Worker ALL WORKERS
City ALL CITIES Include Zero Unit N Include Aggregate N Calculated Amount equals the number of Units Provided times Fixed Cost if it existsService Start Date 01012017 Service End Date 12312017 If Fixed Cost does not exist Calculated
Group by PSA Provider Location Client Name County Worker Amount equals Billed Amount
Unduplicated Client Count 0 Grand Total 000 $000
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Clients In Common PSA All Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 County All Counties Worker All Workers
County JEFFERSON
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
MIAMI-DADE
0 0 0 0 0 0 0 0 0
4061539538 Test NameCounty Count
County
0 01
X
0 1
X
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
4061650856 Test Name X 4061486560 Test Name X 4062452921 Test Name X
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Clients Served Not Enrolled PSA ALL Start Date 01012017 End Date 12312017 Locations 0000 Provider All Providers
Service Service Min Serv Max Serv Program Start End Enrollment PSA Provider Location Program Consumer Name Client ID Service Date Date Status Enrollment Enrollment Provider
Count 0
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
4061472791 04
09
1092
1291
0072
0042
LTCC
LTCC
APCL
APCL
4062714543 06
06
1514
1762
0072
5006
LTCC
LTCC
APCL
APPL
4061802246 11
06
1177
1514
0179
0072
LTCC
LTCC
APCL
APCL
4061563719 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062644312 06
08
1514
1771
0072
0896
LTCC
LTCC
APCL
APCL
1001141670 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
1001141671 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
4062375003 07
05
05
07
1263
1755
1638
1263
0368
0072
0072
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062155124 06
06
1762
1514
0072
0072
LTCC
LTCC
APPL
APCL
4061743886 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0369
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4061499927 06
06
1514
1762
0072
5005
LTCC
LTCC
APCL
APPL
4061583524 08
06
1144
1514
0896
0072
LTCC
LTCC
APCL
APCL
4062694843 06
03
1514
1922
0072
0179
LTCC
LTCC
APCL
APCL
4062744517 07
06
1263
1514
0369
0072
LTCC
LTCC
APCL
APCL
4062005488 10
11
10
11
1929
1177
1164
1177
0072
0073
0179
0179
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
Total Count 15
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CODE DESCRIPTIONS Category ALL STATE TABLES
Code Description Active Available To Code Category
0 UNKNOWN Y CARES SUBJECTIVE_HEALTH_EVALUATION
01 ALACHUA Y COMMON COUNTIES
02 BAKER Y COMMON COUNTIES
03 BAY Y COMMON COUNTIES
04 BRADFORD Y COMMON COUNTIES
05 BREVARD Y COMMON COUNTIES
06 BROWARD Y COMMON COUNTIES
07 CALHOUN Y COMMON COUNTIES
08 CHARLOTTE Y COMMON COUNTIES
09 CITRUS Y COMMON COUNTIES
1 EXCELLENT Y CARES SUBJECTIVE_HEALTH_EVALUATION
10 CLAY Y COMMON COUNTIES
11 COLLIER Y COMMON COUNTIES
12 COLUMBIA Y COMMON COUNTIES
13 MIAMI-DADE Y COMMON COUNTIES
14 DESOTO Y COMMON COUNTIES
15 DIXIE Y COMMON COUNTIES
16 DUVAL Y COMMON COUNTIES
17 ESCAMBIA Y COMMON COUNTIES
18 FLAGLER Y COMMON COUNTIES
19 FRANKLIN Y COMMON COUNTIES
2 GOOD Y CARES SUBJECTIVE_HEALTH_EVALUATION
20 GADSDEN Y COMMON COUNTIES
21 GILCHRIST Y COMMON COUNTIES
22 GLADES Y COMMON COUNTIES
23 GULF Y COMMON COUNTIES
24 HAMILTON Y COMMON COUNTIES
25 HARDEE Y COMMON COUNTIES
26 HENDRY Y COMMON COUNTIES
27 HERNANDO Y COMMON COUNTIES
28 HIGHLANDS Y COMMON COUNTIES
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CONSUMER AGE VERIFICATION REPORT PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Program AC
Age at Start
Enroll or Start Enroll Provider Program Description Consumer Name Client ID DOB Svc date or Svc Date
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Contract Budget Information PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Program Service Provider Location County Served Provider Contract
Projected Service
Units Unit Measure
Projected Unduplicated
State Federal Share Client Count Begin Date End Date
Row Count 0 Amount Total
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Start Enroll Latest Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Date Asmt Date Worker
O3C1 1036 000 4061653427 Test CENTRAL 34982 W M 07091930 09102013 09102013 CIRTS20804 0 Name
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Start Enroll Date
Latest Asmt Date Worker
4061593624 Test Name CENTRAL 34946 B F 11261940 12012011 12312013 CIRTS23407
Count 164
Unduplicated Client Count 163
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Assessments After DOD Report
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Owner 1025
The shaded records indicate clients who have different DOBs andor different names
Assemt Current PSA Owner Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Owner Assessor
Provider Assessor
Assemt Date
Assemt Type
Unduplicated Count Total 0
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Open Enrollments
The Vital Statistics Data for 07192002 - 09112014PSA ALL Provider ALL Program Status ACTV Include MLTC ACTVS N
The shaded records indicate clients who have different DOBs andor different names
Enroll PSA
Enrollment Provider Loc Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Enroll Program Status
Enroll Program
Current Owner ID
02 1065 0072 4062244026 Test Name Test Name 10222004 03231917 03231917 ACTV CCE 1065
Count of enrollments for the Provider 1
Count of enrollments for the PSA 1
Count of enrollments for the Report 1
Unduplicated Count of Individuals with open enrollments and DOD PSA Total Clients Count
02 1
Total 1
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Unduplicated count of individuals with Services after DOD
PSA Total Clients Count
Report Total
Report run on 08312018 0207 PM Page 2 of 3 vs_servicesrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
List of Clients with PSA table entry for SERVICES_AFTER_DOD
Unduplicated Count Total 0
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Age
Provider
Total
Age lt 60 Age 60 - 64 Age 65 - 74 Age 75 - 84 Age 85+ Total Clients Avg Age
Total
Avg Age
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Ethnicity
Provider Hispanic Other Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Race
American Indian Native Hawaiian Other Provider Asian Alaska Native Black Pacific Islander Minority White Multiple Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Gender
Provider Male Female Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Monthly Income
Provider 0 - - Higher than Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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None
Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Total Persons Served 0
Age lt 60 Years 0 0
Age 60 - 64 0 0
Age 65 - 74 0 0
Age 75 - 84 0 0
Age 85+ 0 0
Total Age 0 0
Average 000
Ethnicity Hispanic 0 0
Other Ethnicity 0 0
Unknown Ethnicity 0 0
Total 0 0
Race Asian 0 0
American Indian Alaska Native 0 0
Black 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority 0 0
White 0 0
Multiple 0 0
Unknown 0 0
Total 0 0
Sex Male 0 0
Female 0 0
Unknown Sex 0 0
Total 0 0
Monthly Income 0 - 0 0
- 0 0
Higher than 0 0
Unknown 0 0
Total 0 0
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Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Client ID Date Of Birth Ethnicity Race Sex Individual Monthly Income
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Demographics of Clients OAA Registered Served Only PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 City All Cities Program All Programs Service All Services County ALL COUNTIES Table OAA Registered Services Only Low Income Medium Income
Total Persons Served 0
Agelt 60 Years
Age 60 - 64
Age 65 - 74
Age 75 - 84
Age 85+
0
0
0
0
0
0
0
0
0
0
Monthly Income
0 -
-Higher than
Unknown
0
0
0
0
0
0
0
0
Total
Average
0
000
0 Total 0 0
Ethnicity Hispanic
Other
Unknown
0
0
0
0
0
0
Living Situation
Alone
Null
Policy Change
0
0
0
0
0
0
Total 0 0 Unknown
With Caregiver
0
0
0
0
Race Asian 0 0
With Other
With Other Caregiver
0
0
0
0
American Indian Alaska Native
Black
0
0
0
0Total Living Situation 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority
White
0
0
0
0 Limited English Proficiency
Multiple
Unknown
Total Race
0
0
0
0
0
0
Yes
No
Unknown
0
0
0
0
0
0
Total 0 0
Sex Male
Female
Unknown
0
0
0
0
0
0
Total 0 0
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Disaster Assistance Clients for a Provider PSA ALL Provider All Providers Location 0000 Worker All Workers City All Cities Zip Code All Zip Codes Sort By ZIP
Provider 1036 Provider Name Location 0000 Worker CIRTS18634
Need Care Client Name Address City Zip County Phone Asst Reg Situation Relat Care phone Care Name
34946 N WO DA 000 SAINT JAMES DRIVE CENTRAL (025) 101-0620 Test NameTest Name SAINT LUCIE (005) 100-0369 Y
Client is active and no assessment information is available Special Shelter and Special Registry are unknown
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
Total by PSA 0
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
ALACH BAKER BAY BRADF BREVA BROWA CALHO CHARL CITRUS CLAY COLLIE COLUM DESOT DIXIE DUVAL ESCAM FLAGL FRANK GADSDAssisted Household Report UA ORD RD RD UN OTTE R BIA O BIA ER LIN EN
1 of Household Assisted 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Households AssistedWith Gross Income
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C 100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D 125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
3 Households with at leastOne member
A 60 Years or older 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B Disabled 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C Age 5 years or under 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D Under 60 Years Old 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Undup Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Assisted
Applicant Household Report
of Applicant Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Energy Assisted Household Report
County of Assisted
Households
Households Assisted By Poverty Level
Under 75 75 - 100 101 - 125 126 - 150 Over 150 60 Years or older
At least one member who is
Age 5 years Age 2 years Age 3 years Disabled or younger and younger through 5
Under 60 Years Old
Undup Households
Assisted
Energy Assistance Total
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Unduplicated Total 0 0
County of Assisted
Households Under 75 75 - 100
Households Assisted By Poverty Level
101 - 125 126 - 150 Over 150 60 Years or older Disabled
Age 5 years or younger
Age 2 years and younger
Age 3 years through 5
Under 60 Years Old
At least one member who is
Undup Households
Assisted
Other Assisted Household Report
Other Assistance Total
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Applicant Household Report
County of Applicant
Households Under 75 75 - 100 101 - 125 126 - 150 Over 150 Income data
unavailable
Total 0
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01
Enrollment Active Consumer Count by Program PSA ALL Provider ALL PROVIDERS
County Description Program Count of Clients
BREVARD
ADI
CCE
HCE
LSP
NDP
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
MLTC
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
31
57
44
5
62
123
141
26
9
7
5
40
5
50
67
129
2
19
42
29
1
233
79
63
8
2
14
3
37
14
47
3
3
33
127
10
02
03
04
ALACHUA
BAKER
BAY
BRADFORD
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Enrollment Terminations with Reasons PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 Program All Programs Program Status ALL Program Status Worker ALL WORKERS
Last First Program Medicaid Provider Start End Name Name Client ID Status Description Worker Number Program Location Enrollment Enrollment
Count 0
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Enrollments with Care Plan Report
PSA ALL Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTIVE STATUS Care Plan Service ALL SERVICES Care Plan Start 01012017 Care Plan End 12312017
Care Plan Care Plan Care Plan Client Name
Unduplicated Client Count 0
Client ID Program Status Worker Start Date End Date Service
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PSA CLIENT_ID CLIENT_NAME OWNER PROVIDER_ID ASSESSMENT_DATE ASSESSOR_NAME MEDICAID_NUMBER CAREGIVER_CHANGE ENVIRONMENT_CHANGE HEALTH_CHANGE INCOME_CHANGE SITUATION_CHANGE INITIAL_ASSM ANNUAL_ASSM SSN REFERRAL_SOURCE 1114 N N N N Y N 771771777 SELFFAMILY 812017 JANE CASEWORKER 2 1001141633 TEST TEST N
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Fixed Service Costs List PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Provider Location County Program Service Reimbursement Unit Rate Provider Cost Per Unit Begin Valid End Valid
Count 0
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Start End Worker Most Recent Nutr Medicaid Program Provider Location Client ID Client Name Status Enrollment Enrollment Worker Active Score Number
O3C2 1036 0000 4062379505 Test Name ACTV 11192012 CIRTS20804 Y 5
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Start End Worker Most Recent Nutr Medicaid Program Provider Location Client ID Client Name Status Enrollment Enrollment Worker Active Score Number
O3C2 1036 0000 4062401063 Test Name ACTV 10162013 CIRTS20804 Y 3
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Provider Location Client ID Client Name Program Status
Start Enrollment
End Enrollment Worker
Worker Active
Most Recent Nutr Score
Medicaid Number
O3C2 1036 0000 4062538939 ACTV 12082000 CIRTS20388 Y Test Name
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All Enrollments Counts During Date Range PSA ALL Start Date 01012017 End Date Location 0000 Provider Program Program Status
12312017 ALL PROVIDERS
ACTV
Group By Program Provider Location
Program Provider Location Client Count O3C1 1036 0000 45
1951 0000 3
O3C2 1036 0000 113
OA3E 1821 0000 2
OA3ES 1821 0000 1
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C1 1036 0000 4061950299 Test Name ACTV 04072011 CIRTS23407 N 11
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C1 1036 4062586019 Test Name ACTV 12292008 CIRTS23407 N 1
Total for Location 45
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C1 1951 0000 4062452921 Test Name ACTV 03301989 CIRTS22695 N 10
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4062786256 Test Name ACTV 09232013 CIRTS20804 Y 4 1
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4062380426 Test Name ACTV 04112012 CIRTS23407 N 55 2
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4061608826 Test Name ACTV 08102011 CIRTS18634 Y 7 3
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4062615533 Test Name ACTV 10032013 CIRTS20804 Y 6 3
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start Enrollment
End Enrollment Worker
Worker Active
Medicaid Number
Most Recent Nutr Score Rank
O3C2 1036 4062466582 Test Name ACTV 10262010 CIRTS23407 N 105 2
Total for Location 113
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PSA
APCL Clients With No Services ALL Owner All Owners Provider ALL PROVIDERS
Start Date 01012017 End Date 12312017
Includes Clients Receiving Only CM INSC SCAS CA REFE Services
PSA Client ID Client Name Owner Provider Program
Count 0
Unduplicated Clients Count 0
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APCL Clients With Services PSA ALL Owner All Owners Provider ALL PROVIDERS Start Date 01012017 End Date 12312017
Exclude CM CA INSC REFE SCAS
PSA Client ID Name Owner Provider Program 10 4062527553 Test Name 1539 1929 CCE
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APCL Clients With Services PSA ALL Owner All Owners Provider ALL PROVIDERS Start Date 01012017 End Date 12312017
Exclude CM CA INSC REFE SCAS
PSA Client ID Name Owner Provider Program 11 4062732638 Test Name 1177 1177 LTCC
Total 21067
Unduplicated clients count 12460
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APS Assessments PSA ALL Risk Level ALL Owner All Owners Referral Date From 01012017 To 12312017
Order by Referral Date and Owner ID
PSA 03
Ref Date Owner ID Client ID Client Name Risk Level Asmt Type Asmt Date
03032017 1390 4062058415 L 701A 03302018 Test Name
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APS Assessments PSA ALL Risk Level ALL Owner All Owners Referral Date From 01012017 To 12312017
Order by Referral Date and Owner ID
12042017 1980 4061617559 H 701B 12072017 Test Name
Assessment Count for the PSA 52
PSA 04A
Ref Date Owner ID Client ID
09102017 4062308458
Client Name
Test Name
Risk Level
H
Asmt Type
O
Asmt Date
09162017
Assessment Count for the PSA 2
Risk Level H
M
L
Count of Assessments 138
23
21
Total Count of Assessments 182
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APS Repeat Referrals in a Time Range
PSA ALL Owner All Owners
Start Date 01012017 End Date 12312017
Current DOEA CIRTS Cirts SSN if Risk Date Created PSA Owner Abuse No different than DCF DCF SSN Name County Level Date of Birth Date Sent by DCF
Count 0
Unduplicated Client Count by PSA
PSA Count SSN
Total
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Assessed Prioritized Consumer List PSA ALL Provider ALL PROVIDERS Program AC County ALL COUNTIES
County Program Consumer Name Client ID
Total Count 0
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Assessment Due Report PSA 01 Start Date 01012017 End Date 08312018 Owner ALL PROVIDERS Worker ALL WORKERS Program Status ACTV and APCL Assessment Type Needed ALL
Overdue and missing assessments are always listed
Owner ID 1065
Client ID Client Name
Owner Assessor ID
Date of Birth
06281928
CIRTS28099
County of Service
GULF
Worker Name HARPER KENNY
Zip Assessment PSA Date
32534 01 01022014
Type
701A
Active Y
Nutr PriorityScore Score
11 58
Rank
5
Due Date
01022015
Status
701S OVERDUE
LTCC APPL Start Date
03252014 4062235673 Test name
Total Clients for Worker 1
Total Clients for Owner 1
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Assessment Due Report PSA 01 Start Date 01012017 End Date 08312018 Owner ALL PROVIDERS Worker ALL WORKERS Program Status ACTV and APCL Assessment Type Needed ALL
Overdue and missing assessments are always listed
Summary by PSA
PSA 01 701A Overdue 1
701B Overdue 213
701C Overdue 0
701S Overdue 157
No 701A 0
No 701B 2
No 701C 0
No 701S 0
701A Not Overdue 0
701B Not Overdue 0
701C Not Overdue 0
701S Not Overdue 0
701S Optional 0
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CIC Service Units and Costs Projections County SummaryPSA 99 Program CCE
Start Date 01012017 End Date 12312017
County LEON
Total Total Total Avg Max Projected
StateFederal Projected Reimbursement Provider Unduplicated Provider Service Share Service Units Unit Rate Cost Per Unit Client Count
Report Total
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CIC Service Units and Costs Projections Provider SummaryPSA ALL Provider ALL PROVIDERS Program FEDERALLY FUNDED (0101 TO 1231) Year 2017 From 01012017 To 12312017
PSA County Program Service Total State
Federal Share
Total Projected
Service Units
Avg Reimbursement
Unit Rate
Max Provider
Cost Per Unit
Total Projected Unduplicated Client Count
02 FRANKLIN O3C1 CONGREGATE MEALS $810300 1710 15
Program Total
County Total
$810300
$810300
GULF O3C1 CONGREGATE MEALS $25205 3 5
Program Total $25205
O3C2 HOME DELIVERED MEALS $25205 3 6
Program Total
County Total
$25205
$50411
LEON O3C1 CONGREGATE MEALS $621300 1311 15
CONGREGATE MEALS GUEST
CONGREGATE MEALS VOLUNTEERS
$252055
$277260
25
30
2
5
Program Total $1150615
O3C2 HOME DELIVERED MEAL GUEST $252055 25 3
Program Total $252055
OA3D PEARLS (SESSION 5)
PEARLS (SESSION 6)
PEARLS (SESSION 7)
PEARLS (SESSION 8)
$10247
$10247
$10247
$10247
10
10
10
10
3
3
3
3
Program Total $40988
OA3E RESPITE IN-HOME $200 2 2
Program Total
County Total
$200
$1443858
WAKULLA O3C2 EMERGENCY HOME DELIVERED SHELF MEALS
$8065604 14899 90
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CIC Service Units and Costs Projections - PSA Summary
PSA ALL Program CCE
Strat Date 01012017 End Date 12312017
Total
PSA County Provider Service
Total State Federal
Share
Total Projected
Service Units
Avg Reimbursement
Unit Rate
Max Projected Provider Unduplicated
Cost Per Unit Client Count
02 LEON SOUTHERN SERVICE CASE MANAGEMENT PROVIDER EMERGENCY HOME DELIVERED SHELF MEALS
$2175533
$602000
483
689
32
20
HOME DELIVERED MEALS $530262 993 5
MATERIAL AID $1994536 199
Provider Total $5302331
CountyTotal $5302331
WAKULLA SOUTHERN SERVICE CASE MANAGEMENT PROVIDER EMERGENCY HOME DELIVERED SHELF MEALS
$2175533
$1240200
483
689
32
5
MATERIAL AID $1994536 199
Provider Total $5410269
CountyTotal $5410269
PSA Total $10712599
05 PINELLAS BURSTEIN-APPLEBEE ADULT DAY CARE $000 0 $900 $1000 0
COUNSELING (MENTAL HEALTH COUNSELINGSCREENING) - INDIVIDUAL
Provider Total
$000
$000
0 $6600 $7700 0
CountyTotal $000
PSA Total $000
Report Total $10712599
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CID Service Units and Costs Projections - PSA SummaryPSA ALL Program CCE
Start Date 01012017 End Date 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
PSA County Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
02 LEON CASE MANAGEMENT $2175533 483
EMERGENCY HOME $602000 689DELIVERED SHELF MEALS HOME DELIVERED MEALS $530262 993
MATERIAL AID $1994536 199
County Total $5302331 2364
WAKULLA CASE MANAGEMENT $2175533 483
EMERGENCY HOME $1240200 689DELIVERED SHELF MEALS MATERIAL AID $1994536 199
County Total $5410269 1371
PSA Total $10712599 3735
05 PINELLAS ADULT DAY CARE $000 0
COUNSELING (MENTAL $000 0 HEALTH COUNSELINGSCREENING) - INDIVIDUAL
County Total $000 0
PSA Total $000 0
Report Total $10712599 3735
$900 $900 $900 $1000 $1000 $1000
$6600 $6600 $6600 $7700 $7700 $7700
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CID Service Units and Costs Projections County SummaryPSA 99
Program CCE County LEON
Start Date 01012017 End Date 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
Report Total
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CIE Service Units and Costs Projections - PSA Summary - All Programs
PSA 99 Program FEDERALLY FUNDED (0101 TO 1231) Year 2017 From 01012017 To 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
Program Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
Report Total
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CIE Service Units and Costs Projections - PSA Summary
PSA ALL Program CCE
Start Date 01012017 End Date 12312017
Avg High Low Total Total Avg High Low Provider Provider Provider
StateFederal Projected Reimbursement Reimbursement Reimbursement Cost Cost CostPSA
02
Service
CASE MANAGEMENT
Share
$4351066
Service Units
966
Unit Rate Unit Rate Unit Rate Per Unit Per Unit Per Unit
EMERGENCY HOME DELIVERED SHELF MEALS $1842200 1378
HOME DELIVERED MEALS $530262 993
MATERIAL AID $3989071 398
PSA Total $10712599 3735
05 ADULT DAY CARE $000 0 $900 $900 $900 $1000 $1000 $1000
COUNSELING (MENTAL HEALTH $000 0 $6600 $6600 $6600 $7700 $7700 $7700 COUNSELINGSCREENING) - INDIVIDUAL
PSA Total $000 0
Report Total $10712599 3735
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CAREGIVER SEARCH REPORT
SEARCH RESULTS FOR CONSUMERS
Criteria First Name Last Name SSN PSA ALL
Client Name Client SSN Caregiver Name Caregiver SSN
000000000 000000000 Test Name Test Name
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CARES Referrals in a Time Range PSA ALL
Start Date 01012017 End Date 12312017
Referred to ALL REFERRALS
Referring PSA Employee Name Client Name Client ID
Referral Imminent NH Admit Aging Date Risk Date Referred To Cares Provider Name Received Date
03A 4061561263 Test Name Test Name 09242017 Y 05292017 ARC or ADRC 09252017
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CARES Referrals in a Time Range PSA ALL
Start Date 01012017 End Date 12312017
Referred to ALL REFERRALS
Referring PSA Employee Name Client Name Client ID
Referral Date
Imminent Risk
NH Admit Date Referred To Cares Provider Name
Aging Received Date
04B Test Name Test Name 4061738075 04082017 N ARC or ADRC Test Name 04082017
Total Clients 110
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CARES Referrals not acknowledged by the Aging Network PSA ALL For Referrals after 01012017 Owner ID ALL Owners
Unduplicated Client count Cares Office Total Clients Count
Report Total
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
CIRTS Issue PSA Client ID Client Name Program
Program Status Start Provider Enrollment ID Provider Name
APCL CLIENT WITH DATE OF DEATH 08 4061759417 Test Name OA3B APCL 07232013 1141 WESTERN WORLD RADIO
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
Program Start Provider CIRTS Issue PSA Client ID Client Name Program Status Enrollment ID Provider Name
06 LTCC APCL 01242014 1514 4061713685 Test Name APCL CLIENT WITH DATE OF DEATH CENTRAL THE ORIGINAL HOUSE OF PIES
Count 503
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Civil Rights PSA ALL Provider ALL PROVIDERS Program AC Start Date 01012017 End Date 12312017 The Poverty Level for Single is The Poverty Level for Couple is Sort by County
County Unduplicated Count
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Client Information Report Start Date 01012017 End Date 12312017
Client ID 1001141246
Emergency
Client Name Test Name
Telephone () - Address 78 TEST STREET TALLAHASSEE FL 32399
Most Recent Caregiver Information Date Updated
Doctor
Comments
Client Demographic Information
Birth Date 06041940 Race W
Owner ID Ethnicity O
Most Recent Income Information
Ind Mon Inc Cpl Mon Inc
Ind Assets Couple Assets
Most Recent Assessment Information
Asmt Date Ref Risk Lvl
Asmt Site Spec Shel
AsmtType Spec Reg
Ref Date Primary CG
Ref Source Living Sit
Enrollment Information
Sex
Marital Status
F
S
Medicaid Number
ADL Score
ADL Count
IADL Score
IADL Count
Memory Score
Priority Score
Env Score
Nutr Score
Risk Score
Social Score
Rank
Provider Location Program Program Status Worker Start Date End Date
Care Plan Service Needed
Date Service Units Type Frq End Date
Care Plan Service Planned
Program Service Units Type Frq Start Date End Date
Services Received between 01012017 and 12312017
Service Billed Provider Location Worker Program Service Date Units Unit Type Amount
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Provider N
Client Service Units Report PSA ALL Provider ALL PROVIDERS Location 0000
Program ALL PROGRAMS Service ALL SERVICES Worker ALL WORKERS
City ALL CITIES Include Zero Unit N Include Aggregate N Calculated Amount equals the number of Units Provided times Fixed Cost if it existsService Start Date 01012017 Service End Date 12312017 If Fixed Cost does not exist Calculated
Group by PSA Provider Location Client Name County Worker Amount equals Billed Amount
Unduplicated Client Count 0 Grand Total 000 $000
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Clients In Common PSA All Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 County All Counties Worker All Workers
County JEFFERSON
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
MIAMI-DADE
0 0 0 0 0 0 0 0 0
4061539538 Test NameCounty Count
County
0 01
X
0 1
X
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
4061650856 Test Name X 4061486560 Test Name X 4062452921 Test Name X
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Clients Served Not Enrolled PSA ALL Start Date 01012017 End Date 12312017 Locations 0000 Provider All Providers
Service Service Min Serv Max Serv Program Start End Enrollment PSA Provider Location Program Consumer Name Client ID Service Date Date Status Enrollment Enrollment Provider
Count 0
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
4061472791 04
09
1092
1291
0072
0042
LTCC
LTCC
APCL
APCL
4062714543 06
06
1514
1762
0072
5006
LTCC
LTCC
APCL
APPL
4061802246 11
06
1177
1514
0179
0072
LTCC
LTCC
APCL
APCL
4061563719 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062644312 06
08
1514
1771
0072
0896
LTCC
LTCC
APCL
APCL
1001141670 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
1001141671 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
4062375003 07
05
05
07
1263
1755
1638
1263
0368
0072
0072
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062155124 06
06
1762
1514
0072
0072
LTCC
LTCC
APPL
APCL
4061743886 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0369
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4061499927 06
06
1514
1762
0072
5005
LTCC
LTCC
APCL
APPL
4061583524 08
06
1144
1514
0896
0072
LTCC
LTCC
APCL
APCL
4062694843 06
03
1514
1922
0072
0179
LTCC
LTCC
APCL
APCL
4062744517 07
06
1263
1514
0369
0072
LTCC
LTCC
APCL
APCL
4062005488 10
11
10
11
1929
1177
1164
1177
0072
0073
0179
0179
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
Total Count 15
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CODE DESCRIPTIONS Category ALL STATE TABLES
Code Description Active Available To Code Category
0 UNKNOWN Y CARES SUBJECTIVE_HEALTH_EVALUATION
01 ALACHUA Y COMMON COUNTIES
02 BAKER Y COMMON COUNTIES
03 BAY Y COMMON COUNTIES
04 BRADFORD Y COMMON COUNTIES
05 BREVARD Y COMMON COUNTIES
06 BROWARD Y COMMON COUNTIES
07 CALHOUN Y COMMON COUNTIES
08 CHARLOTTE Y COMMON COUNTIES
09 CITRUS Y COMMON COUNTIES
1 EXCELLENT Y CARES SUBJECTIVE_HEALTH_EVALUATION
10 CLAY Y COMMON COUNTIES
11 COLLIER Y COMMON COUNTIES
12 COLUMBIA Y COMMON COUNTIES
13 MIAMI-DADE Y COMMON COUNTIES
14 DESOTO Y COMMON COUNTIES
15 DIXIE Y COMMON COUNTIES
16 DUVAL Y COMMON COUNTIES
17 ESCAMBIA Y COMMON COUNTIES
18 FLAGLER Y COMMON COUNTIES
19 FRANKLIN Y COMMON COUNTIES
2 GOOD Y CARES SUBJECTIVE_HEALTH_EVALUATION
20 GADSDEN Y COMMON COUNTIES
21 GILCHRIST Y COMMON COUNTIES
22 GLADES Y COMMON COUNTIES
23 GULF Y COMMON COUNTIES
24 HAMILTON Y COMMON COUNTIES
25 HARDEE Y COMMON COUNTIES
26 HENDRY Y COMMON COUNTIES
27 HERNANDO Y COMMON COUNTIES
28 HIGHLANDS Y COMMON COUNTIES
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CONSUMER AGE VERIFICATION REPORT PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Program AC
Age at Start
Enroll or Start Enroll Provider Program Description Consumer Name Client ID DOB Svc date or Svc Date
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Contract Budget Information PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Program Service Provider Location County Served Provider Contract
Projected Service
Units Unit Measure
Projected Unduplicated
State Federal Share Client Count Begin Date End Date
Row Count 0 Amount Total
Report run on 08312018 0233 PM Page 1 of 1 contract_budgetrdf
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Start Enroll Latest Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Date Asmt Date Worker
O3C1 1036 000 4061653427 Test CENTRAL 34982 W M 07091930 09102013 09102013 CIRTS20804 0 Name
Report run on 08312018 1133 AM Page 1 of 6 actv_by_progrdf
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Start Enroll Date
Latest Asmt Date Worker
4061593624 Test Name CENTRAL 34946 B F 11261940 12012011 12312013 CIRTS23407
Count 164
Unduplicated Client Count 163
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Assessments After DOD Report
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Owner 1025
The shaded records indicate clients who have different DOBs andor different names
Assemt Current PSA Owner Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Owner Assessor
Provider Assessor
Assemt Date
Assemt Type
Unduplicated Count Total 0
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Open Enrollments
The Vital Statistics Data for 07192002 - 09112014PSA ALL Provider ALL Program Status ACTV Include MLTC ACTVS N
The shaded records indicate clients who have different DOBs andor different names
Enroll PSA
Enrollment Provider Loc Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Enroll Program Status
Enroll Program
Current Owner ID
02 1065 0072 4062244026 Test Name Test Name 10222004 03231917 03231917 ACTV CCE 1065
Count of enrollments for the Provider 1
Count of enrollments for the PSA 1
Count of enrollments for the Report 1
Unduplicated Count of Individuals with open enrollments and DOD PSA Total Clients Count
02 1
Total 1
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Unduplicated count of individuals with Services after DOD
PSA Total Clients Count
Report Total
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
List of Clients with PSA table entry for SERVICES_AFTER_DOD
Unduplicated Count Total 0
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Age
Provider
Total
Age lt 60 Age 60 - 64 Age 65 - 74 Age 75 - 84 Age 85+ Total Clients Avg Age
Total
Avg Age
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Ethnicity
Provider Hispanic Other Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Race
American Indian Native Hawaiian Other Provider Asian Alaska Native Black Pacific Islander Minority White Multiple Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Gender
Provider Male Female Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Monthly Income
Provider 0 - - Higher than Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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None
Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Total Persons Served 0
Age lt 60 Years 0 0
Age 60 - 64 0 0
Age 65 - 74 0 0
Age 75 - 84 0 0
Age 85+ 0 0
Total Age 0 0
Average 000
Ethnicity Hispanic 0 0
Other Ethnicity 0 0
Unknown Ethnicity 0 0
Total 0 0
Race Asian 0 0
American Indian Alaska Native 0 0
Black 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority 0 0
White 0 0
Multiple 0 0
Unknown 0 0
Total 0 0
Sex Male 0 0
Female 0 0
Unknown Sex 0 0
Total 0 0
Monthly Income 0 - 0 0
- 0 0
Higher than 0 0
Unknown 0 0
Total 0 0
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Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Client ID Date Of Birth Ethnicity Race Sex Individual Monthly Income
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Demographics of Clients OAA Registered Served Only PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 City All Cities Program All Programs Service All Services County ALL COUNTIES Table OAA Registered Services Only Low Income Medium Income
Total Persons Served 0
Agelt 60 Years
Age 60 - 64
Age 65 - 74
Age 75 - 84
Age 85+
0
0
0
0
0
0
0
0
0
0
Monthly Income
0 -
-Higher than
Unknown
0
0
0
0
0
0
0
0
Total
Average
0
000
0 Total 0 0
Ethnicity Hispanic
Other
Unknown
0
0
0
0
0
0
Living Situation
Alone
Null
Policy Change
0
0
0
0
0
0
Total 0 0 Unknown
With Caregiver
0
0
0
0
Race Asian 0 0
With Other
With Other Caregiver
0
0
0
0
American Indian Alaska Native
Black
0
0
0
0Total Living Situation 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority
White
0
0
0
0 Limited English Proficiency
Multiple
Unknown
Total Race
0
0
0
0
0
0
Yes
No
Unknown
0
0
0
0
0
0
Total 0 0
Sex Male
Female
Unknown
0
0
0
0
0
0
Total 0 0
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Disaster Assistance Clients for a Provider PSA ALL Provider All Providers Location 0000 Worker All Workers City All Cities Zip Code All Zip Codes Sort By ZIP
Provider 1036 Provider Name Location 0000 Worker CIRTS18634
Need Care Client Name Address City Zip County Phone Asst Reg Situation Relat Care phone Care Name
34946 N WO DA 000 SAINT JAMES DRIVE CENTRAL (025) 101-0620 Test NameTest Name SAINT LUCIE (005) 100-0369 Y
Client is active and no assessment information is available Special Shelter and Special Registry are unknown
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
Total by PSA 0
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
ALACH BAKER BAY BRADF BREVA BROWA CALHO CHARL CITRUS CLAY COLLIE COLUM DESOT DIXIE DUVAL ESCAM FLAGL FRANK GADSDAssisted Household Report UA ORD RD RD UN OTTE R BIA O BIA ER LIN EN
1 of Household Assisted 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Households AssistedWith Gross Income
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C 100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D 125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
3 Households with at leastOne member
A 60 Years or older 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B Disabled 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C Age 5 years or under 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D Under 60 Years Old 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Undup Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Assisted
Applicant Household Report
of Applicant Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Energy Assisted Household Report
County of Assisted
Households
Households Assisted By Poverty Level
Under 75 75 - 100 101 - 125 126 - 150 Over 150 60 Years or older
At least one member who is
Age 5 years Age 2 years Age 3 years Disabled or younger and younger through 5
Under 60 Years Old
Undup Households
Assisted
Energy Assistance Total
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Unduplicated Total 0 0
County of Assisted
Households Under 75 75 - 100
Households Assisted By Poverty Level
101 - 125 126 - 150 Over 150 60 Years or older Disabled
Age 5 years or younger
Age 2 years and younger
Age 3 years through 5
Under 60 Years Old
At least one member who is
Undup Households
Assisted
Other Assisted Household Report
Other Assistance Total
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Applicant Household Report
County of Applicant
Households Under 75 75 - 100 101 - 125 126 - 150 Over 150 Income data
unavailable
Total 0
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01
Enrollment Active Consumer Count by Program PSA ALL Provider ALL PROVIDERS
County Description Program Count of Clients
BREVARD
ADI
CCE
HCE
LSP
NDP
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
MLTC
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
31
57
44
5
62
123
141
26
9
7
5
40
5
50
67
129
2
19
42
29
1
233
79
63
8
2
14
3
37
14
47
3
3
33
127
10
02
03
04
ALACHUA
BAKER
BAY
BRADFORD
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Enrollment Terminations with Reasons PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 Program All Programs Program Status ALL Program Status Worker ALL WORKERS
Last First Program Medicaid Provider Start End Name Name Client ID Status Description Worker Number Program Location Enrollment Enrollment
Count 0
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Enrollments with Care Plan Report
PSA ALL Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTIVE STATUS Care Plan Service ALL SERVICES Care Plan Start 01012017 Care Plan End 12312017
Care Plan Care Plan Care Plan Client Name
Unduplicated Client Count 0
Client ID Program Status Worker Start Date End Date Service
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PSA CLIENT_ID CLIENT_NAME OWNER PROVIDER_ID ASSESSMENT_DATE ASSESSOR_NAME MEDICAID_NUMBER CAREGIVER_CHANGE ENVIRONMENT_CHANGE HEALTH_CHANGE INCOME_CHANGE SITUATION_CHANGE INITIAL_ASSM ANNUAL_ASSM SSN REFERRAL_SOURCE 1114 N N N N Y N 771771777 SELFFAMILY 812017 JANE CASEWORKER 2 1001141633 TEST TEST N
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Fixed Service Costs List PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Provider Location County Program Service Reimbursement Unit Rate Provider Cost Per Unit Begin Valid End Valid
Count 0
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Start End Worker Most Recent Nutr Medicaid Program Provider Location Client ID Client Name Status Enrollment Enrollment Worker Active Score Number
O3C2 1036 0000 4062401063 Test Name ACTV 10162013 CIRTS20804 Y 3
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Provider Location Client ID Client Name Program Status
Start Enrollment
End Enrollment Worker
Worker Active
Most Recent Nutr Score
Medicaid Number
O3C2 1036 0000 4062538939 ACTV 12082000 CIRTS20388 Y Test Name
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All Enrollments Counts During Date Range PSA ALL Start Date 01012017 End Date Location 0000 Provider Program Program Status
12312017 ALL PROVIDERS
ACTV
Group By Program Provider Location
Program Provider Location Client Count O3C1 1036 0000 45
1951 0000 3
O3C2 1036 0000 113
OA3E 1821 0000 2
OA3ES 1821 0000 1
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C1 1036 0000 4061950299 Test Name ACTV 04072011 CIRTS23407 N 11
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C1 1036 4062586019 Test Name ACTV 12292008 CIRTS23407 N 1
Total for Location 45
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C1 1951 0000 4062452921 Test Name ACTV 03301989 CIRTS22695 N 10
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4062786256 Test Name ACTV 09232013 CIRTS20804 Y 4 1
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4062380426 Test Name ACTV 04112012 CIRTS23407 N 55 2
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4061608826 Test Name ACTV 08102011 CIRTS18634 Y 7 3
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4062615533 Test Name ACTV 10032013 CIRTS20804 Y 6 3
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start Enrollment
End Enrollment Worker
Worker Active
Medicaid Number
Most Recent Nutr Score Rank
O3C2 1036 4062466582 Test Name ACTV 10262010 CIRTS23407 N 105 2
Total for Location 113
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PSA
APCL Clients With No Services ALL Owner All Owners Provider ALL PROVIDERS
Start Date 01012017 End Date 12312017
Includes Clients Receiving Only CM INSC SCAS CA REFE Services
PSA Client ID Client Name Owner Provider Program
Count 0
Unduplicated Clients Count 0
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APCL Clients With Services PSA ALL Owner All Owners Provider ALL PROVIDERS Start Date 01012017 End Date 12312017
Exclude CM CA INSC REFE SCAS
PSA Client ID Name Owner Provider Program 10 4062527553 Test Name 1539 1929 CCE
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APCL Clients With Services PSA ALL Owner All Owners Provider ALL PROVIDERS Start Date 01012017 End Date 12312017
Exclude CM CA INSC REFE SCAS
PSA Client ID Name Owner Provider Program 11 4062732638 Test Name 1177 1177 LTCC
Total 21067
Unduplicated clients count 12460
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APS Assessments PSA ALL Risk Level ALL Owner All Owners Referral Date From 01012017 To 12312017
Order by Referral Date and Owner ID
PSA 03
Ref Date Owner ID Client ID Client Name Risk Level Asmt Type Asmt Date
03032017 1390 4062058415 L 701A 03302018 Test Name
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APS Assessments PSA ALL Risk Level ALL Owner All Owners Referral Date From 01012017 To 12312017
Order by Referral Date and Owner ID
12042017 1980 4061617559 H 701B 12072017 Test Name
Assessment Count for the PSA 52
PSA 04A
Ref Date Owner ID Client ID
09102017 4062308458
Client Name
Test Name
Risk Level
H
Asmt Type
O
Asmt Date
09162017
Assessment Count for the PSA 2
Risk Level H
M
L
Count of Assessments 138
23
21
Total Count of Assessments 182
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APS Repeat Referrals in a Time Range
PSA ALL Owner All Owners
Start Date 01012017 End Date 12312017
Current DOEA CIRTS Cirts SSN if Risk Date Created PSA Owner Abuse No different than DCF DCF SSN Name County Level Date of Birth Date Sent by DCF
Count 0
Unduplicated Client Count by PSA
PSA Count SSN
Total
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Assessed Prioritized Consumer List PSA ALL Provider ALL PROVIDERS Program AC County ALL COUNTIES
County Program Consumer Name Client ID
Total Count 0
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Assessment Due Report PSA 01 Start Date 01012017 End Date 08312018 Owner ALL PROVIDERS Worker ALL WORKERS Program Status ACTV and APCL Assessment Type Needed ALL
Overdue and missing assessments are always listed
Owner ID 1065
Client ID Client Name
Owner Assessor ID
Date of Birth
06281928
CIRTS28099
County of Service
GULF
Worker Name HARPER KENNY
Zip Assessment PSA Date
32534 01 01022014
Type
701A
Active Y
Nutr PriorityScore Score
11 58
Rank
5
Due Date
01022015
Status
701S OVERDUE
LTCC APPL Start Date
03252014 4062235673 Test name
Total Clients for Worker 1
Total Clients for Owner 1
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Assessment Due Report PSA 01 Start Date 01012017 End Date 08312018 Owner ALL PROVIDERS Worker ALL WORKERS Program Status ACTV and APCL Assessment Type Needed ALL
Overdue and missing assessments are always listed
Summary by PSA
PSA 01 701A Overdue 1
701B Overdue 213
701C Overdue 0
701S Overdue 157
No 701A 0
No 701B 2
No 701C 0
No 701S 0
701A Not Overdue 0
701B Not Overdue 0
701C Not Overdue 0
701S Not Overdue 0
701S Optional 0
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CIC Service Units and Costs Projections County SummaryPSA 99 Program CCE
Start Date 01012017 End Date 12312017
County LEON
Total Total Total Avg Max Projected
StateFederal Projected Reimbursement Provider Unduplicated Provider Service Share Service Units Unit Rate Cost Per Unit Client Count
Report Total
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CIC Service Units and Costs Projections Provider SummaryPSA ALL Provider ALL PROVIDERS Program FEDERALLY FUNDED (0101 TO 1231) Year 2017 From 01012017 To 12312017
PSA County Program Service Total State
Federal Share
Total Projected
Service Units
Avg Reimbursement
Unit Rate
Max Provider
Cost Per Unit
Total Projected Unduplicated Client Count
02 FRANKLIN O3C1 CONGREGATE MEALS $810300 1710 15
Program Total
County Total
$810300
$810300
GULF O3C1 CONGREGATE MEALS $25205 3 5
Program Total $25205
O3C2 HOME DELIVERED MEALS $25205 3 6
Program Total
County Total
$25205
$50411
LEON O3C1 CONGREGATE MEALS $621300 1311 15
CONGREGATE MEALS GUEST
CONGREGATE MEALS VOLUNTEERS
$252055
$277260
25
30
2
5
Program Total $1150615
O3C2 HOME DELIVERED MEAL GUEST $252055 25 3
Program Total $252055
OA3D PEARLS (SESSION 5)
PEARLS (SESSION 6)
PEARLS (SESSION 7)
PEARLS (SESSION 8)
$10247
$10247
$10247
$10247
10
10
10
10
3
3
3
3
Program Total $40988
OA3E RESPITE IN-HOME $200 2 2
Program Total
County Total
$200
$1443858
WAKULLA O3C2 EMERGENCY HOME DELIVERED SHELF MEALS
$8065604 14899 90
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CIC Service Units and Costs Projections - PSA Summary
PSA ALL Program CCE
Strat Date 01012017 End Date 12312017
Total
PSA County Provider Service
Total State Federal
Share
Total Projected
Service Units
Avg Reimbursement
Unit Rate
Max Projected Provider Unduplicated
Cost Per Unit Client Count
02 LEON SOUTHERN SERVICE CASE MANAGEMENT PROVIDER EMERGENCY HOME DELIVERED SHELF MEALS
$2175533
$602000
483
689
32
20
HOME DELIVERED MEALS $530262 993 5
MATERIAL AID $1994536 199
Provider Total $5302331
CountyTotal $5302331
WAKULLA SOUTHERN SERVICE CASE MANAGEMENT PROVIDER EMERGENCY HOME DELIVERED SHELF MEALS
$2175533
$1240200
483
689
32
5
MATERIAL AID $1994536 199
Provider Total $5410269
CountyTotal $5410269
PSA Total $10712599
05 PINELLAS BURSTEIN-APPLEBEE ADULT DAY CARE $000 0 $900 $1000 0
COUNSELING (MENTAL HEALTH COUNSELINGSCREENING) - INDIVIDUAL
Provider Total
$000
$000
0 $6600 $7700 0
CountyTotal $000
PSA Total $000
Report Total $10712599
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CID Service Units and Costs Projections - PSA SummaryPSA ALL Program CCE
Start Date 01012017 End Date 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
PSA County Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
02 LEON CASE MANAGEMENT $2175533 483
EMERGENCY HOME $602000 689DELIVERED SHELF MEALS HOME DELIVERED MEALS $530262 993
MATERIAL AID $1994536 199
County Total $5302331 2364
WAKULLA CASE MANAGEMENT $2175533 483
EMERGENCY HOME $1240200 689DELIVERED SHELF MEALS MATERIAL AID $1994536 199
County Total $5410269 1371
PSA Total $10712599 3735
05 PINELLAS ADULT DAY CARE $000 0
COUNSELING (MENTAL $000 0 HEALTH COUNSELINGSCREENING) - INDIVIDUAL
County Total $000 0
PSA Total $000 0
Report Total $10712599 3735
$900 $900 $900 $1000 $1000 $1000
$6600 $6600 $6600 $7700 $7700 $7700
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CID Service Units and Costs Projections County SummaryPSA 99
Program CCE County LEON
Start Date 01012017 End Date 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
Report Total
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CIE Service Units and Costs Projections - PSA Summary - All Programs
PSA 99 Program FEDERALLY FUNDED (0101 TO 1231) Year 2017 From 01012017 To 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
Program Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
Report Total
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CIE Service Units and Costs Projections - PSA Summary
PSA ALL Program CCE
Start Date 01012017 End Date 12312017
Avg High Low Total Total Avg High Low Provider Provider Provider
StateFederal Projected Reimbursement Reimbursement Reimbursement Cost Cost CostPSA
02
Service
CASE MANAGEMENT
Share
$4351066
Service Units
966
Unit Rate Unit Rate Unit Rate Per Unit Per Unit Per Unit
EMERGENCY HOME DELIVERED SHELF MEALS $1842200 1378
HOME DELIVERED MEALS $530262 993
MATERIAL AID $3989071 398
PSA Total $10712599 3735
05 ADULT DAY CARE $000 0 $900 $900 $900 $1000 $1000 $1000
COUNSELING (MENTAL HEALTH $000 0 $6600 $6600 $6600 $7700 $7700 $7700 COUNSELINGSCREENING) - INDIVIDUAL
PSA Total $000 0
Report Total $10712599 3735
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CAREGIVER SEARCH REPORT
SEARCH RESULTS FOR CONSUMERS
Criteria First Name Last Name SSN PSA ALL
Client Name Client SSN Caregiver Name Caregiver SSN
000000000 000000000 Test Name Test Name
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CARES Referrals in a Time Range PSA ALL
Start Date 01012017 End Date 12312017
Referred to ALL REFERRALS
Referring PSA Employee Name Client Name Client ID
Referral Imminent NH Admit Aging Date Risk Date Referred To Cares Provider Name Received Date
03A 4061561263 Test Name Test Name 09242017 Y 05292017 ARC or ADRC 09252017
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CARES Referrals in a Time Range PSA ALL
Start Date 01012017 End Date 12312017
Referred to ALL REFERRALS
Referring PSA Employee Name Client Name Client ID
Referral Date
Imminent Risk
NH Admit Date Referred To Cares Provider Name
Aging Received Date
04B Test Name Test Name 4061738075 04082017 N ARC or ADRC Test Name 04082017
Total Clients 110
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CARES Referrals not acknowledged by the Aging Network PSA ALL For Referrals after 01012017 Owner ID ALL Owners
Unduplicated Client count Cares Office Total Clients Count
Report Total
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
CIRTS Issue PSA Client ID Client Name Program
Program Status Start Provider Enrollment ID Provider Name
APCL CLIENT WITH DATE OF DEATH 08 4061759417 Test Name OA3B APCL 07232013 1141 WESTERN WORLD RADIO
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
Program Start Provider CIRTS Issue PSA Client ID Client Name Program Status Enrollment ID Provider Name
06 LTCC APCL 01242014 1514 4061713685 Test Name APCL CLIENT WITH DATE OF DEATH CENTRAL THE ORIGINAL HOUSE OF PIES
Count 503
Report run on 08312018 0224 PM Page 22 of 22 data_cleanuprdf Report run by RSHQALL Dispose of this report so that it can not be read or reconstructed
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Civil Rights PSA ALL Provider ALL PROVIDERS Program AC Start Date 01012017 End Date 12312017 The Poverty Level for Single is The Poverty Level for Couple is Sort by County
County Unduplicated Count
Report run on 08312018 1055 AM Page 1 of 1 civil_rightsrdf
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Client Information Report Start Date 01012017 End Date 12312017
Client ID 1001141246
Emergency
Client Name Test Name
Telephone () - Address 78 TEST STREET TALLAHASSEE FL 32399
Most Recent Caregiver Information Date Updated
Doctor
Comments
Client Demographic Information
Birth Date 06041940 Race W
Owner ID Ethnicity O
Most Recent Income Information
Ind Mon Inc Cpl Mon Inc
Ind Assets Couple Assets
Most Recent Assessment Information
Asmt Date Ref Risk Lvl
Asmt Site Spec Shel
AsmtType Spec Reg
Ref Date Primary CG
Ref Source Living Sit
Enrollment Information
Sex
Marital Status
F
S
Medicaid Number
ADL Score
ADL Count
IADL Score
IADL Count
Memory Score
Priority Score
Env Score
Nutr Score
Risk Score
Social Score
Rank
Provider Location Program Program Status Worker Start Date End Date
Care Plan Service Needed
Date Service Units Type Frq End Date
Care Plan Service Planned
Program Service Units Type Frq Start Date End Date
Services Received between 01012017 and 12312017
Service Billed Provider Location Worker Program Service Date Units Unit Type Amount
Report run on 08312018 0159 PM Page 1 of 1 client_info_formrdf
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Provider N
Client Service Units Report PSA ALL Provider ALL PROVIDERS Location 0000
Program ALL PROGRAMS Service ALL SERVICES Worker ALL WORKERS
City ALL CITIES Include Zero Unit N Include Aggregate N Calculated Amount equals the number of Units Provided times Fixed Cost if it existsService Start Date 01012017 Service End Date 12312017 If Fixed Cost does not exist Calculated
Group by PSA Provider Location Client Name County Worker Amount equals Billed Amount
Unduplicated Client Count 0 Grand Total 000 $000
Report run on 08312018 0234 PM Page 1 of 1 clnt_serv_unitsrdf
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Clients In Common PSA All Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 County All Counties Worker All Workers
County JEFFERSON
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
MIAMI-DADE
0 0 0 0 0 0 0 0 0
4061539538 Test NameCounty Count
County
0 01
X
0 1
X
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
4061650856 Test Name X 4061486560 Test Name X 4062452921 Test Name X
Report run on 08312018 1148 AM clients_commonrdfPage 1 of 4 Report run by RSHQALL Dispose of this Report so that it can not be read or reconstructed
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Clients Served Not Enrolled PSA ALL Start Date 01012017 End Date 12312017 Locations 0000 Provider All Providers
Service Service Min Serv Max Serv Program Start End Enrollment PSA Provider Location Program Consumer Name Client ID Service Date Date Status Enrollment Enrollment Provider
Count 0
Report run on 08312018 0201 PM Page 1 of 1 clnts_serv_no_enrrdf
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
4061472791 04
09
1092
1291
0072
0042
LTCC
LTCC
APCL
APCL
4062714543 06
06
1514
1762
0072
5006
LTCC
LTCC
APCL
APPL
4061802246 11
06
1177
1514
0179
0072
LTCC
LTCC
APCL
APCL
4061563719 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062644312 06
08
1514
1771
0072
0896
LTCC
LTCC
APCL
APCL
1001141670 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
1001141671 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
4062375003 07
05
05
07
1263
1755
1638
1263
0368
0072
0072
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062155124 06
06
1762
1514
0072
0072
LTCC
LTCC
APPL
APCL
4061743886 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0369
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4061499927 06
06
1514
1762
0072
5005
LTCC
LTCC
APCL
APPL
4061583524 08
06
1144
1514
0896
0072
LTCC
LTCC
APCL
APCL
4062694843 06
03
1514
1922
0072
0179
LTCC
LTCC
APCL
APCL
4062744517 07
06
1263
1514
0369
0072
LTCC
LTCC
APCL
APCL
4062005488 10
11
10
11
1929
1177
1164
1177
0072
0073
0179
0179
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
Report run on 08312018 0200 PM Page 1 of 2 clnts_mult_enrollrdf
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
Total Count 15
Report run on 08312018 0200 PM Page 2 of 2 clnts_mult_enrollrdf
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CODE DESCRIPTIONS Category ALL STATE TABLES
Code Description Active Available To Code Category
0 UNKNOWN Y CARES SUBJECTIVE_HEALTH_EVALUATION
01 ALACHUA Y COMMON COUNTIES
02 BAKER Y COMMON COUNTIES
03 BAY Y COMMON COUNTIES
04 BRADFORD Y COMMON COUNTIES
05 BREVARD Y COMMON COUNTIES
06 BROWARD Y COMMON COUNTIES
07 CALHOUN Y COMMON COUNTIES
08 CHARLOTTE Y COMMON COUNTIES
09 CITRUS Y COMMON COUNTIES
1 EXCELLENT Y CARES SUBJECTIVE_HEALTH_EVALUATION
10 CLAY Y COMMON COUNTIES
11 COLLIER Y COMMON COUNTIES
12 COLUMBIA Y COMMON COUNTIES
13 MIAMI-DADE Y COMMON COUNTIES
14 DESOTO Y COMMON COUNTIES
15 DIXIE Y COMMON COUNTIES
16 DUVAL Y COMMON COUNTIES
17 ESCAMBIA Y COMMON COUNTIES
18 FLAGLER Y COMMON COUNTIES
19 FRANKLIN Y COMMON COUNTIES
2 GOOD Y CARES SUBJECTIVE_HEALTH_EVALUATION
20 GADSDEN Y COMMON COUNTIES
21 GILCHRIST Y COMMON COUNTIES
22 GLADES Y COMMON COUNTIES
23 GULF Y COMMON COUNTIES
24 HAMILTON Y COMMON COUNTIES
25 HARDEE Y COMMON COUNTIES
26 HENDRY Y COMMON COUNTIES
27 HERNANDO Y COMMON COUNTIES
28 HIGHLANDS Y COMMON COUNTIES
Report run on 08312018 0140 PM Page 1 of 45 state_codesrdf Report run by RSHQALL Dispose of this report so that it cannot be read or reconstructed
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CONSUMER AGE VERIFICATION REPORT PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Program AC
Age at Start
Enroll or Start Enroll Provider Program Description Consumer Name Client ID DOB Svc date or Svc Date
Report run on 08312018 0203 PM Page 1 of 1 age_verifyrdf
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Contract Budget Information PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Program Service Provider Location County Served Provider Contract
Projected Service
Units Unit Measure
Projected Unduplicated
State Federal Share Client Count Begin Date End Date
Row Count 0 Amount Total
Report run on 08312018 0233 PM Page 1 of 1 contract_budgetrdf
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Start Enroll Latest Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Date Asmt Date Worker
O3C1 1036 000 4061653427 Test CENTRAL 34982 W M 07091930 09102013 09102013 CIRTS20804 0 Name
Report run on 08312018 1133 AM Page 1 of 6 actv_by_progrdf
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Start Enroll Date
Latest Asmt Date Worker
4061593624 Test Name CENTRAL 34946 B F 11261940 12012011 12312013 CIRTS23407
Count 164
Unduplicated Client Count 163
Report run on 08312018 1133 AM Page 6 of 6 actv_by_progrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Assessments After DOD Report
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Owner 1025
The shaded records indicate clients who have different DOBs andor different names
Assemt Current PSA Owner Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Owner Assessor
Provider Assessor
Assemt Date
Assemt Type
Unduplicated Count Total 0
Report run on 08312018 0206 PM Page 1 of 1 vs_assmrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Open Enrollments
The Vital Statistics Data for 07192002 - 09112014PSA ALL Provider ALL Program Status ACTV Include MLTC ACTVS N
The shaded records indicate clients who have different DOBs andor different names
Enroll PSA
Enrollment Provider Loc Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Enroll Program Status
Enroll Program
Current Owner ID
02 1065 0072 4062244026 Test Name Test Name 10222004 03231917 03231917 ACTV CCE 1065
Count of enrollments for the Provider 1
Count of enrollments for the PSA 1
Count of enrollments for the Report 1
Unduplicated Count of Individuals with open enrollments and DOD PSA Total Clients Count
02 1
Total 1
Report run on 08312018 0205 PM Page 1 of 1 vs_open_enrollrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Report run on 08312018 0207 PM Page 1 of 3 vs_servicesrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Unduplicated count of individuals with Services after DOD
PSA Total Clients Count
Report Total
Report run on 08312018 0207 PM Page 2 of 3 vs_servicesrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
List of Clients with PSA table entry for SERVICES_AFTER_DOD
Unduplicated Count Total 0
Report run on 08312018 0207 PM Page 3 of 3 vs_servicesrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Age
Provider
Total
Age lt 60 Age 60 - 64 Age 65 - 74 Age 75 - 84 Age 85+ Total Clients Avg Age
Total
Avg Age
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 1 of 5 demo_all_prvrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Ethnicity
Provider Hispanic Other Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 2 of 5 demo_all_prvrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Race
American Indian Native Hawaiian Other Provider Asian Alaska Native Black Pacific Islander Minority White Multiple Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 3 of 5 demo_all_prvrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Gender
Provider Male Female Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 4 of 5 demo_all_prvrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Monthly Income
Provider 0 - - Higher than Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 5 of 5 demo_all_prvrdf
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None
Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Total Persons Served 0
Age lt 60 Years 0 0
Age 60 - 64 0 0
Age 65 - 74 0 0
Age 75 - 84 0 0
Age 85+ 0 0
Total Age 0 0
Average 000
Ethnicity Hispanic 0 0
Other Ethnicity 0 0
Unknown Ethnicity 0 0
Total 0 0
Race Asian 0 0
American Indian Alaska Native 0 0
Black 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority 0 0
White 0 0
Multiple 0 0
Unknown 0 0
Total 0 0
Sex Male 0 0
Female 0 0
Unknown Sex 0 0
Total 0 0
Monthly Income 0 - 0 0
- 0 0
Higher than 0 0
Unknown 0 0
Total 0 0
Report run on 08312018 1058 AM Page 1 of 2 demo_by_prov_detrdf Report run byRSHQALL Dispose of this report so that it can not be read or reconstructed
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Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Client ID Date Of Birth Ethnicity Race Sex Individual Monthly Income
Report run on 08312018 1058 AM Page 2 of 2 demo_by_prov_detrdf Report run byRSHQALL Dispose of this report so that it can not be read or reconstructed
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Demographics of Clients OAA Registered Served Only PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 City All Cities Program All Programs Service All Services County ALL COUNTIES Table OAA Registered Services Only Low Income Medium Income
Total Persons Served 0
Agelt 60 Years
Age 60 - 64
Age 65 - 74
Age 75 - 84
Age 85+
0
0
0
0
0
0
0
0
0
0
Monthly Income
0 -
-Higher than
Unknown
0
0
0
0
0
0
0
0
Total
Average
0
000
0 Total 0 0
Ethnicity Hispanic
Other
Unknown
0
0
0
0
0
0
Living Situation
Alone
Null
Policy Change
0
0
0
0
0
0
Total 0 0 Unknown
With Caregiver
0
0
0
0
Race Asian 0 0
With Other
With Other Caregiver
0
0
0
0
American Indian Alaska Native
Black
0
0
0
0Total Living Situation 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority
White
0
0
0
0 Limited English Proficiency
Multiple
Unknown
Total Race
0
0
0
0
0
0
Yes
No
Unknown
0
0
0
0
0
0
Total 0 0
Sex Male
Female
Unknown
0
0
0
0
0
0
Total 0 0
Report run on 08312018 1056 AM Page 1 of 1 demo_by_provrdf
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Disaster Assistance Clients for a Provider PSA ALL Provider All Providers Location 0000 Worker All Workers City All Cities Zip Code All Zip Codes Sort By ZIP
Provider 1036 Provider Name Location 0000 Worker CIRTS18634
Need Care Client Name Address City Zip County Phone Asst Reg Situation Relat Care phone Care Name
34946 N WO DA 000 SAINT JAMES DRIVE CENTRAL (025) 101-0620 Test NameTest Name SAINT LUCIE (005) 100-0369 Y
Client is active and no assessment information is available Special Shelter and Special Registry are unknown
Report run on 08312018 1102 AM Page 1 of 8 disaster_by_provrdf
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
Total by PSA 0
Report run on 08312018 1111 AM Page 1 of 5 eheap_exceptionsrdf
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
ALACH BAKER BAY BRADF BREVA BROWA CALHO CHARL CITRUS CLAY COLLIE COLUM DESOT DIXIE DUVAL ESCAM FLAGL FRANK GADSDAssisted Household Report UA ORD RD RD UN OTTE R BIA O BIA ER LIN EN
1 of Household Assisted 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Households AssistedWith Gross Income
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C 100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D 125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
3 Households with at leastOne member
A 60 Years or older 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B Disabled 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C Age 5 years or under 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D Under 60 Years Old 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Undup Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Assisted
Applicant Household Report
of Applicant Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
Report run on 08312018 1111 AM Page 2 of 5 eheap_exceptionsrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Energy Assisted Household Report
County of Assisted
Households
Households Assisted By Poverty Level
Under 75 75 - 100 101 - 125 126 - 150 Over 150 60 Years or older
At least one member who is
Age 5 years Age 2 years Age 3 years Disabled or younger and younger through 5
Under 60 Years Old
Undup Households
Assisted
Energy Assistance Total
Report run on 08312018 1107 AM Page 1 of 3 eheap_summaryrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Unduplicated Total 0 0
County of Assisted
Households Under 75 75 - 100
Households Assisted By Poverty Level
101 - 125 126 - 150 Over 150 60 Years or older Disabled
Age 5 years or younger
Age 2 years and younger
Age 3 years through 5
Under 60 Years Old
At least one member who is
Undup Households
Assisted
Other Assisted Household Report
Other Assistance Total
Report run on 08312018 1107 AM Page 2 of 3 eheap_summaryrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Applicant Household Report
County of Applicant
Households Under 75 75 - 100 101 - 125 126 - 150 Over 150 Income data
unavailable
Total 0
Report run on 08312018 1107 AM Page 3 of 3 eheap_summaryrdf
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01
Enrollment Active Consumer Count by Program PSA ALL Provider ALL PROVIDERS
County Description Program Count of Clients
BREVARD
ADI
CCE
HCE
LSP
NDP
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
MLTC
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
31
57
44
5
62
123
141
26
9
7
5
40
5
50
67
129
2
19
42
29
1
233
79
63
8
2
14
3
37
14
47
3
3
33
127
10
02
03
04
ALACHUA
BAKER
BAY
BRADFORD
Report run on 08312018 1148 AM Page 1 of 18 actv_countrdf
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Enrollment Terminations with Reasons PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 Program All Programs Program Status ALL Program Status Worker ALL WORKERS
Last First Program Medicaid Provider Start End Name Name Client ID Status Description Worker Number Program Location Enrollment Enrollment
Count 0
Report run on 08312018 1150 AM Page 1 of 1 enroll_term_reasonrdf
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Enrollments with Care Plan Report
PSA ALL Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTIVE STATUS Care Plan Service ALL SERVICES Care Plan Start 01012017 Care Plan End 12312017
Care Plan Care Plan Care Plan Client Name
Unduplicated Client Count 0
Client ID Program Status Worker Start Date End Date Service
Report run on 08312018 1054 AM Page 1 of 1 enroll_careplrdf Report run by RSHQALL Dispose of this report so that it cannot be read or reconstructed
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PSA CLIENT_ID CLIENT_NAME OWNER PROVIDER_ID ASSESSMENT_DATE ASSESSOR_NAME MEDICAID_NUMBER CAREGIVER_CHANGE ENVIRONMENT_CHANGE HEALTH_CHANGE INCOME_CHANGE SITUATION_CHANGE INITIAL_ASSM ANNUAL_ASSM SSN REFERRAL_SOURCE 1114 N N N N Y N 771771777 SELFFAMILY 812017 JANE CASEWORKER 2 1001141633 TEST TEST N
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Fixed Service Costs List PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Provider Location County Program Service Reimbursement Unit Rate Provider Cost Per Unit Begin Valid End Valid
Count 0
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All Active Clients by Provider or program(includes clients who are now terminated) Start Date 01012017 End Date 12312017 PSA All PSAs Provider All Providers Location 0000 Program All Programs Order By Program
Program Provider Location Client ID Client Name Program Status
Start Enrollment
End Enrollment Worker
Worker Active
Most Recent Nutr Score
Medicaid Number
O3C2 1036 0000 4062538939 ACTV 12082000 CIRTS20388 Y Test Name
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All Enrollments Counts During Date Range PSA ALL Start Date 01012017 End Date Location 0000 Provider Program Program Status
12312017 ALL PROVIDERS
ACTV
Group By Program Provider Location
Program Provider Location Client Count O3C1 1036 0000 45
1951 0000 3
O3C2 1036 0000 113
OA3E 1821 0000 2
OA3ES 1821 0000 1
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C1 1036 0000 4061950299 Test Name ACTV 04072011 CIRTS23407 N 11
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C1 1036 4062586019 Test Name ACTV 12292008 CIRTS23407 N 1
Total for Location 45
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C1 1951 0000 4062452921 Test Name ACTV 03301989 CIRTS22695 N 10
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4062786256 Test Name ACTV 09232013 CIRTS20804 Y 4 1
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4062380426 Test Name ACTV 04112012 CIRTS23407 N 55 2
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4061608826 Test Name ACTV 08102011 CIRTS18634 Y 7 3
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4062615533 Test Name ACTV 10032013 CIRTS20804 Y 6 3
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start Enrollment
End Enrollment Worker
Worker Active
Medicaid Number
Most Recent Nutr Score Rank
O3C2 1036 4062466582 Test Name ACTV 10262010 CIRTS23407 N 105 2
Total for Location 113
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PSA
APCL Clients With No Services ALL Owner All Owners Provider ALL PROVIDERS
Start Date 01012017 End Date 12312017
Includes Clients Receiving Only CM INSC SCAS CA REFE Services
PSA Client ID Client Name Owner Provider Program
Count 0
Unduplicated Clients Count 0
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APCL Clients With Services PSA ALL Owner All Owners Provider ALL PROVIDERS Start Date 01012017 End Date 12312017
Exclude CM CA INSC REFE SCAS
PSA Client ID Name Owner Provider Program 10 4062527553 Test Name 1539 1929 CCE
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APCL Clients With Services PSA ALL Owner All Owners Provider ALL PROVIDERS Start Date 01012017 End Date 12312017
Exclude CM CA INSC REFE SCAS
PSA Client ID Name Owner Provider Program 11 4062732638 Test Name 1177 1177 LTCC
Total 21067
Unduplicated clients count 12460
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APS Assessments PSA ALL Risk Level ALL Owner All Owners Referral Date From 01012017 To 12312017
Order by Referral Date and Owner ID
PSA 03
Ref Date Owner ID Client ID Client Name Risk Level Asmt Type Asmt Date
03032017 1390 4062058415 L 701A 03302018 Test Name
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APS Assessments PSA ALL Risk Level ALL Owner All Owners Referral Date From 01012017 To 12312017
Order by Referral Date and Owner ID
12042017 1980 4061617559 H 701B 12072017 Test Name
Assessment Count for the PSA 52
PSA 04A
Ref Date Owner ID Client ID
09102017 4062308458
Client Name
Test Name
Risk Level
H
Asmt Type
O
Asmt Date
09162017
Assessment Count for the PSA 2
Risk Level H
M
L
Count of Assessments 138
23
21
Total Count of Assessments 182
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APS Repeat Referrals in a Time Range
PSA ALL Owner All Owners
Start Date 01012017 End Date 12312017
Current DOEA CIRTS Cirts SSN if Risk Date Created PSA Owner Abuse No different than DCF DCF SSN Name County Level Date of Birth Date Sent by DCF
Count 0
Unduplicated Client Count by PSA
PSA Count SSN
Total
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Assessed Prioritized Consumer List PSA ALL Provider ALL PROVIDERS Program AC County ALL COUNTIES
County Program Consumer Name Client ID
Total Count 0
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Assessment Due Report PSA 01 Start Date 01012017 End Date 08312018 Owner ALL PROVIDERS Worker ALL WORKERS Program Status ACTV and APCL Assessment Type Needed ALL
Overdue and missing assessments are always listed
Owner ID 1065
Client ID Client Name
Owner Assessor ID
Date of Birth
06281928
CIRTS28099
County of Service
GULF
Worker Name HARPER KENNY
Zip Assessment PSA Date
32534 01 01022014
Type
701A
Active Y
Nutr PriorityScore Score
11 58
Rank
5
Due Date
01022015
Status
701S OVERDUE
LTCC APPL Start Date
03252014 4062235673 Test name
Total Clients for Worker 1
Total Clients for Owner 1
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Assessment Due Report PSA 01 Start Date 01012017 End Date 08312018 Owner ALL PROVIDERS Worker ALL WORKERS Program Status ACTV and APCL Assessment Type Needed ALL
Overdue and missing assessments are always listed
Summary by PSA
PSA 01 701A Overdue 1
701B Overdue 213
701C Overdue 0
701S Overdue 157
No 701A 0
No 701B 2
No 701C 0
No 701S 0
701A Not Overdue 0
701B Not Overdue 0
701C Not Overdue 0
701S Not Overdue 0
701S Optional 0
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CIC Service Units and Costs Projections County SummaryPSA 99 Program CCE
Start Date 01012017 End Date 12312017
County LEON
Total Total Total Avg Max Projected
StateFederal Projected Reimbursement Provider Unduplicated Provider Service Share Service Units Unit Rate Cost Per Unit Client Count
Report Total
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CIC Service Units and Costs Projections Provider SummaryPSA ALL Provider ALL PROVIDERS Program FEDERALLY FUNDED (0101 TO 1231) Year 2017 From 01012017 To 12312017
PSA County Program Service Total State
Federal Share
Total Projected
Service Units
Avg Reimbursement
Unit Rate
Max Provider
Cost Per Unit
Total Projected Unduplicated Client Count
02 FRANKLIN O3C1 CONGREGATE MEALS $810300 1710 15
Program Total
County Total
$810300
$810300
GULF O3C1 CONGREGATE MEALS $25205 3 5
Program Total $25205
O3C2 HOME DELIVERED MEALS $25205 3 6
Program Total
County Total
$25205
$50411
LEON O3C1 CONGREGATE MEALS $621300 1311 15
CONGREGATE MEALS GUEST
CONGREGATE MEALS VOLUNTEERS
$252055
$277260
25
30
2
5
Program Total $1150615
O3C2 HOME DELIVERED MEAL GUEST $252055 25 3
Program Total $252055
OA3D PEARLS (SESSION 5)
PEARLS (SESSION 6)
PEARLS (SESSION 7)
PEARLS (SESSION 8)
$10247
$10247
$10247
$10247
10
10
10
10
3
3
3
3
Program Total $40988
OA3E RESPITE IN-HOME $200 2 2
Program Total
County Total
$200
$1443858
WAKULLA O3C2 EMERGENCY HOME DELIVERED SHELF MEALS
$8065604 14899 90
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CIC Service Units and Costs Projections - PSA Summary
PSA ALL Program CCE
Strat Date 01012017 End Date 12312017
Total
PSA County Provider Service
Total State Federal
Share
Total Projected
Service Units
Avg Reimbursement
Unit Rate
Max Projected Provider Unduplicated
Cost Per Unit Client Count
02 LEON SOUTHERN SERVICE CASE MANAGEMENT PROVIDER EMERGENCY HOME DELIVERED SHELF MEALS
$2175533
$602000
483
689
32
20
HOME DELIVERED MEALS $530262 993 5
MATERIAL AID $1994536 199
Provider Total $5302331
CountyTotal $5302331
WAKULLA SOUTHERN SERVICE CASE MANAGEMENT PROVIDER EMERGENCY HOME DELIVERED SHELF MEALS
$2175533
$1240200
483
689
32
5
MATERIAL AID $1994536 199
Provider Total $5410269
CountyTotal $5410269
PSA Total $10712599
05 PINELLAS BURSTEIN-APPLEBEE ADULT DAY CARE $000 0 $900 $1000 0
COUNSELING (MENTAL HEALTH COUNSELINGSCREENING) - INDIVIDUAL
Provider Total
$000
$000
0 $6600 $7700 0
CountyTotal $000
PSA Total $000
Report Total $10712599
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CID Service Units and Costs Projections - PSA SummaryPSA ALL Program CCE
Start Date 01012017 End Date 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
PSA County Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
02 LEON CASE MANAGEMENT $2175533 483
EMERGENCY HOME $602000 689DELIVERED SHELF MEALS HOME DELIVERED MEALS $530262 993
MATERIAL AID $1994536 199
County Total $5302331 2364
WAKULLA CASE MANAGEMENT $2175533 483
EMERGENCY HOME $1240200 689DELIVERED SHELF MEALS MATERIAL AID $1994536 199
County Total $5410269 1371
PSA Total $10712599 3735
05 PINELLAS ADULT DAY CARE $000 0
COUNSELING (MENTAL $000 0 HEALTH COUNSELINGSCREENING) - INDIVIDUAL
County Total $000 0
PSA Total $000 0
Report Total $10712599 3735
$900 $900 $900 $1000 $1000 $1000
$6600 $6600 $6600 $7700 $7700 $7700
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CID Service Units and Costs Projections County SummaryPSA 99
Program CCE County LEON
Start Date 01012017 End Date 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
Report Total
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CIE Service Units and Costs Projections - PSA Summary - All Programs
PSA 99 Program FEDERALLY FUNDED (0101 TO 1231) Year 2017 From 01012017 To 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
Program Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
Report Total
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CIE Service Units and Costs Projections - PSA Summary
PSA ALL Program CCE
Start Date 01012017 End Date 12312017
Avg High Low Total Total Avg High Low Provider Provider Provider
StateFederal Projected Reimbursement Reimbursement Reimbursement Cost Cost CostPSA
02
Service
CASE MANAGEMENT
Share
$4351066
Service Units
966
Unit Rate Unit Rate Unit Rate Per Unit Per Unit Per Unit
EMERGENCY HOME DELIVERED SHELF MEALS $1842200 1378
HOME DELIVERED MEALS $530262 993
MATERIAL AID $3989071 398
PSA Total $10712599 3735
05 ADULT DAY CARE $000 0 $900 $900 $900 $1000 $1000 $1000
COUNSELING (MENTAL HEALTH $000 0 $6600 $6600 $6600 $7700 $7700 $7700 COUNSELINGSCREENING) - INDIVIDUAL
PSA Total $000 0
Report Total $10712599 3735
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CAREGIVER SEARCH REPORT
SEARCH RESULTS FOR CONSUMERS
Criteria First Name Last Name SSN PSA ALL
Client Name Client SSN Caregiver Name Caregiver SSN
000000000 000000000 Test Name Test Name
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CARES Referrals in a Time Range PSA ALL
Start Date 01012017 End Date 12312017
Referred to ALL REFERRALS
Referring PSA Employee Name Client Name Client ID
Referral Imminent NH Admit Aging Date Risk Date Referred To Cares Provider Name Received Date
03A 4061561263 Test Name Test Name 09242017 Y 05292017 ARC or ADRC 09252017
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CARES Referrals in a Time Range PSA ALL
Start Date 01012017 End Date 12312017
Referred to ALL REFERRALS
Referring PSA Employee Name Client Name Client ID
Referral Date
Imminent Risk
NH Admit Date Referred To Cares Provider Name
Aging Received Date
04B Test Name Test Name 4061738075 04082017 N ARC or ADRC Test Name 04082017
Total Clients 110
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CARES Referrals not acknowledged by the Aging Network PSA ALL For Referrals after 01012017 Owner ID ALL Owners
Unduplicated Client count Cares Office Total Clients Count
Report Total
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
CIRTS Issue PSA Client ID Client Name Program
Program Status Start Provider Enrollment ID Provider Name
APCL CLIENT WITH DATE OF DEATH 08 4061759417 Test Name OA3B APCL 07232013 1141 WESTERN WORLD RADIO
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
Program Start Provider CIRTS Issue PSA Client ID Client Name Program Status Enrollment ID Provider Name
06 LTCC APCL 01242014 1514 4061713685 Test Name APCL CLIENT WITH DATE OF DEATH CENTRAL THE ORIGINAL HOUSE OF PIES
Count 503
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Civil Rights PSA ALL Provider ALL PROVIDERS Program AC Start Date 01012017 End Date 12312017 The Poverty Level for Single is The Poverty Level for Couple is Sort by County
County Unduplicated Count
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Client Information Report Start Date 01012017 End Date 12312017
Client ID 1001141246
Emergency
Client Name Test Name
Telephone () - Address 78 TEST STREET TALLAHASSEE FL 32399
Most Recent Caregiver Information Date Updated
Doctor
Comments
Client Demographic Information
Birth Date 06041940 Race W
Owner ID Ethnicity O
Most Recent Income Information
Ind Mon Inc Cpl Mon Inc
Ind Assets Couple Assets
Most Recent Assessment Information
Asmt Date Ref Risk Lvl
Asmt Site Spec Shel
AsmtType Spec Reg
Ref Date Primary CG
Ref Source Living Sit
Enrollment Information
Sex
Marital Status
F
S
Medicaid Number
ADL Score
ADL Count
IADL Score
IADL Count
Memory Score
Priority Score
Env Score
Nutr Score
Risk Score
Social Score
Rank
Provider Location Program Program Status Worker Start Date End Date
Care Plan Service Needed
Date Service Units Type Frq End Date
Care Plan Service Planned
Program Service Units Type Frq Start Date End Date
Services Received between 01012017 and 12312017
Service Billed Provider Location Worker Program Service Date Units Unit Type Amount
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Provider N
Client Service Units Report PSA ALL Provider ALL PROVIDERS Location 0000
Program ALL PROGRAMS Service ALL SERVICES Worker ALL WORKERS
City ALL CITIES Include Zero Unit N Include Aggregate N Calculated Amount equals the number of Units Provided times Fixed Cost if it existsService Start Date 01012017 Service End Date 12312017 If Fixed Cost does not exist Calculated
Group by PSA Provider Location Client Name County Worker Amount equals Billed Amount
Unduplicated Client Count 0 Grand Total 000 $000
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Clients In Common PSA All Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 County All Counties Worker All Workers
County JEFFERSON
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
MIAMI-DADE
0 0 0 0 0 0 0 0 0
4061539538 Test NameCounty Count
County
0 01
X
0 1
X
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
4061650856 Test Name X 4061486560 Test Name X 4062452921 Test Name X
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Clients Served Not Enrolled PSA ALL Start Date 01012017 End Date 12312017 Locations 0000 Provider All Providers
Service Service Min Serv Max Serv Program Start End Enrollment PSA Provider Location Program Consumer Name Client ID Service Date Date Status Enrollment Enrollment Provider
Count 0
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
4061472791 04
09
1092
1291
0072
0042
LTCC
LTCC
APCL
APCL
4062714543 06
06
1514
1762
0072
5006
LTCC
LTCC
APCL
APPL
4061802246 11
06
1177
1514
0179
0072
LTCC
LTCC
APCL
APCL
4061563719 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062644312 06
08
1514
1771
0072
0896
LTCC
LTCC
APCL
APCL
1001141670 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
1001141671 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
4062375003 07
05
05
07
1263
1755
1638
1263
0368
0072
0072
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062155124 06
06
1762
1514
0072
0072
LTCC
LTCC
APPL
APCL
4061743886 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0369
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4061499927 06
06
1514
1762
0072
5005
LTCC
LTCC
APCL
APPL
4061583524 08
06
1144
1514
0896
0072
LTCC
LTCC
APCL
APCL
4062694843 06
03
1514
1922
0072
0179
LTCC
LTCC
APCL
APCL
4062744517 07
06
1263
1514
0369
0072
LTCC
LTCC
APCL
APCL
4062005488 10
11
10
11
1929
1177
1164
1177
0072
0073
0179
0179
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
Total Count 15
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CODE DESCRIPTIONS Category ALL STATE TABLES
Code Description Active Available To Code Category
0 UNKNOWN Y CARES SUBJECTIVE_HEALTH_EVALUATION
01 ALACHUA Y COMMON COUNTIES
02 BAKER Y COMMON COUNTIES
03 BAY Y COMMON COUNTIES
04 BRADFORD Y COMMON COUNTIES
05 BREVARD Y COMMON COUNTIES
06 BROWARD Y COMMON COUNTIES
07 CALHOUN Y COMMON COUNTIES
08 CHARLOTTE Y COMMON COUNTIES
09 CITRUS Y COMMON COUNTIES
1 EXCELLENT Y CARES SUBJECTIVE_HEALTH_EVALUATION
10 CLAY Y COMMON COUNTIES
11 COLLIER Y COMMON COUNTIES
12 COLUMBIA Y COMMON COUNTIES
13 MIAMI-DADE Y COMMON COUNTIES
14 DESOTO Y COMMON COUNTIES
15 DIXIE Y COMMON COUNTIES
16 DUVAL Y COMMON COUNTIES
17 ESCAMBIA Y COMMON COUNTIES
18 FLAGLER Y COMMON COUNTIES
19 FRANKLIN Y COMMON COUNTIES
2 GOOD Y CARES SUBJECTIVE_HEALTH_EVALUATION
20 GADSDEN Y COMMON COUNTIES
21 GILCHRIST Y COMMON COUNTIES
22 GLADES Y COMMON COUNTIES
23 GULF Y COMMON COUNTIES
24 HAMILTON Y COMMON COUNTIES
25 HARDEE Y COMMON COUNTIES
26 HENDRY Y COMMON COUNTIES
27 HERNANDO Y COMMON COUNTIES
28 HIGHLANDS Y COMMON COUNTIES
Report run on 08312018 0140 PM Page 1 of 45 state_codesrdf Report run by RSHQALL Dispose of this report so that it cannot be read or reconstructed
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CONSUMER AGE VERIFICATION REPORT PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Program AC
Age at Start
Enroll or Start Enroll Provider Program Description Consumer Name Client ID DOB Svc date or Svc Date
Report run on 08312018 0203 PM Page 1 of 1 age_verifyrdf
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Contract Budget Information PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Program Service Provider Location County Served Provider Contract
Projected Service
Units Unit Measure
Projected Unduplicated
State Federal Share Client Count Begin Date End Date
Row Count 0 Amount Total
Report run on 08312018 0233 PM Page 1 of 1 contract_budgetrdf
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Start Enroll Latest Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Date Asmt Date Worker
O3C1 1036 000 4061653427 Test CENTRAL 34982 W M 07091930 09102013 09102013 CIRTS20804 0 Name
Report run on 08312018 1133 AM Page 1 of 6 actv_by_progrdf
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Start Enroll Date
Latest Asmt Date Worker
4061593624 Test Name CENTRAL 34946 B F 11261940 12012011 12312013 CIRTS23407
Count 164
Unduplicated Client Count 163
Report run on 08312018 1133 AM Page 6 of 6 actv_by_progrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Assessments After DOD Report
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Owner 1025
The shaded records indicate clients who have different DOBs andor different names
Assemt Current PSA Owner Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Owner Assessor
Provider Assessor
Assemt Date
Assemt Type
Unduplicated Count Total 0
Report run on 08312018 0206 PM Page 1 of 1 vs_assmrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Open Enrollments
The Vital Statistics Data for 07192002 - 09112014PSA ALL Provider ALL Program Status ACTV Include MLTC ACTVS N
The shaded records indicate clients who have different DOBs andor different names
Enroll PSA
Enrollment Provider Loc Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Enroll Program Status
Enroll Program
Current Owner ID
02 1065 0072 4062244026 Test Name Test Name 10222004 03231917 03231917 ACTV CCE 1065
Count of enrollments for the Provider 1
Count of enrollments for the PSA 1
Count of enrollments for the Report 1
Unduplicated Count of Individuals with open enrollments and DOD PSA Total Clients Count
02 1
Total 1
Report run on 08312018 0205 PM Page 1 of 1 vs_open_enrollrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Report run on 08312018 0207 PM Page 1 of 3 vs_servicesrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Unduplicated count of individuals with Services after DOD
PSA Total Clients Count
Report Total
Report run on 08312018 0207 PM Page 2 of 3 vs_servicesrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
List of Clients with PSA table entry for SERVICES_AFTER_DOD
Unduplicated Count Total 0
Report run on 08312018 0207 PM Page 3 of 3 vs_servicesrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Age
Provider
Total
Age lt 60 Age 60 - 64 Age 65 - 74 Age 75 - 84 Age 85+ Total Clients Avg Age
Total
Avg Age
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Ethnicity
Provider Hispanic Other Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Race
American Indian Native Hawaiian Other Provider Asian Alaska Native Black Pacific Islander Minority White Multiple Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Gender
Provider Male Female Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Monthly Income
Provider 0 - - Higher than Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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None
Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Total Persons Served 0
Age lt 60 Years 0 0
Age 60 - 64 0 0
Age 65 - 74 0 0
Age 75 - 84 0 0
Age 85+ 0 0
Total Age 0 0
Average 000
Ethnicity Hispanic 0 0
Other Ethnicity 0 0
Unknown Ethnicity 0 0
Total 0 0
Race Asian 0 0
American Indian Alaska Native 0 0
Black 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority 0 0
White 0 0
Multiple 0 0
Unknown 0 0
Total 0 0
Sex Male 0 0
Female 0 0
Unknown Sex 0 0
Total 0 0
Monthly Income 0 - 0 0
- 0 0
Higher than 0 0
Unknown 0 0
Total 0 0
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Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Client ID Date Of Birth Ethnicity Race Sex Individual Monthly Income
Report run on 08312018 1058 AM Page 2 of 2 demo_by_prov_detrdf Report run byRSHQALL Dispose of this report so that it can not be read or reconstructed
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Demographics of Clients OAA Registered Served Only PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 City All Cities Program All Programs Service All Services County ALL COUNTIES Table OAA Registered Services Only Low Income Medium Income
Total Persons Served 0
Agelt 60 Years
Age 60 - 64
Age 65 - 74
Age 75 - 84
Age 85+
0
0
0
0
0
0
0
0
0
0
Monthly Income
0 -
-Higher than
Unknown
0
0
0
0
0
0
0
0
Total
Average
0
000
0 Total 0 0
Ethnicity Hispanic
Other
Unknown
0
0
0
0
0
0
Living Situation
Alone
Null
Policy Change
0
0
0
0
0
0
Total 0 0 Unknown
With Caregiver
0
0
0
0
Race Asian 0 0
With Other
With Other Caregiver
0
0
0
0
American Indian Alaska Native
Black
0
0
0
0Total Living Situation 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority
White
0
0
0
0 Limited English Proficiency
Multiple
Unknown
Total Race
0
0
0
0
0
0
Yes
No
Unknown
0
0
0
0
0
0
Total 0 0
Sex Male
Female
Unknown
0
0
0
0
0
0
Total 0 0
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Disaster Assistance Clients for a Provider PSA ALL Provider All Providers Location 0000 Worker All Workers City All Cities Zip Code All Zip Codes Sort By ZIP
Provider 1036 Provider Name Location 0000 Worker CIRTS18634
Need Care Client Name Address City Zip County Phone Asst Reg Situation Relat Care phone Care Name
34946 N WO DA 000 SAINT JAMES DRIVE CENTRAL (025) 101-0620 Test NameTest Name SAINT LUCIE (005) 100-0369 Y
Client is active and no assessment information is available Special Shelter and Special Registry are unknown
Report run on 08312018 1102 AM Page 1 of 8 disaster_by_provrdf
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
Total by PSA 0
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
ALACH BAKER BAY BRADF BREVA BROWA CALHO CHARL CITRUS CLAY COLLIE COLUM DESOT DIXIE DUVAL ESCAM FLAGL FRANK GADSDAssisted Household Report UA ORD RD RD UN OTTE R BIA O BIA ER LIN EN
1 of Household Assisted 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Households AssistedWith Gross Income
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C 100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D 125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
3 Households with at leastOne member
A 60 Years or older 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B Disabled 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C Age 5 years or under 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D Under 60 Years Old 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Undup Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Assisted
Applicant Household Report
of Applicant Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Energy Assisted Household Report
County of Assisted
Households
Households Assisted By Poverty Level
Under 75 75 - 100 101 - 125 126 - 150 Over 150 60 Years or older
At least one member who is
Age 5 years Age 2 years Age 3 years Disabled or younger and younger through 5
Under 60 Years Old
Undup Households
Assisted
Energy Assistance Total
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Unduplicated Total 0 0
County of Assisted
Households Under 75 75 - 100
Households Assisted By Poverty Level
101 - 125 126 - 150 Over 150 60 Years or older Disabled
Age 5 years or younger
Age 2 years and younger
Age 3 years through 5
Under 60 Years Old
At least one member who is
Undup Households
Assisted
Other Assisted Household Report
Other Assistance Total
Report run on 08312018 1107 AM Page 2 of 3 eheap_summaryrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Applicant Household Report
County of Applicant
Households Under 75 75 - 100 101 - 125 126 - 150 Over 150 Income data
unavailable
Total 0
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01
Enrollment Active Consumer Count by Program PSA ALL Provider ALL PROVIDERS
County Description Program Count of Clients
BREVARD
ADI
CCE
HCE
LSP
NDP
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
MLTC
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
31
57
44
5
62
123
141
26
9
7
5
40
5
50
67
129
2
19
42
29
1
233
79
63
8
2
14
3
37
14
47
3
3
33
127
10
02
03
04
ALACHUA
BAKER
BAY
BRADFORD
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Enrollment Terminations with Reasons PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 Program All Programs Program Status ALL Program Status Worker ALL WORKERS
Last First Program Medicaid Provider Start End Name Name Client ID Status Description Worker Number Program Location Enrollment Enrollment
Count 0
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Enrollments with Care Plan Report
PSA ALL Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTIVE STATUS Care Plan Service ALL SERVICES Care Plan Start 01012017 Care Plan End 12312017
Care Plan Care Plan Care Plan Client Name
Unduplicated Client Count 0
Client ID Program Status Worker Start Date End Date Service
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PSA CLIENT_ID CLIENT_NAME OWNER PROVIDER_ID ASSESSMENT_DATE ASSESSOR_NAME MEDICAID_NUMBER CAREGIVER_CHANGE ENVIRONMENT_CHANGE HEALTH_CHANGE INCOME_CHANGE SITUATION_CHANGE INITIAL_ASSM ANNUAL_ASSM SSN REFERRAL_SOURCE 1114 N N N N Y N 771771777 SELFFAMILY 812017 JANE CASEWORKER 2 1001141633 TEST TEST N
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Fixed Service Costs List PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Provider Location County Program Service Reimbursement Unit Rate Provider Cost Per Unit Begin Valid End Valid
Count 0
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All Enrollments Counts During Date Range PSA ALL Start Date 01012017 End Date Location 0000 Provider Program Program Status
12312017 ALL PROVIDERS
ACTV
Group By Program Provider Location
Program Provider Location Client Count O3C1 1036 0000 45
1951 0000 3
O3C2 1036 0000 113
OA3E 1821 0000 2
OA3ES 1821 0000 1
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C1 1036 0000 4061950299 Test Name ACTV 04072011 CIRTS23407 N 11
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C1 1036 4062586019 Test Name ACTV 12292008 CIRTS23407 N 1
Total for Location 45
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C1 1951 0000 4062452921 Test Name ACTV 03301989 CIRTS22695 N 10
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4062786256 Test Name ACTV 09232013 CIRTS20804 Y 4 1
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4062380426 Test Name ACTV 04112012 CIRTS23407 N 55 2
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4061608826 Test Name ACTV 08102011 CIRTS18634 Y 7 3
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4062615533 Test Name ACTV 10032013 CIRTS20804 Y 6 3
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start Enrollment
End Enrollment Worker
Worker Active
Medicaid Number
Most Recent Nutr Score Rank
O3C2 1036 4062466582 Test Name ACTV 10262010 CIRTS23407 N 105 2
Total for Location 113
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PSA
APCL Clients With No Services ALL Owner All Owners Provider ALL PROVIDERS
Start Date 01012017 End Date 12312017
Includes Clients Receiving Only CM INSC SCAS CA REFE Services
PSA Client ID Client Name Owner Provider Program
Count 0
Unduplicated Clients Count 0
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APCL Clients With Services PSA ALL Owner All Owners Provider ALL PROVIDERS Start Date 01012017 End Date 12312017
Exclude CM CA INSC REFE SCAS
PSA Client ID Name Owner Provider Program 10 4062527553 Test Name 1539 1929 CCE
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APCL Clients With Services PSA ALL Owner All Owners Provider ALL PROVIDERS Start Date 01012017 End Date 12312017
Exclude CM CA INSC REFE SCAS
PSA Client ID Name Owner Provider Program 11 4062732638 Test Name 1177 1177 LTCC
Total 21067
Unduplicated clients count 12460
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APS Assessments PSA ALL Risk Level ALL Owner All Owners Referral Date From 01012017 To 12312017
Order by Referral Date and Owner ID
PSA 03
Ref Date Owner ID Client ID Client Name Risk Level Asmt Type Asmt Date
03032017 1390 4062058415 L 701A 03302018 Test Name
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APS Assessments PSA ALL Risk Level ALL Owner All Owners Referral Date From 01012017 To 12312017
Order by Referral Date and Owner ID
12042017 1980 4061617559 H 701B 12072017 Test Name
Assessment Count for the PSA 52
PSA 04A
Ref Date Owner ID Client ID
09102017 4062308458
Client Name
Test Name
Risk Level
H
Asmt Type
O
Asmt Date
09162017
Assessment Count for the PSA 2
Risk Level H
M
L
Count of Assessments 138
23
21
Total Count of Assessments 182
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APS Repeat Referrals in a Time Range
PSA ALL Owner All Owners
Start Date 01012017 End Date 12312017
Current DOEA CIRTS Cirts SSN if Risk Date Created PSA Owner Abuse No different than DCF DCF SSN Name County Level Date of Birth Date Sent by DCF
Count 0
Unduplicated Client Count by PSA
PSA Count SSN
Total
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Assessed Prioritized Consumer List PSA ALL Provider ALL PROVIDERS Program AC County ALL COUNTIES
County Program Consumer Name Client ID
Total Count 0
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Assessment Due Report PSA 01 Start Date 01012017 End Date 08312018 Owner ALL PROVIDERS Worker ALL WORKERS Program Status ACTV and APCL Assessment Type Needed ALL
Overdue and missing assessments are always listed
Owner ID 1065
Client ID Client Name
Owner Assessor ID
Date of Birth
06281928
CIRTS28099
County of Service
GULF
Worker Name HARPER KENNY
Zip Assessment PSA Date
32534 01 01022014
Type
701A
Active Y
Nutr PriorityScore Score
11 58
Rank
5
Due Date
01022015
Status
701S OVERDUE
LTCC APPL Start Date
03252014 4062235673 Test name
Total Clients for Worker 1
Total Clients for Owner 1
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Assessment Due Report PSA 01 Start Date 01012017 End Date 08312018 Owner ALL PROVIDERS Worker ALL WORKERS Program Status ACTV and APCL Assessment Type Needed ALL
Overdue and missing assessments are always listed
Summary by PSA
PSA 01 701A Overdue 1
701B Overdue 213
701C Overdue 0
701S Overdue 157
No 701A 0
No 701B 2
No 701C 0
No 701S 0
701A Not Overdue 0
701B Not Overdue 0
701C Not Overdue 0
701S Not Overdue 0
701S Optional 0
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CIC Service Units and Costs Projections County SummaryPSA 99 Program CCE
Start Date 01012017 End Date 12312017
County LEON
Total Total Total Avg Max Projected
StateFederal Projected Reimbursement Provider Unduplicated Provider Service Share Service Units Unit Rate Cost Per Unit Client Count
Report Total
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CIC Service Units and Costs Projections Provider SummaryPSA ALL Provider ALL PROVIDERS Program FEDERALLY FUNDED (0101 TO 1231) Year 2017 From 01012017 To 12312017
PSA County Program Service Total State
Federal Share
Total Projected
Service Units
Avg Reimbursement
Unit Rate
Max Provider
Cost Per Unit
Total Projected Unduplicated Client Count
02 FRANKLIN O3C1 CONGREGATE MEALS $810300 1710 15
Program Total
County Total
$810300
$810300
GULF O3C1 CONGREGATE MEALS $25205 3 5
Program Total $25205
O3C2 HOME DELIVERED MEALS $25205 3 6
Program Total
County Total
$25205
$50411
LEON O3C1 CONGREGATE MEALS $621300 1311 15
CONGREGATE MEALS GUEST
CONGREGATE MEALS VOLUNTEERS
$252055
$277260
25
30
2
5
Program Total $1150615
O3C2 HOME DELIVERED MEAL GUEST $252055 25 3
Program Total $252055
OA3D PEARLS (SESSION 5)
PEARLS (SESSION 6)
PEARLS (SESSION 7)
PEARLS (SESSION 8)
$10247
$10247
$10247
$10247
10
10
10
10
3
3
3
3
Program Total $40988
OA3E RESPITE IN-HOME $200 2 2
Program Total
County Total
$200
$1443858
WAKULLA O3C2 EMERGENCY HOME DELIVERED SHELF MEALS
$8065604 14899 90
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CIC Service Units and Costs Projections - PSA Summary
PSA ALL Program CCE
Strat Date 01012017 End Date 12312017
Total
PSA County Provider Service
Total State Federal
Share
Total Projected
Service Units
Avg Reimbursement
Unit Rate
Max Projected Provider Unduplicated
Cost Per Unit Client Count
02 LEON SOUTHERN SERVICE CASE MANAGEMENT PROVIDER EMERGENCY HOME DELIVERED SHELF MEALS
$2175533
$602000
483
689
32
20
HOME DELIVERED MEALS $530262 993 5
MATERIAL AID $1994536 199
Provider Total $5302331
CountyTotal $5302331
WAKULLA SOUTHERN SERVICE CASE MANAGEMENT PROVIDER EMERGENCY HOME DELIVERED SHELF MEALS
$2175533
$1240200
483
689
32
5
MATERIAL AID $1994536 199
Provider Total $5410269
CountyTotal $5410269
PSA Total $10712599
05 PINELLAS BURSTEIN-APPLEBEE ADULT DAY CARE $000 0 $900 $1000 0
COUNSELING (MENTAL HEALTH COUNSELINGSCREENING) - INDIVIDUAL
Provider Total
$000
$000
0 $6600 $7700 0
CountyTotal $000
PSA Total $000
Report Total $10712599
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CID Service Units and Costs Projections - PSA SummaryPSA ALL Program CCE
Start Date 01012017 End Date 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
PSA County Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
02 LEON CASE MANAGEMENT $2175533 483
EMERGENCY HOME $602000 689DELIVERED SHELF MEALS HOME DELIVERED MEALS $530262 993
MATERIAL AID $1994536 199
County Total $5302331 2364
WAKULLA CASE MANAGEMENT $2175533 483
EMERGENCY HOME $1240200 689DELIVERED SHELF MEALS MATERIAL AID $1994536 199
County Total $5410269 1371
PSA Total $10712599 3735
05 PINELLAS ADULT DAY CARE $000 0
COUNSELING (MENTAL $000 0 HEALTH COUNSELINGSCREENING) - INDIVIDUAL
County Total $000 0
PSA Total $000 0
Report Total $10712599 3735
$900 $900 $900 $1000 $1000 $1000
$6600 $6600 $6600 $7700 $7700 $7700
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CID Service Units and Costs Projections County SummaryPSA 99
Program CCE County LEON
Start Date 01012017 End Date 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
Report Total
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CIE Service Units and Costs Projections - PSA Summary - All Programs
PSA 99 Program FEDERALLY FUNDED (0101 TO 1231) Year 2017 From 01012017 To 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
Program Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
Report Total
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CIE Service Units and Costs Projections - PSA Summary
PSA ALL Program CCE
Start Date 01012017 End Date 12312017
Avg High Low Total Total Avg High Low Provider Provider Provider
StateFederal Projected Reimbursement Reimbursement Reimbursement Cost Cost CostPSA
02
Service
CASE MANAGEMENT
Share
$4351066
Service Units
966
Unit Rate Unit Rate Unit Rate Per Unit Per Unit Per Unit
EMERGENCY HOME DELIVERED SHELF MEALS $1842200 1378
HOME DELIVERED MEALS $530262 993
MATERIAL AID $3989071 398
PSA Total $10712599 3735
05 ADULT DAY CARE $000 0 $900 $900 $900 $1000 $1000 $1000
COUNSELING (MENTAL HEALTH $000 0 $6600 $6600 $6600 $7700 $7700 $7700 COUNSELINGSCREENING) - INDIVIDUAL
PSA Total $000 0
Report Total $10712599 3735
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CAREGIVER SEARCH REPORT
SEARCH RESULTS FOR CONSUMERS
Criteria First Name Last Name SSN PSA ALL
Client Name Client SSN Caregiver Name Caregiver SSN
000000000 000000000 Test Name Test Name
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CARES Referrals in a Time Range PSA ALL
Start Date 01012017 End Date 12312017
Referred to ALL REFERRALS
Referring PSA Employee Name Client Name Client ID
Referral Imminent NH Admit Aging Date Risk Date Referred To Cares Provider Name Received Date
03A 4061561263 Test Name Test Name 09242017 Y 05292017 ARC or ADRC 09252017
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CARES Referrals in a Time Range PSA ALL
Start Date 01012017 End Date 12312017
Referred to ALL REFERRALS
Referring PSA Employee Name Client Name Client ID
Referral Date
Imminent Risk
NH Admit Date Referred To Cares Provider Name
Aging Received Date
04B Test Name Test Name 4061738075 04082017 N ARC or ADRC Test Name 04082017
Total Clients 110
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CARES Referrals not acknowledged by the Aging Network PSA ALL For Referrals after 01012017 Owner ID ALL Owners
Unduplicated Client count Cares Office Total Clients Count
Report Total
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
CIRTS Issue PSA Client ID Client Name Program
Program Status Start Provider Enrollment ID Provider Name
APCL CLIENT WITH DATE OF DEATH 08 4061759417 Test Name OA3B APCL 07232013 1141 WESTERN WORLD RADIO
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
Program Start Provider CIRTS Issue PSA Client ID Client Name Program Status Enrollment ID Provider Name
06 LTCC APCL 01242014 1514 4061713685 Test Name APCL CLIENT WITH DATE OF DEATH CENTRAL THE ORIGINAL HOUSE OF PIES
Count 503
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Civil Rights PSA ALL Provider ALL PROVIDERS Program AC Start Date 01012017 End Date 12312017 The Poverty Level for Single is The Poverty Level for Couple is Sort by County
County Unduplicated Count
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Client Information Report Start Date 01012017 End Date 12312017
Client ID 1001141246
Emergency
Client Name Test Name
Telephone () - Address 78 TEST STREET TALLAHASSEE FL 32399
Most Recent Caregiver Information Date Updated
Doctor
Comments
Client Demographic Information
Birth Date 06041940 Race W
Owner ID Ethnicity O
Most Recent Income Information
Ind Mon Inc Cpl Mon Inc
Ind Assets Couple Assets
Most Recent Assessment Information
Asmt Date Ref Risk Lvl
Asmt Site Spec Shel
AsmtType Spec Reg
Ref Date Primary CG
Ref Source Living Sit
Enrollment Information
Sex
Marital Status
F
S
Medicaid Number
ADL Score
ADL Count
IADL Score
IADL Count
Memory Score
Priority Score
Env Score
Nutr Score
Risk Score
Social Score
Rank
Provider Location Program Program Status Worker Start Date End Date
Care Plan Service Needed
Date Service Units Type Frq End Date
Care Plan Service Planned
Program Service Units Type Frq Start Date End Date
Services Received between 01012017 and 12312017
Service Billed Provider Location Worker Program Service Date Units Unit Type Amount
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Provider N
Client Service Units Report PSA ALL Provider ALL PROVIDERS Location 0000
Program ALL PROGRAMS Service ALL SERVICES Worker ALL WORKERS
City ALL CITIES Include Zero Unit N Include Aggregate N Calculated Amount equals the number of Units Provided times Fixed Cost if it existsService Start Date 01012017 Service End Date 12312017 If Fixed Cost does not exist Calculated
Group by PSA Provider Location Client Name County Worker Amount equals Billed Amount
Unduplicated Client Count 0 Grand Total 000 $000
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Clients In Common PSA All Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 County All Counties Worker All Workers
County JEFFERSON
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
MIAMI-DADE
0 0 0 0 0 0 0 0 0
4061539538 Test NameCounty Count
County
0 01
X
0 1
X
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
4061650856 Test Name X 4061486560 Test Name X 4062452921 Test Name X
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Clients Served Not Enrolled PSA ALL Start Date 01012017 End Date 12312017 Locations 0000 Provider All Providers
Service Service Min Serv Max Serv Program Start End Enrollment PSA Provider Location Program Consumer Name Client ID Service Date Date Status Enrollment Enrollment Provider
Count 0
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
4061472791 04
09
1092
1291
0072
0042
LTCC
LTCC
APCL
APCL
4062714543 06
06
1514
1762
0072
5006
LTCC
LTCC
APCL
APPL
4061802246 11
06
1177
1514
0179
0072
LTCC
LTCC
APCL
APCL
4061563719 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062644312 06
08
1514
1771
0072
0896
LTCC
LTCC
APCL
APCL
1001141670 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
1001141671 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
4062375003 07
05
05
07
1263
1755
1638
1263
0368
0072
0072
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062155124 06
06
1762
1514
0072
0072
LTCC
LTCC
APPL
APCL
4061743886 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0369
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4061499927 06
06
1514
1762
0072
5005
LTCC
LTCC
APCL
APPL
4061583524 08
06
1144
1514
0896
0072
LTCC
LTCC
APCL
APCL
4062694843 06
03
1514
1922
0072
0179
LTCC
LTCC
APCL
APCL
4062744517 07
06
1263
1514
0369
0072
LTCC
LTCC
APCL
APCL
4062005488 10
11
10
11
1929
1177
1164
1177
0072
0073
0179
0179
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
Total Count 15
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CODE DESCRIPTIONS Category ALL STATE TABLES
Code Description Active Available To Code Category
0 UNKNOWN Y CARES SUBJECTIVE_HEALTH_EVALUATION
01 ALACHUA Y COMMON COUNTIES
02 BAKER Y COMMON COUNTIES
03 BAY Y COMMON COUNTIES
04 BRADFORD Y COMMON COUNTIES
05 BREVARD Y COMMON COUNTIES
06 BROWARD Y COMMON COUNTIES
07 CALHOUN Y COMMON COUNTIES
08 CHARLOTTE Y COMMON COUNTIES
09 CITRUS Y COMMON COUNTIES
1 EXCELLENT Y CARES SUBJECTIVE_HEALTH_EVALUATION
10 CLAY Y COMMON COUNTIES
11 COLLIER Y COMMON COUNTIES
12 COLUMBIA Y COMMON COUNTIES
13 MIAMI-DADE Y COMMON COUNTIES
14 DESOTO Y COMMON COUNTIES
15 DIXIE Y COMMON COUNTIES
16 DUVAL Y COMMON COUNTIES
17 ESCAMBIA Y COMMON COUNTIES
18 FLAGLER Y COMMON COUNTIES
19 FRANKLIN Y COMMON COUNTIES
2 GOOD Y CARES SUBJECTIVE_HEALTH_EVALUATION
20 GADSDEN Y COMMON COUNTIES
21 GILCHRIST Y COMMON COUNTIES
22 GLADES Y COMMON COUNTIES
23 GULF Y COMMON COUNTIES
24 HAMILTON Y COMMON COUNTIES
25 HARDEE Y COMMON COUNTIES
26 HENDRY Y COMMON COUNTIES
27 HERNANDO Y COMMON COUNTIES
28 HIGHLANDS Y COMMON COUNTIES
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CONSUMER AGE VERIFICATION REPORT PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Program AC
Age at Start
Enroll or Start Enroll Provider Program Description Consumer Name Client ID DOB Svc date or Svc Date
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Contract Budget Information PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Program Service Provider Location County Served Provider Contract
Projected Service
Units Unit Measure
Projected Unduplicated
State Federal Share Client Count Begin Date End Date
Row Count 0 Amount Total
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Start Enroll Latest Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Date Asmt Date Worker
O3C1 1036 000 4061653427 Test CENTRAL 34982 W M 07091930 09102013 09102013 CIRTS20804 0 Name
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Start Enroll Date
Latest Asmt Date Worker
4061593624 Test Name CENTRAL 34946 B F 11261940 12012011 12312013 CIRTS23407
Count 164
Unduplicated Client Count 163
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Assessments After DOD Report
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Owner 1025
The shaded records indicate clients who have different DOBs andor different names
Assemt Current PSA Owner Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Owner Assessor
Provider Assessor
Assemt Date
Assemt Type
Unduplicated Count Total 0
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Open Enrollments
The Vital Statistics Data for 07192002 - 09112014PSA ALL Provider ALL Program Status ACTV Include MLTC ACTVS N
The shaded records indicate clients who have different DOBs andor different names
Enroll PSA
Enrollment Provider Loc Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Enroll Program Status
Enroll Program
Current Owner ID
02 1065 0072 4062244026 Test Name Test Name 10222004 03231917 03231917 ACTV CCE 1065
Count of enrollments for the Provider 1
Count of enrollments for the PSA 1
Count of enrollments for the Report 1
Unduplicated Count of Individuals with open enrollments and DOD PSA Total Clients Count
02 1
Total 1
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Unduplicated count of individuals with Services after DOD
PSA Total Clients Count
Report Total
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
List of Clients with PSA table entry for SERVICES_AFTER_DOD
Unduplicated Count Total 0
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Age
Provider
Total
Age lt 60 Age 60 - 64 Age 65 - 74 Age 75 - 84 Age 85+ Total Clients Avg Age
Total
Avg Age
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Ethnicity
Provider Hispanic Other Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Race
American Indian Native Hawaiian Other Provider Asian Alaska Native Black Pacific Islander Minority White Multiple Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Gender
Provider Male Female Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Monthly Income
Provider 0 - - Higher than Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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None
Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Total Persons Served 0
Age lt 60 Years 0 0
Age 60 - 64 0 0
Age 65 - 74 0 0
Age 75 - 84 0 0
Age 85+ 0 0
Total Age 0 0
Average 000
Ethnicity Hispanic 0 0
Other Ethnicity 0 0
Unknown Ethnicity 0 0
Total 0 0
Race Asian 0 0
American Indian Alaska Native 0 0
Black 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority 0 0
White 0 0
Multiple 0 0
Unknown 0 0
Total 0 0
Sex Male 0 0
Female 0 0
Unknown Sex 0 0
Total 0 0
Monthly Income 0 - 0 0
- 0 0
Higher than 0 0
Unknown 0 0
Total 0 0
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Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Client ID Date Of Birth Ethnicity Race Sex Individual Monthly Income
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Demographics of Clients OAA Registered Served Only PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 City All Cities Program All Programs Service All Services County ALL COUNTIES Table OAA Registered Services Only Low Income Medium Income
Total Persons Served 0
Agelt 60 Years
Age 60 - 64
Age 65 - 74
Age 75 - 84
Age 85+
0
0
0
0
0
0
0
0
0
0
Monthly Income
0 -
-Higher than
Unknown
0
0
0
0
0
0
0
0
Total
Average
0
000
0 Total 0 0
Ethnicity Hispanic
Other
Unknown
0
0
0
0
0
0
Living Situation
Alone
Null
Policy Change
0
0
0
0
0
0
Total 0 0 Unknown
With Caregiver
0
0
0
0
Race Asian 0 0
With Other
With Other Caregiver
0
0
0
0
American Indian Alaska Native
Black
0
0
0
0Total Living Situation 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority
White
0
0
0
0 Limited English Proficiency
Multiple
Unknown
Total Race
0
0
0
0
0
0
Yes
No
Unknown
0
0
0
0
0
0
Total 0 0
Sex Male
Female
Unknown
0
0
0
0
0
0
Total 0 0
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Disaster Assistance Clients for a Provider PSA ALL Provider All Providers Location 0000 Worker All Workers City All Cities Zip Code All Zip Codes Sort By ZIP
Provider 1036 Provider Name Location 0000 Worker CIRTS18634
Need Care Client Name Address City Zip County Phone Asst Reg Situation Relat Care phone Care Name
34946 N WO DA 000 SAINT JAMES DRIVE CENTRAL (025) 101-0620 Test NameTest Name SAINT LUCIE (005) 100-0369 Y
Client is active and no assessment information is available Special Shelter and Special Registry are unknown
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
Total by PSA 0
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
ALACH BAKER BAY BRADF BREVA BROWA CALHO CHARL CITRUS CLAY COLLIE COLUM DESOT DIXIE DUVAL ESCAM FLAGL FRANK GADSDAssisted Household Report UA ORD RD RD UN OTTE R BIA O BIA ER LIN EN
1 of Household Assisted 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Households AssistedWith Gross Income
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C 100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D 125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
3 Households with at leastOne member
A 60 Years or older 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B Disabled 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C Age 5 years or under 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D Under 60 Years Old 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Undup Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Assisted
Applicant Household Report
of Applicant Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Energy Assisted Household Report
County of Assisted
Households
Households Assisted By Poverty Level
Under 75 75 - 100 101 - 125 126 - 150 Over 150 60 Years or older
At least one member who is
Age 5 years Age 2 years Age 3 years Disabled or younger and younger through 5
Under 60 Years Old
Undup Households
Assisted
Energy Assistance Total
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Unduplicated Total 0 0
County of Assisted
Households Under 75 75 - 100
Households Assisted By Poverty Level
101 - 125 126 - 150 Over 150 60 Years or older Disabled
Age 5 years or younger
Age 2 years and younger
Age 3 years through 5
Under 60 Years Old
At least one member who is
Undup Households
Assisted
Other Assisted Household Report
Other Assistance Total
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Applicant Household Report
County of Applicant
Households Under 75 75 - 100 101 - 125 126 - 150 Over 150 Income data
unavailable
Total 0
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01
Enrollment Active Consumer Count by Program PSA ALL Provider ALL PROVIDERS
County Description Program Count of Clients
BREVARD
ADI
CCE
HCE
LSP
NDP
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
MLTC
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
31
57
44
5
62
123
141
26
9
7
5
40
5
50
67
129
2
19
42
29
1
233
79
63
8
2
14
3
37
14
47
3
3
33
127
10
02
03
04
ALACHUA
BAKER
BAY
BRADFORD
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Enrollment Terminations with Reasons PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 Program All Programs Program Status ALL Program Status Worker ALL WORKERS
Last First Program Medicaid Provider Start End Name Name Client ID Status Description Worker Number Program Location Enrollment Enrollment
Count 0
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Enrollments with Care Plan Report
PSA ALL Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTIVE STATUS Care Plan Service ALL SERVICES Care Plan Start 01012017 Care Plan End 12312017
Care Plan Care Plan Care Plan Client Name
Unduplicated Client Count 0
Client ID Program Status Worker Start Date End Date Service
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PSA CLIENT_ID CLIENT_NAME OWNER PROVIDER_ID ASSESSMENT_DATE ASSESSOR_NAME MEDICAID_NUMBER CAREGIVER_CHANGE ENVIRONMENT_CHANGE HEALTH_CHANGE INCOME_CHANGE SITUATION_CHANGE INITIAL_ASSM ANNUAL_ASSM SSN REFERRAL_SOURCE 1114 N N N N Y N 771771777 SELFFAMILY 812017 JANE CASEWORKER 2 1001141633 TEST TEST N
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Fixed Service Costs List PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Provider Location County Program Service Reimbursement Unit Rate Provider Cost Per Unit Begin Valid End Valid
Count 0
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C1 1036 0000 4061950299 Test Name ACTV 04072011 CIRTS23407 N 11
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C1 1036 4062586019 Test Name ACTV 12292008 CIRTS23407 N 1
Total for Location 45
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C1 1951 0000 4062452921 Test Name ACTV 03301989 CIRTS22695 N 10
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4062786256 Test Name ACTV 09232013 CIRTS20804 Y 4 1
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4062380426 Test Name ACTV 04112012 CIRTS23407 N 55 2
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4061608826 Test Name ACTV 08102011 CIRTS18634 Y 7 3
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4062615533 Test Name ACTV 10032013 CIRTS20804 Y 6 3
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start Enrollment
End Enrollment Worker
Worker Active
Medicaid Number
Most Recent Nutr Score Rank
O3C2 1036 4062466582 Test Name ACTV 10262010 CIRTS23407 N 105 2
Total for Location 113
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PSA
APCL Clients With No Services ALL Owner All Owners Provider ALL PROVIDERS
Start Date 01012017 End Date 12312017
Includes Clients Receiving Only CM INSC SCAS CA REFE Services
PSA Client ID Client Name Owner Provider Program
Count 0
Unduplicated Clients Count 0
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APCL Clients With Services PSA ALL Owner All Owners Provider ALL PROVIDERS Start Date 01012017 End Date 12312017
Exclude CM CA INSC REFE SCAS
PSA Client ID Name Owner Provider Program 10 4062527553 Test Name 1539 1929 CCE
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APCL Clients With Services PSA ALL Owner All Owners Provider ALL PROVIDERS Start Date 01012017 End Date 12312017
Exclude CM CA INSC REFE SCAS
PSA Client ID Name Owner Provider Program 11 4062732638 Test Name 1177 1177 LTCC
Total 21067
Unduplicated clients count 12460
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APS Assessments PSA ALL Risk Level ALL Owner All Owners Referral Date From 01012017 To 12312017
Order by Referral Date and Owner ID
PSA 03
Ref Date Owner ID Client ID Client Name Risk Level Asmt Type Asmt Date
03032017 1390 4062058415 L 701A 03302018 Test Name
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APS Assessments PSA ALL Risk Level ALL Owner All Owners Referral Date From 01012017 To 12312017
Order by Referral Date and Owner ID
12042017 1980 4061617559 H 701B 12072017 Test Name
Assessment Count for the PSA 52
PSA 04A
Ref Date Owner ID Client ID
09102017 4062308458
Client Name
Test Name
Risk Level
H
Asmt Type
O
Asmt Date
09162017
Assessment Count for the PSA 2
Risk Level H
M
L
Count of Assessments 138
23
21
Total Count of Assessments 182
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APS Repeat Referrals in a Time Range
PSA ALL Owner All Owners
Start Date 01012017 End Date 12312017
Current DOEA CIRTS Cirts SSN if Risk Date Created PSA Owner Abuse No different than DCF DCF SSN Name County Level Date of Birth Date Sent by DCF
Count 0
Unduplicated Client Count by PSA
PSA Count SSN
Total
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Assessed Prioritized Consumer List PSA ALL Provider ALL PROVIDERS Program AC County ALL COUNTIES
County Program Consumer Name Client ID
Total Count 0
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Assessment Due Report PSA 01 Start Date 01012017 End Date 08312018 Owner ALL PROVIDERS Worker ALL WORKERS Program Status ACTV and APCL Assessment Type Needed ALL
Overdue and missing assessments are always listed
Owner ID 1065
Client ID Client Name
Owner Assessor ID
Date of Birth
06281928
CIRTS28099
County of Service
GULF
Worker Name HARPER KENNY
Zip Assessment PSA Date
32534 01 01022014
Type
701A
Active Y
Nutr PriorityScore Score
11 58
Rank
5
Due Date
01022015
Status
701S OVERDUE
LTCC APPL Start Date
03252014 4062235673 Test name
Total Clients for Worker 1
Total Clients for Owner 1
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Assessment Due Report PSA 01 Start Date 01012017 End Date 08312018 Owner ALL PROVIDERS Worker ALL WORKERS Program Status ACTV and APCL Assessment Type Needed ALL
Overdue and missing assessments are always listed
Summary by PSA
PSA 01 701A Overdue 1
701B Overdue 213
701C Overdue 0
701S Overdue 157
No 701A 0
No 701B 2
No 701C 0
No 701S 0
701A Not Overdue 0
701B Not Overdue 0
701C Not Overdue 0
701S Not Overdue 0
701S Optional 0
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CIC Service Units and Costs Projections County SummaryPSA 99 Program CCE
Start Date 01012017 End Date 12312017
County LEON
Total Total Total Avg Max Projected
StateFederal Projected Reimbursement Provider Unduplicated Provider Service Share Service Units Unit Rate Cost Per Unit Client Count
Report Total
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CIC Service Units and Costs Projections Provider SummaryPSA ALL Provider ALL PROVIDERS Program FEDERALLY FUNDED (0101 TO 1231) Year 2017 From 01012017 To 12312017
PSA County Program Service Total State
Federal Share
Total Projected
Service Units
Avg Reimbursement
Unit Rate
Max Provider
Cost Per Unit
Total Projected Unduplicated Client Count
02 FRANKLIN O3C1 CONGREGATE MEALS $810300 1710 15
Program Total
County Total
$810300
$810300
GULF O3C1 CONGREGATE MEALS $25205 3 5
Program Total $25205
O3C2 HOME DELIVERED MEALS $25205 3 6
Program Total
County Total
$25205
$50411
LEON O3C1 CONGREGATE MEALS $621300 1311 15
CONGREGATE MEALS GUEST
CONGREGATE MEALS VOLUNTEERS
$252055
$277260
25
30
2
5
Program Total $1150615
O3C2 HOME DELIVERED MEAL GUEST $252055 25 3
Program Total $252055
OA3D PEARLS (SESSION 5)
PEARLS (SESSION 6)
PEARLS (SESSION 7)
PEARLS (SESSION 8)
$10247
$10247
$10247
$10247
10
10
10
10
3
3
3
3
Program Total $40988
OA3E RESPITE IN-HOME $200 2 2
Program Total
County Total
$200
$1443858
WAKULLA O3C2 EMERGENCY HOME DELIVERED SHELF MEALS
$8065604 14899 90
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CIC Service Units and Costs Projections - PSA Summary
PSA ALL Program CCE
Strat Date 01012017 End Date 12312017
Total
PSA County Provider Service
Total State Federal
Share
Total Projected
Service Units
Avg Reimbursement
Unit Rate
Max Projected Provider Unduplicated
Cost Per Unit Client Count
02 LEON SOUTHERN SERVICE CASE MANAGEMENT PROVIDER EMERGENCY HOME DELIVERED SHELF MEALS
$2175533
$602000
483
689
32
20
HOME DELIVERED MEALS $530262 993 5
MATERIAL AID $1994536 199
Provider Total $5302331
CountyTotal $5302331
WAKULLA SOUTHERN SERVICE CASE MANAGEMENT PROVIDER EMERGENCY HOME DELIVERED SHELF MEALS
$2175533
$1240200
483
689
32
5
MATERIAL AID $1994536 199
Provider Total $5410269
CountyTotal $5410269
PSA Total $10712599
05 PINELLAS BURSTEIN-APPLEBEE ADULT DAY CARE $000 0 $900 $1000 0
COUNSELING (MENTAL HEALTH COUNSELINGSCREENING) - INDIVIDUAL
Provider Total
$000
$000
0 $6600 $7700 0
CountyTotal $000
PSA Total $000
Report Total $10712599
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CID Service Units and Costs Projections - PSA SummaryPSA ALL Program CCE
Start Date 01012017 End Date 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
PSA County Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
02 LEON CASE MANAGEMENT $2175533 483
EMERGENCY HOME $602000 689DELIVERED SHELF MEALS HOME DELIVERED MEALS $530262 993
MATERIAL AID $1994536 199
County Total $5302331 2364
WAKULLA CASE MANAGEMENT $2175533 483
EMERGENCY HOME $1240200 689DELIVERED SHELF MEALS MATERIAL AID $1994536 199
County Total $5410269 1371
PSA Total $10712599 3735
05 PINELLAS ADULT DAY CARE $000 0
COUNSELING (MENTAL $000 0 HEALTH COUNSELINGSCREENING) - INDIVIDUAL
County Total $000 0
PSA Total $000 0
Report Total $10712599 3735
$900 $900 $900 $1000 $1000 $1000
$6600 $6600 $6600 $7700 $7700 $7700
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CID Service Units and Costs Projections County SummaryPSA 99
Program CCE County LEON
Start Date 01012017 End Date 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
Report Total
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CIE Service Units and Costs Projections - PSA Summary - All Programs
PSA 99 Program FEDERALLY FUNDED (0101 TO 1231) Year 2017 From 01012017 To 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
Program Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
Report Total
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CIE Service Units and Costs Projections - PSA Summary
PSA ALL Program CCE
Start Date 01012017 End Date 12312017
Avg High Low Total Total Avg High Low Provider Provider Provider
StateFederal Projected Reimbursement Reimbursement Reimbursement Cost Cost CostPSA
02
Service
CASE MANAGEMENT
Share
$4351066
Service Units
966
Unit Rate Unit Rate Unit Rate Per Unit Per Unit Per Unit
EMERGENCY HOME DELIVERED SHELF MEALS $1842200 1378
HOME DELIVERED MEALS $530262 993
MATERIAL AID $3989071 398
PSA Total $10712599 3735
05 ADULT DAY CARE $000 0 $900 $900 $900 $1000 $1000 $1000
COUNSELING (MENTAL HEALTH $000 0 $6600 $6600 $6600 $7700 $7700 $7700 COUNSELINGSCREENING) - INDIVIDUAL
PSA Total $000 0
Report Total $10712599 3735
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CAREGIVER SEARCH REPORT
SEARCH RESULTS FOR CONSUMERS
Criteria First Name Last Name SSN PSA ALL
Client Name Client SSN Caregiver Name Caregiver SSN
000000000 000000000 Test Name Test Name
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CARES Referrals in a Time Range PSA ALL
Start Date 01012017 End Date 12312017
Referred to ALL REFERRALS
Referring PSA Employee Name Client Name Client ID
Referral Imminent NH Admit Aging Date Risk Date Referred To Cares Provider Name Received Date
03A 4061561263 Test Name Test Name 09242017 Y 05292017 ARC or ADRC 09252017
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CARES Referrals in a Time Range PSA ALL
Start Date 01012017 End Date 12312017
Referred to ALL REFERRALS
Referring PSA Employee Name Client Name Client ID
Referral Date
Imminent Risk
NH Admit Date Referred To Cares Provider Name
Aging Received Date
04B Test Name Test Name 4061738075 04082017 N ARC or ADRC Test Name 04082017
Total Clients 110
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CARES Referrals not acknowledged by the Aging Network PSA ALL For Referrals after 01012017 Owner ID ALL Owners
Unduplicated Client count Cares Office Total Clients Count
Report Total
Report run on 08312018 0158 PM Page 1 of 1 cares_not_ackrdf
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
CIRTS Issue PSA Client ID Client Name Program
Program Status Start Provider Enrollment ID Provider Name
APCL CLIENT WITH DATE OF DEATH 08 4061759417 Test Name OA3B APCL 07232013 1141 WESTERN WORLD RADIO
Report run on 08312018 0224 PM
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
Program Start Provider CIRTS Issue PSA Client ID Client Name Program Status Enrollment ID Provider Name
06 LTCC APCL 01242014 1514 4061713685 Test Name APCL CLIENT WITH DATE OF DEATH CENTRAL THE ORIGINAL HOUSE OF PIES
Count 503
Report run on 08312018 0224 PM Page 22 of 22 data_cleanuprdf Report run by RSHQALL Dispose of this report so that it can not be read or reconstructed
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Civil Rights PSA ALL Provider ALL PROVIDERS Program AC Start Date 01012017 End Date 12312017 The Poverty Level for Single is The Poverty Level for Couple is Sort by County
County Unduplicated Count
Report run on 08312018 1055 AM Page 1 of 1 civil_rightsrdf
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Client Information Report Start Date 01012017 End Date 12312017
Client ID 1001141246
Emergency
Client Name Test Name
Telephone () - Address 78 TEST STREET TALLAHASSEE FL 32399
Most Recent Caregiver Information Date Updated
Doctor
Comments
Client Demographic Information
Birth Date 06041940 Race W
Owner ID Ethnicity O
Most Recent Income Information
Ind Mon Inc Cpl Mon Inc
Ind Assets Couple Assets
Most Recent Assessment Information
Asmt Date Ref Risk Lvl
Asmt Site Spec Shel
AsmtType Spec Reg
Ref Date Primary CG
Ref Source Living Sit
Enrollment Information
Sex
Marital Status
F
S
Medicaid Number
ADL Score
ADL Count
IADL Score
IADL Count
Memory Score
Priority Score
Env Score
Nutr Score
Risk Score
Social Score
Rank
Provider Location Program Program Status Worker Start Date End Date
Care Plan Service Needed
Date Service Units Type Frq End Date
Care Plan Service Planned
Program Service Units Type Frq Start Date End Date
Services Received between 01012017 and 12312017
Service Billed Provider Location Worker Program Service Date Units Unit Type Amount
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Provider N
Client Service Units Report PSA ALL Provider ALL PROVIDERS Location 0000
Program ALL PROGRAMS Service ALL SERVICES Worker ALL WORKERS
City ALL CITIES Include Zero Unit N Include Aggregate N Calculated Amount equals the number of Units Provided times Fixed Cost if it existsService Start Date 01012017 Service End Date 12312017 If Fixed Cost does not exist Calculated
Group by PSA Provider Location Client Name County Worker Amount equals Billed Amount
Unduplicated Client Count 0 Grand Total 000 $000
Report run on 08312018 0234 PM Page 1 of 1 clnt_serv_unitsrdf
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Clients In Common PSA All Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 County All Counties Worker All Workers
County JEFFERSON
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
MIAMI-DADE
0 0 0 0 0 0 0 0 0
4061539538 Test NameCounty Count
County
0 01
X
0 1
X
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
4061650856 Test Name X 4061486560 Test Name X 4062452921 Test Name X
Report run on 08312018 1148 AM clients_commonrdfPage 1 of 4 Report run by RSHQALL Dispose of this Report so that it can not be read or reconstructed
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Clients Served Not Enrolled PSA ALL Start Date 01012017 End Date 12312017 Locations 0000 Provider All Providers
Service Service Min Serv Max Serv Program Start End Enrollment PSA Provider Location Program Consumer Name Client ID Service Date Date Status Enrollment Enrollment Provider
Count 0
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
4061472791 04
09
1092
1291
0072
0042
LTCC
LTCC
APCL
APCL
4062714543 06
06
1514
1762
0072
5006
LTCC
LTCC
APCL
APPL
4061802246 11
06
1177
1514
0179
0072
LTCC
LTCC
APCL
APCL
4061563719 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062644312 06
08
1514
1771
0072
0896
LTCC
LTCC
APCL
APCL
1001141670 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
1001141671 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
4062375003 07
05
05
07
1263
1755
1638
1263
0368
0072
0072
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062155124 06
06
1762
1514
0072
0072
LTCC
LTCC
APPL
APCL
4061743886 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0369
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4061499927 06
06
1514
1762
0072
5005
LTCC
LTCC
APCL
APPL
4061583524 08
06
1144
1514
0896
0072
LTCC
LTCC
APCL
APCL
4062694843 06
03
1514
1922
0072
0179
LTCC
LTCC
APCL
APCL
4062744517 07
06
1263
1514
0369
0072
LTCC
LTCC
APCL
APCL
4062005488 10
11
10
11
1929
1177
1164
1177
0072
0073
0179
0179
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
Report run on 08312018 0200 PM Page 1 of 2 clnts_mult_enrollrdf
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
Total Count 15
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CODE DESCRIPTIONS Category ALL STATE TABLES
Code Description Active Available To Code Category
0 UNKNOWN Y CARES SUBJECTIVE_HEALTH_EVALUATION
01 ALACHUA Y COMMON COUNTIES
02 BAKER Y COMMON COUNTIES
03 BAY Y COMMON COUNTIES
04 BRADFORD Y COMMON COUNTIES
05 BREVARD Y COMMON COUNTIES
06 BROWARD Y COMMON COUNTIES
07 CALHOUN Y COMMON COUNTIES
08 CHARLOTTE Y COMMON COUNTIES
09 CITRUS Y COMMON COUNTIES
1 EXCELLENT Y CARES SUBJECTIVE_HEALTH_EVALUATION
10 CLAY Y COMMON COUNTIES
11 COLLIER Y COMMON COUNTIES
12 COLUMBIA Y COMMON COUNTIES
13 MIAMI-DADE Y COMMON COUNTIES
14 DESOTO Y COMMON COUNTIES
15 DIXIE Y COMMON COUNTIES
16 DUVAL Y COMMON COUNTIES
17 ESCAMBIA Y COMMON COUNTIES
18 FLAGLER Y COMMON COUNTIES
19 FRANKLIN Y COMMON COUNTIES
2 GOOD Y CARES SUBJECTIVE_HEALTH_EVALUATION
20 GADSDEN Y COMMON COUNTIES
21 GILCHRIST Y COMMON COUNTIES
22 GLADES Y COMMON COUNTIES
23 GULF Y COMMON COUNTIES
24 HAMILTON Y COMMON COUNTIES
25 HARDEE Y COMMON COUNTIES
26 HENDRY Y COMMON COUNTIES
27 HERNANDO Y COMMON COUNTIES
28 HIGHLANDS Y COMMON COUNTIES
Report run on 08312018 0140 PM Page 1 of 45 state_codesrdf Report run by RSHQALL Dispose of this report so that it cannot be read or reconstructed
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CONSUMER AGE VERIFICATION REPORT PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Program AC
Age at Start
Enroll or Start Enroll Provider Program Description Consumer Name Client ID DOB Svc date or Svc Date
Report run on 08312018 0203 PM Page 1 of 1 age_verifyrdf
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Contract Budget Information PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Program Service Provider Location County Served Provider Contract
Projected Service
Units Unit Measure
Projected Unduplicated
State Federal Share Client Count Begin Date End Date
Row Count 0 Amount Total
Report run on 08312018 0233 PM Page 1 of 1 contract_budgetrdf
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Start Enroll Latest Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Date Asmt Date Worker
O3C1 1036 000 4061653427 Test CENTRAL 34982 W M 07091930 09102013 09102013 CIRTS20804 0 Name
Report run on 08312018 1133 AM Page 1 of 6 actv_by_progrdf
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Start Enroll Date
Latest Asmt Date Worker
4061593624 Test Name CENTRAL 34946 B F 11261940 12012011 12312013 CIRTS23407
Count 164
Unduplicated Client Count 163
Report run on 08312018 1133 AM Page 6 of 6 actv_by_progrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Assessments After DOD Report
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Owner 1025
The shaded records indicate clients who have different DOBs andor different names
Assemt Current PSA Owner Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Owner Assessor
Provider Assessor
Assemt Date
Assemt Type
Unduplicated Count Total 0
Report run on 08312018 0206 PM Page 1 of 1 vs_assmrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Open Enrollments
The Vital Statistics Data for 07192002 - 09112014PSA ALL Provider ALL Program Status ACTV Include MLTC ACTVS N
The shaded records indicate clients who have different DOBs andor different names
Enroll PSA
Enrollment Provider Loc Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Enroll Program Status
Enroll Program
Current Owner ID
02 1065 0072 4062244026 Test Name Test Name 10222004 03231917 03231917 ACTV CCE 1065
Count of enrollments for the Provider 1
Count of enrollments for the PSA 1
Count of enrollments for the Report 1
Unduplicated Count of Individuals with open enrollments and DOD PSA Total Clients Count
02 1
Total 1
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Report run on 08312018 0207 PM Page 1 of 3 vs_servicesrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Unduplicated count of individuals with Services after DOD
PSA Total Clients Count
Report Total
Report run on 08312018 0207 PM Page 2 of 3 vs_servicesrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
List of Clients with PSA table entry for SERVICES_AFTER_DOD
Unduplicated Count Total 0
Report run on 08312018 0207 PM Page 3 of 3 vs_servicesrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Age
Provider
Total
Age lt 60 Age 60 - 64 Age 65 - 74 Age 75 - 84 Age 85+ Total Clients Avg Age
Total
Avg Age
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Ethnicity
Provider Hispanic Other Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Race
American Indian Native Hawaiian Other Provider Asian Alaska Native Black Pacific Islander Minority White Multiple Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Gender
Provider Male Female Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Monthly Income
Provider 0 - - Higher than Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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None
Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Total Persons Served 0
Age lt 60 Years 0 0
Age 60 - 64 0 0
Age 65 - 74 0 0
Age 75 - 84 0 0
Age 85+ 0 0
Total Age 0 0
Average 000
Ethnicity Hispanic 0 0
Other Ethnicity 0 0
Unknown Ethnicity 0 0
Total 0 0
Race Asian 0 0
American Indian Alaska Native 0 0
Black 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority 0 0
White 0 0
Multiple 0 0
Unknown 0 0
Total 0 0
Sex Male 0 0
Female 0 0
Unknown Sex 0 0
Total 0 0
Monthly Income 0 - 0 0
- 0 0
Higher than 0 0
Unknown 0 0
Total 0 0
Report run on 08312018 1058 AM Page 1 of 2 demo_by_prov_detrdf Report run byRSHQALL Dispose of this report so that it can not be read or reconstructed
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Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Client ID Date Of Birth Ethnicity Race Sex Individual Monthly Income
Report run on 08312018 1058 AM Page 2 of 2 demo_by_prov_detrdf Report run byRSHQALL Dispose of this report so that it can not be read or reconstructed
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Demographics of Clients OAA Registered Served Only PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 City All Cities Program All Programs Service All Services County ALL COUNTIES Table OAA Registered Services Only Low Income Medium Income
Total Persons Served 0
Agelt 60 Years
Age 60 - 64
Age 65 - 74
Age 75 - 84
Age 85+
0
0
0
0
0
0
0
0
0
0
Monthly Income
0 -
-Higher than
Unknown
0
0
0
0
0
0
0
0
Total
Average
0
000
0 Total 0 0
Ethnicity Hispanic
Other
Unknown
0
0
0
0
0
0
Living Situation
Alone
Null
Policy Change
0
0
0
0
0
0
Total 0 0 Unknown
With Caregiver
0
0
0
0
Race Asian 0 0
With Other
With Other Caregiver
0
0
0
0
American Indian Alaska Native
Black
0
0
0
0Total Living Situation 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority
White
0
0
0
0 Limited English Proficiency
Multiple
Unknown
Total Race
0
0
0
0
0
0
Yes
No
Unknown
0
0
0
0
0
0
Total 0 0
Sex Male
Female
Unknown
0
0
0
0
0
0
Total 0 0
Report run on 08312018 1056 AM Page 1 of 1 demo_by_provrdf
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Disaster Assistance Clients for a Provider PSA ALL Provider All Providers Location 0000 Worker All Workers City All Cities Zip Code All Zip Codes Sort By ZIP
Provider 1036 Provider Name Location 0000 Worker CIRTS18634
Need Care Client Name Address City Zip County Phone Asst Reg Situation Relat Care phone Care Name
34946 N WO DA 000 SAINT JAMES DRIVE CENTRAL (025) 101-0620 Test NameTest Name SAINT LUCIE (005) 100-0369 Y
Client is active and no assessment information is available Special Shelter and Special Registry are unknown
Report run on 08312018 1102 AM Page 1 of 8 disaster_by_provrdf
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
Total by PSA 0
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
ALACH BAKER BAY BRADF BREVA BROWA CALHO CHARL CITRUS CLAY COLLIE COLUM DESOT DIXIE DUVAL ESCAM FLAGL FRANK GADSDAssisted Household Report UA ORD RD RD UN OTTE R BIA O BIA ER LIN EN
1 of Household Assisted 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Households AssistedWith Gross Income
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C 100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D 125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
3 Households with at leastOne member
A 60 Years or older 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B Disabled 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C Age 5 years or under 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D Under 60 Years Old 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Undup Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Assisted
Applicant Household Report
of Applicant Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Energy Assisted Household Report
County of Assisted
Households
Households Assisted By Poverty Level
Under 75 75 - 100 101 - 125 126 - 150 Over 150 60 Years or older
At least one member who is
Age 5 years Age 2 years Age 3 years Disabled or younger and younger through 5
Under 60 Years Old
Undup Households
Assisted
Energy Assistance Total
Report run on 08312018 1107 AM Page 1 of 3 eheap_summaryrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Unduplicated Total 0 0
County of Assisted
Households Under 75 75 - 100
Households Assisted By Poverty Level
101 - 125 126 - 150 Over 150 60 Years or older Disabled
Age 5 years or younger
Age 2 years and younger
Age 3 years through 5
Under 60 Years Old
At least one member who is
Undup Households
Assisted
Other Assisted Household Report
Other Assistance Total
Report run on 08312018 1107 AM Page 2 of 3 eheap_summaryrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Applicant Household Report
County of Applicant
Households Under 75 75 - 100 101 - 125 126 - 150 Over 150 Income data
unavailable
Total 0
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01
Enrollment Active Consumer Count by Program PSA ALL Provider ALL PROVIDERS
County Description Program Count of Clients
BREVARD
ADI
CCE
HCE
LSP
NDP
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
MLTC
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
31
57
44
5
62
123
141
26
9
7
5
40
5
50
67
129
2
19
42
29
1
233
79
63
8
2
14
3
37
14
47
3
3
33
127
10
02
03
04
ALACHUA
BAKER
BAY
BRADFORD
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Enrollment Terminations with Reasons PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 Program All Programs Program Status ALL Program Status Worker ALL WORKERS
Last First Program Medicaid Provider Start End Name Name Client ID Status Description Worker Number Program Location Enrollment Enrollment
Count 0
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Enrollments with Care Plan Report
PSA ALL Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTIVE STATUS Care Plan Service ALL SERVICES Care Plan Start 01012017 Care Plan End 12312017
Care Plan Care Plan Care Plan Client Name
Unduplicated Client Count 0
Client ID Program Status Worker Start Date End Date Service
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PSA CLIENT_ID CLIENT_NAME OWNER PROVIDER_ID ASSESSMENT_DATE ASSESSOR_NAME MEDICAID_NUMBER CAREGIVER_CHANGE ENVIRONMENT_CHANGE HEALTH_CHANGE INCOME_CHANGE SITUATION_CHANGE INITIAL_ASSM ANNUAL_ASSM SSN REFERRAL_SOURCE 1114 N N N N Y N 771771777 SELFFAMILY 812017 JANE CASEWORKER 2 1001141633 TEST TEST N
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Fixed Service Costs List PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Provider Location County Program Service Reimbursement Unit Rate Provider Cost Per Unit Begin Valid End Valid
Count 0
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C1 1036 4062586019 Test Name ACTV 12292008 CIRTS23407 N 1
Total for Location 45
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C1 1951 0000 4062452921 Test Name ACTV 03301989 CIRTS22695 N 10
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4062786256 Test Name ACTV 09232013 CIRTS20804 Y 4 1
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4062380426 Test Name ACTV 04112012 CIRTS23407 N 55 2
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4061608826 Test Name ACTV 08102011 CIRTS18634 Y 7 3
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4062615533 Test Name ACTV 10032013 CIRTS20804 Y 6 3
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start Enrollment
End Enrollment Worker
Worker Active
Medicaid Number
Most Recent Nutr Score Rank
O3C2 1036 4062466582 Test Name ACTV 10262010 CIRTS23407 N 105 2
Total for Location 113
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PSA
APCL Clients With No Services ALL Owner All Owners Provider ALL PROVIDERS
Start Date 01012017 End Date 12312017
Includes Clients Receiving Only CM INSC SCAS CA REFE Services
PSA Client ID Client Name Owner Provider Program
Count 0
Unduplicated Clients Count 0
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APCL Clients With Services PSA ALL Owner All Owners Provider ALL PROVIDERS Start Date 01012017 End Date 12312017
Exclude CM CA INSC REFE SCAS
PSA Client ID Name Owner Provider Program 10 4062527553 Test Name 1539 1929 CCE
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APCL Clients With Services PSA ALL Owner All Owners Provider ALL PROVIDERS Start Date 01012017 End Date 12312017
Exclude CM CA INSC REFE SCAS
PSA Client ID Name Owner Provider Program 11 4062732638 Test Name 1177 1177 LTCC
Total 21067
Unduplicated clients count 12460
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APS Assessments PSA ALL Risk Level ALL Owner All Owners Referral Date From 01012017 To 12312017
Order by Referral Date and Owner ID
PSA 03
Ref Date Owner ID Client ID Client Name Risk Level Asmt Type Asmt Date
03032017 1390 4062058415 L 701A 03302018 Test Name
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APS Assessments PSA ALL Risk Level ALL Owner All Owners Referral Date From 01012017 To 12312017
Order by Referral Date and Owner ID
12042017 1980 4061617559 H 701B 12072017 Test Name
Assessment Count for the PSA 52
PSA 04A
Ref Date Owner ID Client ID
09102017 4062308458
Client Name
Test Name
Risk Level
H
Asmt Type
O
Asmt Date
09162017
Assessment Count for the PSA 2
Risk Level H
M
L
Count of Assessments 138
23
21
Total Count of Assessments 182
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APS Repeat Referrals in a Time Range
PSA ALL Owner All Owners
Start Date 01012017 End Date 12312017
Current DOEA CIRTS Cirts SSN if Risk Date Created PSA Owner Abuse No different than DCF DCF SSN Name County Level Date of Birth Date Sent by DCF
Count 0
Unduplicated Client Count by PSA
PSA Count SSN
Total
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Assessed Prioritized Consumer List PSA ALL Provider ALL PROVIDERS Program AC County ALL COUNTIES
County Program Consumer Name Client ID
Total Count 0
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Assessment Due Report PSA 01 Start Date 01012017 End Date 08312018 Owner ALL PROVIDERS Worker ALL WORKERS Program Status ACTV and APCL Assessment Type Needed ALL
Overdue and missing assessments are always listed
Owner ID 1065
Client ID Client Name
Owner Assessor ID
Date of Birth
06281928
CIRTS28099
County of Service
GULF
Worker Name HARPER KENNY
Zip Assessment PSA Date
32534 01 01022014
Type
701A
Active Y
Nutr PriorityScore Score
11 58
Rank
5
Due Date
01022015
Status
701S OVERDUE
LTCC APPL Start Date
03252014 4062235673 Test name
Total Clients for Worker 1
Total Clients for Owner 1
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Assessment Due Report PSA 01 Start Date 01012017 End Date 08312018 Owner ALL PROVIDERS Worker ALL WORKERS Program Status ACTV and APCL Assessment Type Needed ALL
Overdue and missing assessments are always listed
Summary by PSA
PSA 01 701A Overdue 1
701B Overdue 213
701C Overdue 0
701S Overdue 157
No 701A 0
No 701B 2
No 701C 0
No 701S 0
701A Not Overdue 0
701B Not Overdue 0
701C Not Overdue 0
701S Not Overdue 0
701S Optional 0
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CIC Service Units and Costs Projections County SummaryPSA 99 Program CCE
Start Date 01012017 End Date 12312017
County LEON
Total Total Total Avg Max Projected
StateFederal Projected Reimbursement Provider Unduplicated Provider Service Share Service Units Unit Rate Cost Per Unit Client Count
Report Total
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CIC Service Units and Costs Projections Provider SummaryPSA ALL Provider ALL PROVIDERS Program FEDERALLY FUNDED (0101 TO 1231) Year 2017 From 01012017 To 12312017
PSA County Program Service Total State
Federal Share
Total Projected
Service Units
Avg Reimbursement
Unit Rate
Max Provider
Cost Per Unit
Total Projected Unduplicated Client Count
02 FRANKLIN O3C1 CONGREGATE MEALS $810300 1710 15
Program Total
County Total
$810300
$810300
GULF O3C1 CONGREGATE MEALS $25205 3 5
Program Total $25205
O3C2 HOME DELIVERED MEALS $25205 3 6
Program Total
County Total
$25205
$50411
LEON O3C1 CONGREGATE MEALS $621300 1311 15
CONGREGATE MEALS GUEST
CONGREGATE MEALS VOLUNTEERS
$252055
$277260
25
30
2
5
Program Total $1150615
O3C2 HOME DELIVERED MEAL GUEST $252055 25 3
Program Total $252055
OA3D PEARLS (SESSION 5)
PEARLS (SESSION 6)
PEARLS (SESSION 7)
PEARLS (SESSION 8)
$10247
$10247
$10247
$10247
10
10
10
10
3
3
3
3
Program Total $40988
OA3E RESPITE IN-HOME $200 2 2
Program Total
County Total
$200
$1443858
WAKULLA O3C2 EMERGENCY HOME DELIVERED SHELF MEALS
$8065604 14899 90
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CIC Service Units and Costs Projections - PSA Summary
PSA ALL Program CCE
Strat Date 01012017 End Date 12312017
Total
PSA County Provider Service
Total State Federal
Share
Total Projected
Service Units
Avg Reimbursement
Unit Rate
Max Projected Provider Unduplicated
Cost Per Unit Client Count
02 LEON SOUTHERN SERVICE CASE MANAGEMENT PROVIDER EMERGENCY HOME DELIVERED SHELF MEALS
$2175533
$602000
483
689
32
20
HOME DELIVERED MEALS $530262 993 5
MATERIAL AID $1994536 199
Provider Total $5302331
CountyTotal $5302331
WAKULLA SOUTHERN SERVICE CASE MANAGEMENT PROVIDER EMERGENCY HOME DELIVERED SHELF MEALS
$2175533
$1240200
483
689
32
5
MATERIAL AID $1994536 199
Provider Total $5410269
CountyTotal $5410269
PSA Total $10712599
05 PINELLAS BURSTEIN-APPLEBEE ADULT DAY CARE $000 0 $900 $1000 0
COUNSELING (MENTAL HEALTH COUNSELINGSCREENING) - INDIVIDUAL
Provider Total
$000
$000
0 $6600 $7700 0
CountyTotal $000
PSA Total $000
Report Total $10712599
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CID Service Units and Costs Projections - PSA SummaryPSA ALL Program CCE
Start Date 01012017 End Date 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
PSA County Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
02 LEON CASE MANAGEMENT $2175533 483
EMERGENCY HOME $602000 689DELIVERED SHELF MEALS HOME DELIVERED MEALS $530262 993
MATERIAL AID $1994536 199
County Total $5302331 2364
WAKULLA CASE MANAGEMENT $2175533 483
EMERGENCY HOME $1240200 689DELIVERED SHELF MEALS MATERIAL AID $1994536 199
County Total $5410269 1371
PSA Total $10712599 3735
05 PINELLAS ADULT DAY CARE $000 0
COUNSELING (MENTAL $000 0 HEALTH COUNSELINGSCREENING) - INDIVIDUAL
County Total $000 0
PSA Total $000 0
Report Total $10712599 3735
$900 $900 $900 $1000 $1000 $1000
$6600 $6600 $6600 $7700 $7700 $7700
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CID Service Units and Costs Projections County SummaryPSA 99
Program CCE County LEON
Start Date 01012017 End Date 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
Report Total
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CIE Service Units and Costs Projections - PSA Summary - All Programs
PSA 99 Program FEDERALLY FUNDED (0101 TO 1231) Year 2017 From 01012017 To 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
Program Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
Report Total
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CIE Service Units and Costs Projections - PSA Summary
PSA ALL Program CCE
Start Date 01012017 End Date 12312017
Avg High Low Total Total Avg High Low Provider Provider Provider
StateFederal Projected Reimbursement Reimbursement Reimbursement Cost Cost CostPSA
02
Service
CASE MANAGEMENT
Share
$4351066
Service Units
966
Unit Rate Unit Rate Unit Rate Per Unit Per Unit Per Unit
EMERGENCY HOME DELIVERED SHELF MEALS $1842200 1378
HOME DELIVERED MEALS $530262 993
MATERIAL AID $3989071 398
PSA Total $10712599 3735
05 ADULT DAY CARE $000 0 $900 $900 $900 $1000 $1000 $1000
COUNSELING (MENTAL HEALTH $000 0 $6600 $6600 $6600 $7700 $7700 $7700 COUNSELINGSCREENING) - INDIVIDUAL
PSA Total $000 0
Report Total $10712599 3735
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CAREGIVER SEARCH REPORT
SEARCH RESULTS FOR CONSUMERS
Criteria First Name Last Name SSN PSA ALL
Client Name Client SSN Caregiver Name Caregiver SSN
000000000 000000000 Test Name Test Name
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CARES Referrals in a Time Range PSA ALL
Start Date 01012017 End Date 12312017
Referred to ALL REFERRALS
Referring PSA Employee Name Client Name Client ID
Referral Imminent NH Admit Aging Date Risk Date Referred To Cares Provider Name Received Date
03A 4061561263 Test Name Test Name 09242017 Y 05292017 ARC or ADRC 09252017
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CARES Referrals in a Time Range PSA ALL
Start Date 01012017 End Date 12312017
Referred to ALL REFERRALS
Referring PSA Employee Name Client Name Client ID
Referral Date
Imminent Risk
NH Admit Date Referred To Cares Provider Name
Aging Received Date
04B Test Name Test Name 4061738075 04082017 N ARC or ADRC Test Name 04082017
Total Clients 110
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CARES Referrals not acknowledged by the Aging Network PSA ALL For Referrals after 01012017 Owner ID ALL Owners
Unduplicated Client count Cares Office Total Clients Count
Report Total
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
CIRTS Issue PSA Client ID Client Name Program
Program Status Start Provider Enrollment ID Provider Name
APCL CLIENT WITH DATE OF DEATH 08 4061759417 Test Name OA3B APCL 07232013 1141 WESTERN WORLD RADIO
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
Program Start Provider CIRTS Issue PSA Client ID Client Name Program Status Enrollment ID Provider Name
06 LTCC APCL 01242014 1514 4061713685 Test Name APCL CLIENT WITH DATE OF DEATH CENTRAL THE ORIGINAL HOUSE OF PIES
Count 503
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Civil Rights PSA ALL Provider ALL PROVIDERS Program AC Start Date 01012017 End Date 12312017 The Poverty Level for Single is The Poverty Level for Couple is Sort by County
County Unduplicated Count
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Client Information Report Start Date 01012017 End Date 12312017
Client ID 1001141246
Emergency
Client Name Test Name
Telephone () - Address 78 TEST STREET TALLAHASSEE FL 32399
Most Recent Caregiver Information Date Updated
Doctor
Comments
Client Demographic Information
Birth Date 06041940 Race W
Owner ID Ethnicity O
Most Recent Income Information
Ind Mon Inc Cpl Mon Inc
Ind Assets Couple Assets
Most Recent Assessment Information
Asmt Date Ref Risk Lvl
Asmt Site Spec Shel
AsmtType Spec Reg
Ref Date Primary CG
Ref Source Living Sit
Enrollment Information
Sex
Marital Status
F
S
Medicaid Number
ADL Score
ADL Count
IADL Score
IADL Count
Memory Score
Priority Score
Env Score
Nutr Score
Risk Score
Social Score
Rank
Provider Location Program Program Status Worker Start Date End Date
Care Plan Service Needed
Date Service Units Type Frq End Date
Care Plan Service Planned
Program Service Units Type Frq Start Date End Date
Services Received between 01012017 and 12312017
Service Billed Provider Location Worker Program Service Date Units Unit Type Amount
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Provider N
Client Service Units Report PSA ALL Provider ALL PROVIDERS Location 0000
Program ALL PROGRAMS Service ALL SERVICES Worker ALL WORKERS
City ALL CITIES Include Zero Unit N Include Aggregate N Calculated Amount equals the number of Units Provided times Fixed Cost if it existsService Start Date 01012017 Service End Date 12312017 If Fixed Cost does not exist Calculated
Group by PSA Provider Location Client Name County Worker Amount equals Billed Amount
Unduplicated Client Count 0 Grand Total 000 $000
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Clients In Common PSA All Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 County All Counties Worker All Workers
County JEFFERSON
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
MIAMI-DADE
0 0 0 0 0 0 0 0 0
4061539538 Test NameCounty Count
County
0 01
X
0 1
X
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
4061650856 Test Name X 4061486560 Test Name X 4062452921 Test Name X
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Clients Served Not Enrolled PSA ALL Start Date 01012017 End Date 12312017 Locations 0000 Provider All Providers
Service Service Min Serv Max Serv Program Start End Enrollment PSA Provider Location Program Consumer Name Client ID Service Date Date Status Enrollment Enrollment Provider
Count 0
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
4061472791 04
09
1092
1291
0072
0042
LTCC
LTCC
APCL
APCL
4062714543 06
06
1514
1762
0072
5006
LTCC
LTCC
APCL
APPL
4061802246 11
06
1177
1514
0179
0072
LTCC
LTCC
APCL
APCL
4061563719 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062644312 06
08
1514
1771
0072
0896
LTCC
LTCC
APCL
APCL
1001141670 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
1001141671 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
4062375003 07
05
05
07
1263
1755
1638
1263
0368
0072
0072
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062155124 06
06
1762
1514
0072
0072
LTCC
LTCC
APPL
APCL
4061743886 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0369
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4061499927 06
06
1514
1762
0072
5005
LTCC
LTCC
APCL
APPL
4061583524 08
06
1144
1514
0896
0072
LTCC
LTCC
APCL
APCL
4062694843 06
03
1514
1922
0072
0179
LTCC
LTCC
APCL
APCL
4062744517 07
06
1263
1514
0369
0072
LTCC
LTCC
APCL
APCL
4062005488 10
11
10
11
1929
1177
1164
1177
0072
0073
0179
0179
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
Total Count 15
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CODE DESCRIPTIONS Category ALL STATE TABLES
Code Description Active Available To Code Category
0 UNKNOWN Y CARES SUBJECTIVE_HEALTH_EVALUATION
01 ALACHUA Y COMMON COUNTIES
02 BAKER Y COMMON COUNTIES
03 BAY Y COMMON COUNTIES
04 BRADFORD Y COMMON COUNTIES
05 BREVARD Y COMMON COUNTIES
06 BROWARD Y COMMON COUNTIES
07 CALHOUN Y COMMON COUNTIES
08 CHARLOTTE Y COMMON COUNTIES
09 CITRUS Y COMMON COUNTIES
1 EXCELLENT Y CARES SUBJECTIVE_HEALTH_EVALUATION
10 CLAY Y COMMON COUNTIES
11 COLLIER Y COMMON COUNTIES
12 COLUMBIA Y COMMON COUNTIES
13 MIAMI-DADE Y COMMON COUNTIES
14 DESOTO Y COMMON COUNTIES
15 DIXIE Y COMMON COUNTIES
16 DUVAL Y COMMON COUNTIES
17 ESCAMBIA Y COMMON COUNTIES
18 FLAGLER Y COMMON COUNTIES
19 FRANKLIN Y COMMON COUNTIES
2 GOOD Y CARES SUBJECTIVE_HEALTH_EVALUATION
20 GADSDEN Y COMMON COUNTIES
21 GILCHRIST Y COMMON COUNTIES
22 GLADES Y COMMON COUNTIES
23 GULF Y COMMON COUNTIES
24 HAMILTON Y COMMON COUNTIES
25 HARDEE Y COMMON COUNTIES
26 HENDRY Y COMMON COUNTIES
27 HERNANDO Y COMMON COUNTIES
28 HIGHLANDS Y COMMON COUNTIES
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CONSUMER AGE VERIFICATION REPORT PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Program AC
Age at Start
Enroll or Start Enroll Provider Program Description Consumer Name Client ID DOB Svc date or Svc Date
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Contract Budget Information PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Program Service Provider Location County Served Provider Contract
Projected Service
Units Unit Measure
Projected Unduplicated
State Federal Share Client Count Begin Date End Date
Row Count 0 Amount Total
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Start Enroll Latest Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Date Asmt Date Worker
O3C1 1036 000 4061653427 Test CENTRAL 34982 W M 07091930 09102013 09102013 CIRTS20804 0 Name
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Start Enroll Date
Latest Asmt Date Worker
4061593624 Test Name CENTRAL 34946 B F 11261940 12012011 12312013 CIRTS23407
Count 164
Unduplicated Client Count 163
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Assessments After DOD Report
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Owner 1025
The shaded records indicate clients who have different DOBs andor different names
Assemt Current PSA Owner Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Owner Assessor
Provider Assessor
Assemt Date
Assemt Type
Unduplicated Count Total 0
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Open Enrollments
The Vital Statistics Data for 07192002 - 09112014PSA ALL Provider ALL Program Status ACTV Include MLTC ACTVS N
The shaded records indicate clients who have different DOBs andor different names
Enroll PSA
Enrollment Provider Loc Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Enroll Program Status
Enroll Program
Current Owner ID
02 1065 0072 4062244026 Test Name Test Name 10222004 03231917 03231917 ACTV CCE 1065
Count of enrollments for the Provider 1
Count of enrollments for the PSA 1
Count of enrollments for the Report 1
Unduplicated Count of Individuals with open enrollments and DOD PSA Total Clients Count
02 1
Total 1
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Unduplicated count of individuals with Services after DOD
PSA Total Clients Count
Report Total
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
List of Clients with PSA table entry for SERVICES_AFTER_DOD
Unduplicated Count Total 0
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Age
Provider
Total
Age lt 60 Age 60 - 64 Age 65 - 74 Age 75 - 84 Age 85+ Total Clients Avg Age
Total
Avg Age
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Ethnicity
Provider Hispanic Other Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Race
American Indian Native Hawaiian Other Provider Asian Alaska Native Black Pacific Islander Minority White Multiple Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Gender
Provider Male Female Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Monthly Income
Provider 0 - - Higher than Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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None
Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Total Persons Served 0
Age lt 60 Years 0 0
Age 60 - 64 0 0
Age 65 - 74 0 0
Age 75 - 84 0 0
Age 85+ 0 0
Total Age 0 0
Average 000
Ethnicity Hispanic 0 0
Other Ethnicity 0 0
Unknown Ethnicity 0 0
Total 0 0
Race Asian 0 0
American Indian Alaska Native 0 0
Black 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority 0 0
White 0 0
Multiple 0 0
Unknown 0 0
Total 0 0
Sex Male 0 0
Female 0 0
Unknown Sex 0 0
Total 0 0
Monthly Income 0 - 0 0
- 0 0
Higher than 0 0
Unknown 0 0
Total 0 0
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Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Client ID Date Of Birth Ethnicity Race Sex Individual Monthly Income
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Demographics of Clients OAA Registered Served Only PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 City All Cities Program All Programs Service All Services County ALL COUNTIES Table OAA Registered Services Only Low Income Medium Income
Total Persons Served 0
Agelt 60 Years
Age 60 - 64
Age 65 - 74
Age 75 - 84
Age 85+
0
0
0
0
0
0
0
0
0
0
Monthly Income
0 -
-Higher than
Unknown
0
0
0
0
0
0
0
0
Total
Average
0
000
0 Total 0 0
Ethnicity Hispanic
Other
Unknown
0
0
0
0
0
0
Living Situation
Alone
Null
Policy Change
0
0
0
0
0
0
Total 0 0 Unknown
With Caregiver
0
0
0
0
Race Asian 0 0
With Other
With Other Caregiver
0
0
0
0
American Indian Alaska Native
Black
0
0
0
0Total Living Situation 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority
White
0
0
0
0 Limited English Proficiency
Multiple
Unknown
Total Race
0
0
0
0
0
0
Yes
No
Unknown
0
0
0
0
0
0
Total 0 0
Sex Male
Female
Unknown
0
0
0
0
0
0
Total 0 0
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Disaster Assistance Clients for a Provider PSA ALL Provider All Providers Location 0000 Worker All Workers City All Cities Zip Code All Zip Codes Sort By ZIP
Provider 1036 Provider Name Location 0000 Worker CIRTS18634
Need Care Client Name Address City Zip County Phone Asst Reg Situation Relat Care phone Care Name
34946 N WO DA 000 SAINT JAMES DRIVE CENTRAL (025) 101-0620 Test NameTest Name SAINT LUCIE (005) 100-0369 Y
Client is active and no assessment information is available Special Shelter and Special Registry are unknown
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
Total by PSA 0
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
ALACH BAKER BAY BRADF BREVA BROWA CALHO CHARL CITRUS CLAY COLLIE COLUM DESOT DIXIE DUVAL ESCAM FLAGL FRANK GADSDAssisted Household Report UA ORD RD RD UN OTTE R BIA O BIA ER LIN EN
1 of Household Assisted 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Households AssistedWith Gross Income
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C 100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D 125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
3 Households with at leastOne member
A 60 Years or older 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B Disabled 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C Age 5 years or under 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D Under 60 Years Old 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Undup Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Assisted
Applicant Household Report
of Applicant Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Energy Assisted Household Report
County of Assisted
Households
Households Assisted By Poverty Level
Under 75 75 - 100 101 - 125 126 - 150 Over 150 60 Years or older
At least one member who is
Age 5 years Age 2 years Age 3 years Disabled or younger and younger through 5
Under 60 Years Old
Undup Households
Assisted
Energy Assistance Total
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Unduplicated Total 0 0
County of Assisted
Households Under 75 75 - 100
Households Assisted By Poverty Level
101 - 125 126 - 150 Over 150 60 Years or older Disabled
Age 5 years or younger
Age 2 years and younger
Age 3 years through 5
Under 60 Years Old
At least one member who is
Undup Households
Assisted
Other Assisted Household Report
Other Assistance Total
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Applicant Household Report
County of Applicant
Households Under 75 75 - 100 101 - 125 126 - 150 Over 150 Income data
unavailable
Total 0
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01
Enrollment Active Consumer Count by Program PSA ALL Provider ALL PROVIDERS
County Description Program Count of Clients
BREVARD
ADI
CCE
HCE
LSP
NDP
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
MLTC
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
31
57
44
5
62
123
141
26
9
7
5
40
5
50
67
129
2
19
42
29
1
233
79
63
8
2
14
3
37
14
47
3
3
33
127
10
02
03
04
ALACHUA
BAKER
BAY
BRADFORD
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Enrollment Terminations with Reasons PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 Program All Programs Program Status ALL Program Status Worker ALL WORKERS
Last First Program Medicaid Provider Start End Name Name Client ID Status Description Worker Number Program Location Enrollment Enrollment
Count 0
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Enrollments with Care Plan Report
PSA ALL Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTIVE STATUS Care Plan Service ALL SERVICES Care Plan Start 01012017 Care Plan End 12312017
Care Plan Care Plan Care Plan Client Name
Unduplicated Client Count 0
Client ID Program Status Worker Start Date End Date Service
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PSA CLIENT_ID CLIENT_NAME OWNER PROVIDER_ID ASSESSMENT_DATE ASSESSOR_NAME MEDICAID_NUMBER CAREGIVER_CHANGE ENVIRONMENT_CHANGE HEALTH_CHANGE INCOME_CHANGE SITUATION_CHANGE INITIAL_ASSM ANNUAL_ASSM SSN REFERRAL_SOURCE 1114 N N N N Y N 771771777 SELFFAMILY 812017 JANE CASEWORKER 2 1001141633 TEST TEST N
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Fixed Service Costs List PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Provider Location County Program Service Reimbursement Unit Rate Provider Cost Per Unit Begin Valid End Valid
Count 0
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C1 1951 0000 4062452921 Test Name ACTV 03301989 CIRTS22695 N 10
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4062786256 Test Name ACTV 09232013 CIRTS20804 Y 4 1
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4062380426 Test Name ACTV 04112012 CIRTS23407 N 55 2
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4061608826 Test Name ACTV 08102011 CIRTS18634 Y 7 3
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4062615533 Test Name ACTV 10032013 CIRTS20804 Y 6 3
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start Enrollment
End Enrollment Worker
Worker Active
Medicaid Number
Most Recent Nutr Score Rank
O3C2 1036 4062466582 Test Name ACTV 10262010 CIRTS23407 N 105 2
Total for Location 113
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PSA
APCL Clients With No Services ALL Owner All Owners Provider ALL PROVIDERS
Start Date 01012017 End Date 12312017
Includes Clients Receiving Only CM INSC SCAS CA REFE Services
PSA Client ID Client Name Owner Provider Program
Count 0
Unduplicated Clients Count 0
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APCL Clients With Services PSA ALL Owner All Owners Provider ALL PROVIDERS Start Date 01012017 End Date 12312017
Exclude CM CA INSC REFE SCAS
PSA Client ID Name Owner Provider Program 10 4062527553 Test Name 1539 1929 CCE
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APCL Clients With Services PSA ALL Owner All Owners Provider ALL PROVIDERS Start Date 01012017 End Date 12312017
Exclude CM CA INSC REFE SCAS
PSA Client ID Name Owner Provider Program 11 4062732638 Test Name 1177 1177 LTCC
Total 21067
Unduplicated clients count 12460
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APS Assessments PSA ALL Risk Level ALL Owner All Owners Referral Date From 01012017 To 12312017
Order by Referral Date and Owner ID
PSA 03
Ref Date Owner ID Client ID Client Name Risk Level Asmt Type Asmt Date
03032017 1390 4062058415 L 701A 03302018 Test Name
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APS Assessments PSA ALL Risk Level ALL Owner All Owners Referral Date From 01012017 To 12312017
Order by Referral Date and Owner ID
12042017 1980 4061617559 H 701B 12072017 Test Name
Assessment Count for the PSA 52
PSA 04A
Ref Date Owner ID Client ID
09102017 4062308458
Client Name
Test Name
Risk Level
H
Asmt Type
O
Asmt Date
09162017
Assessment Count for the PSA 2
Risk Level H
M
L
Count of Assessments 138
23
21
Total Count of Assessments 182
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APS Repeat Referrals in a Time Range
PSA ALL Owner All Owners
Start Date 01012017 End Date 12312017
Current DOEA CIRTS Cirts SSN if Risk Date Created PSA Owner Abuse No different than DCF DCF SSN Name County Level Date of Birth Date Sent by DCF
Count 0
Unduplicated Client Count by PSA
PSA Count SSN
Total
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Assessed Prioritized Consumer List PSA ALL Provider ALL PROVIDERS Program AC County ALL COUNTIES
County Program Consumer Name Client ID
Total Count 0
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Assessment Due Report PSA 01 Start Date 01012017 End Date 08312018 Owner ALL PROVIDERS Worker ALL WORKERS Program Status ACTV and APCL Assessment Type Needed ALL
Overdue and missing assessments are always listed
Owner ID 1065
Client ID Client Name
Owner Assessor ID
Date of Birth
06281928
CIRTS28099
County of Service
GULF
Worker Name HARPER KENNY
Zip Assessment PSA Date
32534 01 01022014
Type
701A
Active Y
Nutr PriorityScore Score
11 58
Rank
5
Due Date
01022015
Status
701S OVERDUE
LTCC APPL Start Date
03252014 4062235673 Test name
Total Clients for Worker 1
Total Clients for Owner 1
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Assessment Due Report PSA 01 Start Date 01012017 End Date 08312018 Owner ALL PROVIDERS Worker ALL WORKERS Program Status ACTV and APCL Assessment Type Needed ALL
Overdue and missing assessments are always listed
Summary by PSA
PSA 01 701A Overdue 1
701B Overdue 213
701C Overdue 0
701S Overdue 157
No 701A 0
No 701B 2
No 701C 0
No 701S 0
701A Not Overdue 0
701B Not Overdue 0
701C Not Overdue 0
701S Not Overdue 0
701S Optional 0
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CIC Service Units and Costs Projections County SummaryPSA 99 Program CCE
Start Date 01012017 End Date 12312017
County LEON
Total Total Total Avg Max Projected
StateFederal Projected Reimbursement Provider Unduplicated Provider Service Share Service Units Unit Rate Cost Per Unit Client Count
Report Total
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CIC Service Units and Costs Projections Provider SummaryPSA ALL Provider ALL PROVIDERS Program FEDERALLY FUNDED (0101 TO 1231) Year 2017 From 01012017 To 12312017
PSA County Program Service Total State
Federal Share
Total Projected
Service Units
Avg Reimbursement
Unit Rate
Max Provider
Cost Per Unit
Total Projected Unduplicated Client Count
02 FRANKLIN O3C1 CONGREGATE MEALS $810300 1710 15
Program Total
County Total
$810300
$810300
GULF O3C1 CONGREGATE MEALS $25205 3 5
Program Total $25205
O3C2 HOME DELIVERED MEALS $25205 3 6
Program Total
County Total
$25205
$50411
LEON O3C1 CONGREGATE MEALS $621300 1311 15
CONGREGATE MEALS GUEST
CONGREGATE MEALS VOLUNTEERS
$252055
$277260
25
30
2
5
Program Total $1150615
O3C2 HOME DELIVERED MEAL GUEST $252055 25 3
Program Total $252055
OA3D PEARLS (SESSION 5)
PEARLS (SESSION 6)
PEARLS (SESSION 7)
PEARLS (SESSION 8)
$10247
$10247
$10247
$10247
10
10
10
10
3
3
3
3
Program Total $40988
OA3E RESPITE IN-HOME $200 2 2
Program Total
County Total
$200
$1443858
WAKULLA O3C2 EMERGENCY HOME DELIVERED SHELF MEALS
$8065604 14899 90
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CIC Service Units and Costs Projections - PSA Summary
PSA ALL Program CCE
Strat Date 01012017 End Date 12312017
Total
PSA County Provider Service
Total State Federal
Share
Total Projected
Service Units
Avg Reimbursement
Unit Rate
Max Projected Provider Unduplicated
Cost Per Unit Client Count
02 LEON SOUTHERN SERVICE CASE MANAGEMENT PROVIDER EMERGENCY HOME DELIVERED SHELF MEALS
$2175533
$602000
483
689
32
20
HOME DELIVERED MEALS $530262 993 5
MATERIAL AID $1994536 199
Provider Total $5302331
CountyTotal $5302331
WAKULLA SOUTHERN SERVICE CASE MANAGEMENT PROVIDER EMERGENCY HOME DELIVERED SHELF MEALS
$2175533
$1240200
483
689
32
5
MATERIAL AID $1994536 199
Provider Total $5410269
CountyTotal $5410269
PSA Total $10712599
05 PINELLAS BURSTEIN-APPLEBEE ADULT DAY CARE $000 0 $900 $1000 0
COUNSELING (MENTAL HEALTH COUNSELINGSCREENING) - INDIVIDUAL
Provider Total
$000
$000
0 $6600 $7700 0
CountyTotal $000
PSA Total $000
Report Total $10712599
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CID Service Units and Costs Projections - PSA SummaryPSA ALL Program CCE
Start Date 01012017 End Date 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
PSA County Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
02 LEON CASE MANAGEMENT $2175533 483
EMERGENCY HOME $602000 689DELIVERED SHELF MEALS HOME DELIVERED MEALS $530262 993
MATERIAL AID $1994536 199
County Total $5302331 2364
WAKULLA CASE MANAGEMENT $2175533 483
EMERGENCY HOME $1240200 689DELIVERED SHELF MEALS MATERIAL AID $1994536 199
County Total $5410269 1371
PSA Total $10712599 3735
05 PINELLAS ADULT DAY CARE $000 0
COUNSELING (MENTAL $000 0 HEALTH COUNSELINGSCREENING) - INDIVIDUAL
County Total $000 0
PSA Total $000 0
Report Total $10712599 3735
$900 $900 $900 $1000 $1000 $1000
$6600 $6600 $6600 $7700 $7700 $7700
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CID Service Units and Costs Projections County SummaryPSA 99
Program CCE County LEON
Start Date 01012017 End Date 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
Report Total
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CIE Service Units and Costs Projections - PSA Summary - All Programs
PSA 99 Program FEDERALLY FUNDED (0101 TO 1231) Year 2017 From 01012017 To 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
Program Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
Report Total
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CIE Service Units and Costs Projections - PSA Summary
PSA ALL Program CCE
Start Date 01012017 End Date 12312017
Avg High Low Total Total Avg High Low Provider Provider Provider
StateFederal Projected Reimbursement Reimbursement Reimbursement Cost Cost CostPSA
02
Service
CASE MANAGEMENT
Share
$4351066
Service Units
966
Unit Rate Unit Rate Unit Rate Per Unit Per Unit Per Unit
EMERGENCY HOME DELIVERED SHELF MEALS $1842200 1378
HOME DELIVERED MEALS $530262 993
MATERIAL AID $3989071 398
PSA Total $10712599 3735
05 ADULT DAY CARE $000 0 $900 $900 $900 $1000 $1000 $1000
COUNSELING (MENTAL HEALTH $000 0 $6600 $6600 $6600 $7700 $7700 $7700 COUNSELINGSCREENING) - INDIVIDUAL
PSA Total $000 0
Report Total $10712599 3735
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CAREGIVER SEARCH REPORT
SEARCH RESULTS FOR CONSUMERS
Criteria First Name Last Name SSN PSA ALL
Client Name Client SSN Caregiver Name Caregiver SSN
000000000 000000000 Test Name Test Name
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CARES Referrals in a Time Range PSA ALL
Start Date 01012017 End Date 12312017
Referred to ALL REFERRALS
Referring PSA Employee Name Client Name Client ID
Referral Imminent NH Admit Aging Date Risk Date Referred To Cares Provider Name Received Date
03A 4061561263 Test Name Test Name 09242017 Y 05292017 ARC or ADRC 09252017
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CARES Referrals in a Time Range PSA ALL
Start Date 01012017 End Date 12312017
Referred to ALL REFERRALS
Referring PSA Employee Name Client Name Client ID
Referral Date
Imminent Risk
NH Admit Date Referred To Cares Provider Name
Aging Received Date
04B Test Name Test Name 4061738075 04082017 N ARC or ADRC Test Name 04082017
Total Clients 110
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CARES Referrals not acknowledged by the Aging Network PSA ALL For Referrals after 01012017 Owner ID ALL Owners
Unduplicated Client count Cares Office Total Clients Count
Report Total
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
CIRTS Issue PSA Client ID Client Name Program
Program Status Start Provider Enrollment ID Provider Name
APCL CLIENT WITH DATE OF DEATH 08 4061759417 Test Name OA3B APCL 07232013 1141 WESTERN WORLD RADIO
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
Program Start Provider CIRTS Issue PSA Client ID Client Name Program Status Enrollment ID Provider Name
06 LTCC APCL 01242014 1514 4061713685 Test Name APCL CLIENT WITH DATE OF DEATH CENTRAL THE ORIGINAL HOUSE OF PIES
Count 503
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Civil Rights PSA ALL Provider ALL PROVIDERS Program AC Start Date 01012017 End Date 12312017 The Poverty Level for Single is The Poverty Level for Couple is Sort by County
County Unduplicated Count
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Client Information Report Start Date 01012017 End Date 12312017
Client ID 1001141246
Emergency
Client Name Test Name
Telephone () - Address 78 TEST STREET TALLAHASSEE FL 32399
Most Recent Caregiver Information Date Updated
Doctor
Comments
Client Demographic Information
Birth Date 06041940 Race W
Owner ID Ethnicity O
Most Recent Income Information
Ind Mon Inc Cpl Mon Inc
Ind Assets Couple Assets
Most Recent Assessment Information
Asmt Date Ref Risk Lvl
Asmt Site Spec Shel
AsmtType Spec Reg
Ref Date Primary CG
Ref Source Living Sit
Enrollment Information
Sex
Marital Status
F
S
Medicaid Number
ADL Score
ADL Count
IADL Score
IADL Count
Memory Score
Priority Score
Env Score
Nutr Score
Risk Score
Social Score
Rank
Provider Location Program Program Status Worker Start Date End Date
Care Plan Service Needed
Date Service Units Type Frq End Date
Care Plan Service Planned
Program Service Units Type Frq Start Date End Date
Services Received between 01012017 and 12312017
Service Billed Provider Location Worker Program Service Date Units Unit Type Amount
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Provider N
Client Service Units Report PSA ALL Provider ALL PROVIDERS Location 0000
Program ALL PROGRAMS Service ALL SERVICES Worker ALL WORKERS
City ALL CITIES Include Zero Unit N Include Aggregate N Calculated Amount equals the number of Units Provided times Fixed Cost if it existsService Start Date 01012017 Service End Date 12312017 If Fixed Cost does not exist Calculated
Group by PSA Provider Location Client Name County Worker Amount equals Billed Amount
Unduplicated Client Count 0 Grand Total 000 $000
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Clients In Common PSA All Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 County All Counties Worker All Workers
County JEFFERSON
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
MIAMI-DADE
0 0 0 0 0 0 0 0 0
4061539538 Test NameCounty Count
County
0 01
X
0 1
X
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
4061650856 Test Name X 4061486560 Test Name X 4062452921 Test Name X
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Clients Served Not Enrolled PSA ALL Start Date 01012017 End Date 12312017 Locations 0000 Provider All Providers
Service Service Min Serv Max Serv Program Start End Enrollment PSA Provider Location Program Consumer Name Client ID Service Date Date Status Enrollment Enrollment Provider
Count 0
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
4061472791 04
09
1092
1291
0072
0042
LTCC
LTCC
APCL
APCL
4062714543 06
06
1514
1762
0072
5006
LTCC
LTCC
APCL
APPL
4061802246 11
06
1177
1514
0179
0072
LTCC
LTCC
APCL
APCL
4061563719 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062644312 06
08
1514
1771
0072
0896
LTCC
LTCC
APCL
APCL
1001141670 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
1001141671 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
4062375003 07
05
05
07
1263
1755
1638
1263
0368
0072
0072
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062155124 06
06
1762
1514
0072
0072
LTCC
LTCC
APPL
APCL
4061743886 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0369
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4061499927 06
06
1514
1762
0072
5005
LTCC
LTCC
APCL
APPL
4061583524 08
06
1144
1514
0896
0072
LTCC
LTCC
APCL
APCL
4062694843 06
03
1514
1922
0072
0179
LTCC
LTCC
APCL
APCL
4062744517 07
06
1263
1514
0369
0072
LTCC
LTCC
APCL
APCL
4062005488 10
11
10
11
1929
1177
1164
1177
0072
0073
0179
0179
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
Total Count 15
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CODE DESCRIPTIONS Category ALL STATE TABLES
Code Description Active Available To Code Category
0 UNKNOWN Y CARES SUBJECTIVE_HEALTH_EVALUATION
01 ALACHUA Y COMMON COUNTIES
02 BAKER Y COMMON COUNTIES
03 BAY Y COMMON COUNTIES
04 BRADFORD Y COMMON COUNTIES
05 BREVARD Y COMMON COUNTIES
06 BROWARD Y COMMON COUNTIES
07 CALHOUN Y COMMON COUNTIES
08 CHARLOTTE Y COMMON COUNTIES
09 CITRUS Y COMMON COUNTIES
1 EXCELLENT Y CARES SUBJECTIVE_HEALTH_EVALUATION
10 CLAY Y COMMON COUNTIES
11 COLLIER Y COMMON COUNTIES
12 COLUMBIA Y COMMON COUNTIES
13 MIAMI-DADE Y COMMON COUNTIES
14 DESOTO Y COMMON COUNTIES
15 DIXIE Y COMMON COUNTIES
16 DUVAL Y COMMON COUNTIES
17 ESCAMBIA Y COMMON COUNTIES
18 FLAGLER Y COMMON COUNTIES
19 FRANKLIN Y COMMON COUNTIES
2 GOOD Y CARES SUBJECTIVE_HEALTH_EVALUATION
20 GADSDEN Y COMMON COUNTIES
21 GILCHRIST Y COMMON COUNTIES
22 GLADES Y COMMON COUNTIES
23 GULF Y COMMON COUNTIES
24 HAMILTON Y COMMON COUNTIES
25 HARDEE Y COMMON COUNTIES
26 HENDRY Y COMMON COUNTIES
27 HERNANDO Y COMMON COUNTIES
28 HIGHLANDS Y COMMON COUNTIES
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CONSUMER AGE VERIFICATION REPORT PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Program AC
Age at Start
Enroll or Start Enroll Provider Program Description Consumer Name Client ID DOB Svc date or Svc Date
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Contract Budget Information PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Program Service Provider Location County Served Provider Contract
Projected Service
Units Unit Measure
Projected Unduplicated
State Federal Share Client Count Begin Date End Date
Row Count 0 Amount Total
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Start Enroll Latest Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Date Asmt Date Worker
O3C1 1036 000 4061653427 Test CENTRAL 34982 W M 07091930 09102013 09102013 CIRTS20804 0 Name
Report run on 08312018 1133 AM Page 1 of 6 actv_by_progrdf
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Start Enroll Date
Latest Asmt Date Worker
4061593624 Test Name CENTRAL 34946 B F 11261940 12012011 12312013 CIRTS23407
Count 164
Unduplicated Client Count 163
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Assessments After DOD Report
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Owner 1025
The shaded records indicate clients who have different DOBs andor different names
Assemt Current PSA Owner Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Owner Assessor
Provider Assessor
Assemt Date
Assemt Type
Unduplicated Count Total 0
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Open Enrollments
The Vital Statistics Data for 07192002 - 09112014PSA ALL Provider ALL Program Status ACTV Include MLTC ACTVS N
The shaded records indicate clients who have different DOBs andor different names
Enroll PSA
Enrollment Provider Loc Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Enroll Program Status
Enroll Program
Current Owner ID
02 1065 0072 4062244026 Test Name Test Name 10222004 03231917 03231917 ACTV CCE 1065
Count of enrollments for the Provider 1
Count of enrollments for the PSA 1
Count of enrollments for the Report 1
Unduplicated Count of Individuals with open enrollments and DOD PSA Total Clients Count
02 1
Total 1
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Unduplicated count of individuals with Services after DOD
PSA Total Clients Count
Report Total
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
List of Clients with PSA table entry for SERVICES_AFTER_DOD
Unduplicated Count Total 0
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Age
Provider
Total
Age lt 60 Age 60 - 64 Age 65 - 74 Age 75 - 84 Age 85+ Total Clients Avg Age
Total
Avg Age
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Ethnicity
Provider Hispanic Other Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Race
American Indian Native Hawaiian Other Provider Asian Alaska Native Black Pacific Islander Minority White Multiple Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Gender
Provider Male Female Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Monthly Income
Provider 0 - - Higher than Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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None
Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Total Persons Served 0
Age lt 60 Years 0 0
Age 60 - 64 0 0
Age 65 - 74 0 0
Age 75 - 84 0 0
Age 85+ 0 0
Total Age 0 0
Average 000
Ethnicity Hispanic 0 0
Other Ethnicity 0 0
Unknown Ethnicity 0 0
Total 0 0
Race Asian 0 0
American Indian Alaska Native 0 0
Black 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority 0 0
White 0 0
Multiple 0 0
Unknown 0 0
Total 0 0
Sex Male 0 0
Female 0 0
Unknown Sex 0 0
Total 0 0
Monthly Income 0 - 0 0
- 0 0
Higher than 0 0
Unknown 0 0
Total 0 0
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Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Client ID Date Of Birth Ethnicity Race Sex Individual Monthly Income
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Demographics of Clients OAA Registered Served Only PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 City All Cities Program All Programs Service All Services County ALL COUNTIES Table OAA Registered Services Only Low Income Medium Income
Total Persons Served 0
Agelt 60 Years
Age 60 - 64
Age 65 - 74
Age 75 - 84
Age 85+
0
0
0
0
0
0
0
0
0
0
Monthly Income
0 -
-Higher than
Unknown
0
0
0
0
0
0
0
0
Total
Average
0
000
0 Total 0 0
Ethnicity Hispanic
Other
Unknown
0
0
0
0
0
0
Living Situation
Alone
Null
Policy Change
0
0
0
0
0
0
Total 0 0 Unknown
With Caregiver
0
0
0
0
Race Asian 0 0
With Other
With Other Caregiver
0
0
0
0
American Indian Alaska Native
Black
0
0
0
0Total Living Situation 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority
White
0
0
0
0 Limited English Proficiency
Multiple
Unknown
Total Race
0
0
0
0
0
0
Yes
No
Unknown
0
0
0
0
0
0
Total 0 0
Sex Male
Female
Unknown
0
0
0
0
0
0
Total 0 0
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Disaster Assistance Clients for a Provider PSA ALL Provider All Providers Location 0000 Worker All Workers City All Cities Zip Code All Zip Codes Sort By ZIP
Provider 1036 Provider Name Location 0000 Worker CIRTS18634
Need Care Client Name Address City Zip County Phone Asst Reg Situation Relat Care phone Care Name
34946 N WO DA 000 SAINT JAMES DRIVE CENTRAL (025) 101-0620 Test NameTest Name SAINT LUCIE (005) 100-0369 Y
Client is active and no assessment information is available Special Shelter and Special Registry are unknown
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
Total by PSA 0
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
ALACH BAKER BAY BRADF BREVA BROWA CALHO CHARL CITRUS CLAY COLLIE COLUM DESOT DIXIE DUVAL ESCAM FLAGL FRANK GADSDAssisted Household Report UA ORD RD RD UN OTTE R BIA O BIA ER LIN EN
1 of Household Assisted 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Households AssistedWith Gross Income
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C 100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D 125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
3 Households with at leastOne member
A 60 Years or older 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B Disabled 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C Age 5 years or under 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D Under 60 Years Old 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Undup Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Assisted
Applicant Household Report
of Applicant Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Energy Assisted Household Report
County of Assisted
Households
Households Assisted By Poverty Level
Under 75 75 - 100 101 - 125 126 - 150 Over 150 60 Years or older
At least one member who is
Age 5 years Age 2 years Age 3 years Disabled or younger and younger through 5
Under 60 Years Old
Undup Households
Assisted
Energy Assistance Total
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Unduplicated Total 0 0
County of Assisted
Households Under 75 75 - 100
Households Assisted By Poverty Level
101 - 125 126 - 150 Over 150 60 Years or older Disabled
Age 5 years or younger
Age 2 years and younger
Age 3 years through 5
Under 60 Years Old
At least one member who is
Undup Households
Assisted
Other Assisted Household Report
Other Assistance Total
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Applicant Household Report
County of Applicant
Households Under 75 75 - 100 101 - 125 126 - 150 Over 150 Income data
unavailable
Total 0
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01
Enrollment Active Consumer Count by Program PSA ALL Provider ALL PROVIDERS
County Description Program Count of Clients
BREVARD
ADI
CCE
HCE
LSP
NDP
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
MLTC
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
31
57
44
5
62
123
141
26
9
7
5
40
5
50
67
129
2
19
42
29
1
233
79
63
8
2
14
3
37
14
47
3
3
33
127
10
02
03
04
ALACHUA
BAKER
BAY
BRADFORD
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Enrollment Terminations with Reasons PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 Program All Programs Program Status ALL Program Status Worker ALL WORKERS
Last First Program Medicaid Provider Start End Name Name Client ID Status Description Worker Number Program Location Enrollment Enrollment
Count 0
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Enrollments with Care Plan Report
PSA ALL Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTIVE STATUS Care Plan Service ALL SERVICES Care Plan Start 01012017 Care Plan End 12312017
Care Plan Care Plan Care Plan Client Name
Unduplicated Client Count 0
Client ID Program Status Worker Start Date End Date Service
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PSA CLIENT_ID CLIENT_NAME OWNER PROVIDER_ID ASSESSMENT_DATE ASSESSOR_NAME MEDICAID_NUMBER CAREGIVER_CHANGE ENVIRONMENT_CHANGE HEALTH_CHANGE INCOME_CHANGE SITUATION_CHANGE INITIAL_ASSM ANNUAL_ASSM SSN REFERRAL_SOURCE 1114 N N N N Y N 771771777 SELFFAMILY 812017 JANE CASEWORKER 2 1001141633 TEST TEST N
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Fixed Service Costs List PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Provider Location County Program Service Reimbursement Unit Rate Provider Cost Per Unit Begin Valid End Valid
Count 0
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4062786256 Test Name ACTV 09232013 CIRTS20804 Y 4 1
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4062380426 Test Name ACTV 04112012 CIRTS23407 N 55 2
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4061608826 Test Name ACTV 08102011 CIRTS18634 Y 7 3
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4062615533 Test Name ACTV 10032013 CIRTS20804 Y 6 3
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start Enrollment
End Enrollment Worker
Worker Active
Medicaid Number
Most Recent Nutr Score Rank
O3C2 1036 4062466582 Test Name ACTV 10262010 CIRTS23407 N 105 2
Total for Location 113
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PSA
APCL Clients With No Services ALL Owner All Owners Provider ALL PROVIDERS
Start Date 01012017 End Date 12312017
Includes Clients Receiving Only CM INSC SCAS CA REFE Services
PSA Client ID Client Name Owner Provider Program
Count 0
Unduplicated Clients Count 0
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APCL Clients With Services PSA ALL Owner All Owners Provider ALL PROVIDERS Start Date 01012017 End Date 12312017
Exclude CM CA INSC REFE SCAS
PSA Client ID Name Owner Provider Program 10 4062527553 Test Name 1539 1929 CCE
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APCL Clients With Services PSA ALL Owner All Owners Provider ALL PROVIDERS Start Date 01012017 End Date 12312017
Exclude CM CA INSC REFE SCAS
PSA Client ID Name Owner Provider Program 11 4062732638 Test Name 1177 1177 LTCC
Total 21067
Unduplicated clients count 12460
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APS Assessments PSA ALL Risk Level ALL Owner All Owners Referral Date From 01012017 To 12312017
Order by Referral Date and Owner ID
PSA 03
Ref Date Owner ID Client ID Client Name Risk Level Asmt Type Asmt Date
03032017 1390 4062058415 L 701A 03302018 Test Name
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APS Assessments PSA ALL Risk Level ALL Owner All Owners Referral Date From 01012017 To 12312017
Order by Referral Date and Owner ID
12042017 1980 4061617559 H 701B 12072017 Test Name
Assessment Count for the PSA 52
PSA 04A
Ref Date Owner ID Client ID
09102017 4062308458
Client Name
Test Name
Risk Level
H
Asmt Type
O
Asmt Date
09162017
Assessment Count for the PSA 2
Risk Level H
M
L
Count of Assessments 138
23
21
Total Count of Assessments 182
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APS Repeat Referrals in a Time Range
PSA ALL Owner All Owners
Start Date 01012017 End Date 12312017
Current DOEA CIRTS Cirts SSN if Risk Date Created PSA Owner Abuse No different than DCF DCF SSN Name County Level Date of Birth Date Sent by DCF
Count 0
Unduplicated Client Count by PSA
PSA Count SSN
Total
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Assessed Prioritized Consumer List PSA ALL Provider ALL PROVIDERS Program AC County ALL COUNTIES
County Program Consumer Name Client ID
Total Count 0
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Assessment Due Report PSA 01 Start Date 01012017 End Date 08312018 Owner ALL PROVIDERS Worker ALL WORKERS Program Status ACTV and APCL Assessment Type Needed ALL
Overdue and missing assessments are always listed
Owner ID 1065
Client ID Client Name
Owner Assessor ID
Date of Birth
06281928
CIRTS28099
County of Service
GULF
Worker Name HARPER KENNY
Zip Assessment PSA Date
32534 01 01022014
Type
701A
Active Y
Nutr PriorityScore Score
11 58
Rank
5
Due Date
01022015
Status
701S OVERDUE
LTCC APPL Start Date
03252014 4062235673 Test name
Total Clients for Worker 1
Total Clients for Owner 1
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Assessment Due Report PSA 01 Start Date 01012017 End Date 08312018 Owner ALL PROVIDERS Worker ALL WORKERS Program Status ACTV and APCL Assessment Type Needed ALL
Overdue and missing assessments are always listed
Summary by PSA
PSA 01 701A Overdue 1
701B Overdue 213
701C Overdue 0
701S Overdue 157
No 701A 0
No 701B 2
No 701C 0
No 701S 0
701A Not Overdue 0
701B Not Overdue 0
701C Not Overdue 0
701S Not Overdue 0
701S Optional 0
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CIC Service Units and Costs Projections County SummaryPSA 99 Program CCE
Start Date 01012017 End Date 12312017
County LEON
Total Total Total Avg Max Projected
StateFederal Projected Reimbursement Provider Unduplicated Provider Service Share Service Units Unit Rate Cost Per Unit Client Count
Report Total
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CIC Service Units and Costs Projections Provider SummaryPSA ALL Provider ALL PROVIDERS Program FEDERALLY FUNDED (0101 TO 1231) Year 2017 From 01012017 To 12312017
PSA County Program Service Total State
Federal Share
Total Projected
Service Units
Avg Reimbursement
Unit Rate
Max Provider
Cost Per Unit
Total Projected Unduplicated Client Count
02 FRANKLIN O3C1 CONGREGATE MEALS $810300 1710 15
Program Total
County Total
$810300
$810300
GULF O3C1 CONGREGATE MEALS $25205 3 5
Program Total $25205
O3C2 HOME DELIVERED MEALS $25205 3 6
Program Total
County Total
$25205
$50411
LEON O3C1 CONGREGATE MEALS $621300 1311 15
CONGREGATE MEALS GUEST
CONGREGATE MEALS VOLUNTEERS
$252055
$277260
25
30
2
5
Program Total $1150615
O3C2 HOME DELIVERED MEAL GUEST $252055 25 3
Program Total $252055
OA3D PEARLS (SESSION 5)
PEARLS (SESSION 6)
PEARLS (SESSION 7)
PEARLS (SESSION 8)
$10247
$10247
$10247
$10247
10
10
10
10
3
3
3
3
Program Total $40988
OA3E RESPITE IN-HOME $200 2 2
Program Total
County Total
$200
$1443858
WAKULLA O3C2 EMERGENCY HOME DELIVERED SHELF MEALS
$8065604 14899 90
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CIC Service Units and Costs Projections - PSA Summary
PSA ALL Program CCE
Strat Date 01012017 End Date 12312017
Total
PSA County Provider Service
Total State Federal
Share
Total Projected
Service Units
Avg Reimbursement
Unit Rate
Max Projected Provider Unduplicated
Cost Per Unit Client Count
02 LEON SOUTHERN SERVICE CASE MANAGEMENT PROVIDER EMERGENCY HOME DELIVERED SHELF MEALS
$2175533
$602000
483
689
32
20
HOME DELIVERED MEALS $530262 993 5
MATERIAL AID $1994536 199
Provider Total $5302331
CountyTotal $5302331
WAKULLA SOUTHERN SERVICE CASE MANAGEMENT PROVIDER EMERGENCY HOME DELIVERED SHELF MEALS
$2175533
$1240200
483
689
32
5
MATERIAL AID $1994536 199
Provider Total $5410269
CountyTotal $5410269
PSA Total $10712599
05 PINELLAS BURSTEIN-APPLEBEE ADULT DAY CARE $000 0 $900 $1000 0
COUNSELING (MENTAL HEALTH COUNSELINGSCREENING) - INDIVIDUAL
Provider Total
$000
$000
0 $6600 $7700 0
CountyTotal $000
PSA Total $000
Report Total $10712599
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CID Service Units and Costs Projections - PSA SummaryPSA ALL Program CCE
Start Date 01012017 End Date 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
PSA County Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
02 LEON CASE MANAGEMENT $2175533 483
EMERGENCY HOME $602000 689DELIVERED SHELF MEALS HOME DELIVERED MEALS $530262 993
MATERIAL AID $1994536 199
County Total $5302331 2364
WAKULLA CASE MANAGEMENT $2175533 483
EMERGENCY HOME $1240200 689DELIVERED SHELF MEALS MATERIAL AID $1994536 199
County Total $5410269 1371
PSA Total $10712599 3735
05 PINELLAS ADULT DAY CARE $000 0
COUNSELING (MENTAL $000 0 HEALTH COUNSELINGSCREENING) - INDIVIDUAL
County Total $000 0
PSA Total $000 0
Report Total $10712599 3735
$900 $900 $900 $1000 $1000 $1000
$6600 $6600 $6600 $7700 $7700 $7700
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CID Service Units and Costs Projections County SummaryPSA 99
Program CCE County LEON
Start Date 01012017 End Date 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
Report Total
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CIE Service Units and Costs Projections - PSA Summary - All Programs
PSA 99 Program FEDERALLY FUNDED (0101 TO 1231) Year 2017 From 01012017 To 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
Program Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
Report Total
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CIE Service Units and Costs Projections - PSA Summary
PSA ALL Program CCE
Start Date 01012017 End Date 12312017
Avg High Low Total Total Avg High Low Provider Provider Provider
StateFederal Projected Reimbursement Reimbursement Reimbursement Cost Cost CostPSA
02
Service
CASE MANAGEMENT
Share
$4351066
Service Units
966
Unit Rate Unit Rate Unit Rate Per Unit Per Unit Per Unit
EMERGENCY HOME DELIVERED SHELF MEALS $1842200 1378
HOME DELIVERED MEALS $530262 993
MATERIAL AID $3989071 398
PSA Total $10712599 3735
05 ADULT DAY CARE $000 0 $900 $900 $900 $1000 $1000 $1000
COUNSELING (MENTAL HEALTH $000 0 $6600 $6600 $6600 $7700 $7700 $7700 COUNSELINGSCREENING) - INDIVIDUAL
PSA Total $000 0
Report Total $10712599 3735
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CAREGIVER SEARCH REPORT
SEARCH RESULTS FOR CONSUMERS
Criteria First Name Last Name SSN PSA ALL
Client Name Client SSN Caregiver Name Caregiver SSN
000000000 000000000 Test Name Test Name
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CARES Referrals in a Time Range PSA ALL
Start Date 01012017 End Date 12312017
Referred to ALL REFERRALS
Referring PSA Employee Name Client Name Client ID
Referral Imminent NH Admit Aging Date Risk Date Referred To Cares Provider Name Received Date
03A 4061561263 Test Name Test Name 09242017 Y 05292017 ARC or ADRC 09252017
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CARES Referrals in a Time Range PSA ALL
Start Date 01012017 End Date 12312017
Referred to ALL REFERRALS
Referring PSA Employee Name Client Name Client ID
Referral Date
Imminent Risk
NH Admit Date Referred To Cares Provider Name
Aging Received Date
04B Test Name Test Name 4061738075 04082017 N ARC or ADRC Test Name 04082017
Total Clients 110
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CARES Referrals not acknowledged by the Aging Network PSA ALL For Referrals after 01012017 Owner ID ALL Owners
Unduplicated Client count Cares Office Total Clients Count
Report Total
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
CIRTS Issue PSA Client ID Client Name Program
Program Status Start Provider Enrollment ID Provider Name
APCL CLIENT WITH DATE OF DEATH 08 4061759417 Test Name OA3B APCL 07232013 1141 WESTERN WORLD RADIO
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
Program Start Provider CIRTS Issue PSA Client ID Client Name Program Status Enrollment ID Provider Name
06 LTCC APCL 01242014 1514 4061713685 Test Name APCL CLIENT WITH DATE OF DEATH CENTRAL THE ORIGINAL HOUSE OF PIES
Count 503
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Civil Rights PSA ALL Provider ALL PROVIDERS Program AC Start Date 01012017 End Date 12312017 The Poverty Level for Single is The Poverty Level for Couple is Sort by County
County Unduplicated Count
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Client Information Report Start Date 01012017 End Date 12312017
Client ID 1001141246
Emergency
Client Name Test Name
Telephone () - Address 78 TEST STREET TALLAHASSEE FL 32399
Most Recent Caregiver Information Date Updated
Doctor
Comments
Client Demographic Information
Birth Date 06041940 Race W
Owner ID Ethnicity O
Most Recent Income Information
Ind Mon Inc Cpl Mon Inc
Ind Assets Couple Assets
Most Recent Assessment Information
Asmt Date Ref Risk Lvl
Asmt Site Spec Shel
AsmtType Spec Reg
Ref Date Primary CG
Ref Source Living Sit
Enrollment Information
Sex
Marital Status
F
S
Medicaid Number
ADL Score
ADL Count
IADL Score
IADL Count
Memory Score
Priority Score
Env Score
Nutr Score
Risk Score
Social Score
Rank
Provider Location Program Program Status Worker Start Date End Date
Care Plan Service Needed
Date Service Units Type Frq End Date
Care Plan Service Planned
Program Service Units Type Frq Start Date End Date
Services Received between 01012017 and 12312017
Service Billed Provider Location Worker Program Service Date Units Unit Type Amount
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Provider N
Client Service Units Report PSA ALL Provider ALL PROVIDERS Location 0000
Program ALL PROGRAMS Service ALL SERVICES Worker ALL WORKERS
City ALL CITIES Include Zero Unit N Include Aggregate N Calculated Amount equals the number of Units Provided times Fixed Cost if it existsService Start Date 01012017 Service End Date 12312017 If Fixed Cost does not exist Calculated
Group by PSA Provider Location Client Name County Worker Amount equals Billed Amount
Unduplicated Client Count 0 Grand Total 000 $000
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Clients In Common PSA All Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 County All Counties Worker All Workers
County JEFFERSON
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
MIAMI-DADE
0 0 0 0 0 0 0 0 0
4061539538 Test NameCounty Count
County
0 01
X
0 1
X
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
4061650856 Test Name X 4061486560 Test Name X 4062452921 Test Name X
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Clients Served Not Enrolled PSA ALL Start Date 01012017 End Date 12312017 Locations 0000 Provider All Providers
Service Service Min Serv Max Serv Program Start End Enrollment PSA Provider Location Program Consumer Name Client ID Service Date Date Status Enrollment Enrollment Provider
Count 0
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
4061472791 04
09
1092
1291
0072
0042
LTCC
LTCC
APCL
APCL
4062714543 06
06
1514
1762
0072
5006
LTCC
LTCC
APCL
APPL
4061802246 11
06
1177
1514
0179
0072
LTCC
LTCC
APCL
APCL
4061563719 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062644312 06
08
1514
1771
0072
0896
LTCC
LTCC
APCL
APCL
1001141670 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
1001141671 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
4062375003 07
05
05
07
1263
1755
1638
1263
0368
0072
0072
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062155124 06
06
1762
1514
0072
0072
LTCC
LTCC
APPL
APCL
4061743886 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0369
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4061499927 06
06
1514
1762
0072
5005
LTCC
LTCC
APCL
APPL
4061583524 08
06
1144
1514
0896
0072
LTCC
LTCC
APCL
APCL
4062694843 06
03
1514
1922
0072
0179
LTCC
LTCC
APCL
APCL
4062744517 07
06
1263
1514
0369
0072
LTCC
LTCC
APCL
APCL
4062005488 10
11
10
11
1929
1177
1164
1177
0072
0073
0179
0179
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
Report run on 08312018 0200 PM Page 1 of 2 clnts_mult_enrollrdf
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
Total Count 15
Report run on 08312018 0200 PM Page 2 of 2 clnts_mult_enrollrdf
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CODE DESCRIPTIONS Category ALL STATE TABLES
Code Description Active Available To Code Category
0 UNKNOWN Y CARES SUBJECTIVE_HEALTH_EVALUATION
01 ALACHUA Y COMMON COUNTIES
02 BAKER Y COMMON COUNTIES
03 BAY Y COMMON COUNTIES
04 BRADFORD Y COMMON COUNTIES
05 BREVARD Y COMMON COUNTIES
06 BROWARD Y COMMON COUNTIES
07 CALHOUN Y COMMON COUNTIES
08 CHARLOTTE Y COMMON COUNTIES
09 CITRUS Y COMMON COUNTIES
1 EXCELLENT Y CARES SUBJECTIVE_HEALTH_EVALUATION
10 CLAY Y COMMON COUNTIES
11 COLLIER Y COMMON COUNTIES
12 COLUMBIA Y COMMON COUNTIES
13 MIAMI-DADE Y COMMON COUNTIES
14 DESOTO Y COMMON COUNTIES
15 DIXIE Y COMMON COUNTIES
16 DUVAL Y COMMON COUNTIES
17 ESCAMBIA Y COMMON COUNTIES
18 FLAGLER Y COMMON COUNTIES
19 FRANKLIN Y COMMON COUNTIES
2 GOOD Y CARES SUBJECTIVE_HEALTH_EVALUATION
20 GADSDEN Y COMMON COUNTIES
21 GILCHRIST Y COMMON COUNTIES
22 GLADES Y COMMON COUNTIES
23 GULF Y COMMON COUNTIES
24 HAMILTON Y COMMON COUNTIES
25 HARDEE Y COMMON COUNTIES
26 HENDRY Y COMMON COUNTIES
27 HERNANDO Y COMMON COUNTIES
28 HIGHLANDS Y COMMON COUNTIES
Report run on 08312018 0140 PM Page 1 of 45 state_codesrdf Report run by RSHQALL Dispose of this report so that it cannot be read or reconstructed
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CONSUMER AGE VERIFICATION REPORT PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Program AC
Age at Start
Enroll or Start Enroll Provider Program Description Consumer Name Client ID DOB Svc date or Svc Date
Report run on 08312018 0203 PM Page 1 of 1 age_verifyrdf
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Contract Budget Information PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Program Service Provider Location County Served Provider Contract
Projected Service
Units Unit Measure
Projected Unduplicated
State Federal Share Client Count Begin Date End Date
Row Count 0 Amount Total
Report run on 08312018 0233 PM Page 1 of 1 contract_budgetrdf
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Start Enroll Latest Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Date Asmt Date Worker
O3C1 1036 000 4061653427 Test CENTRAL 34982 W M 07091930 09102013 09102013 CIRTS20804 0 Name
Report run on 08312018 1133 AM Page 1 of 6 actv_by_progrdf
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Start Enroll Date
Latest Asmt Date Worker
4061593624 Test Name CENTRAL 34946 B F 11261940 12012011 12312013 CIRTS23407
Count 164
Unduplicated Client Count 163
Report run on 08312018 1133 AM Page 6 of 6 actv_by_progrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Assessments After DOD Report
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Owner 1025
The shaded records indicate clients who have different DOBs andor different names
Assemt Current PSA Owner Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Owner Assessor
Provider Assessor
Assemt Date
Assemt Type
Unduplicated Count Total 0
Report run on 08312018 0206 PM Page 1 of 1 vs_assmrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Open Enrollments
The Vital Statistics Data for 07192002 - 09112014PSA ALL Provider ALL Program Status ACTV Include MLTC ACTVS N
The shaded records indicate clients who have different DOBs andor different names
Enroll PSA
Enrollment Provider Loc Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Enroll Program Status
Enroll Program
Current Owner ID
02 1065 0072 4062244026 Test Name Test Name 10222004 03231917 03231917 ACTV CCE 1065
Count of enrollments for the Provider 1
Count of enrollments for the PSA 1
Count of enrollments for the Report 1
Unduplicated Count of Individuals with open enrollments and DOD PSA Total Clients Count
02 1
Total 1
Report run on 08312018 0205 PM Page 1 of 1 vs_open_enrollrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Report run on 08312018 0207 PM Page 1 of 3 vs_servicesrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Unduplicated count of individuals with Services after DOD
PSA Total Clients Count
Report Total
Report run on 08312018 0207 PM Page 2 of 3 vs_servicesrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
List of Clients with PSA table entry for SERVICES_AFTER_DOD
Unduplicated Count Total 0
Report run on 08312018 0207 PM Page 3 of 3 vs_servicesrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Age
Provider
Total
Age lt 60 Age 60 - 64 Age 65 - 74 Age 75 - 84 Age 85+ Total Clients Avg Age
Total
Avg Age
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Ethnicity
Provider Hispanic Other Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Race
American Indian Native Hawaiian Other Provider Asian Alaska Native Black Pacific Islander Minority White Multiple Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Gender
Provider Male Female Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Monthly Income
Provider 0 - - Higher than Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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None
Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Total Persons Served 0
Age lt 60 Years 0 0
Age 60 - 64 0 0
Age 65 - 74 0 0
Age 75 - 84 0 0
Age 85+ 0 0
Total Age 0 0
Average 000
Ethnicity Hispanic 0 0
Other Ethnicity 0 0
Unknown Ethnicity 0 0
Total 0 0
Race Asian 0 0
American Indian Alaska Native 0 0
Black 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority 0 0
White 0 0
Multiple 0 0
Unknown 0 0
Total 0 0
Sex Male 0 0
Female 0 0
Unknown Sex 0 0
Total 0 0
Monthly Income 0 - 0 0
- 0 0
Higher than 0 0
Unknown 0 0
Total 0 0
Report run on 08312018 1058 AM Page 1 of 2 demo_by_prov_detrdf Report run byRSHQALL Dispose of this report so that it can not be read or reconstructed
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Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Client ID Date Of Birth Ethnicity Race Sex Individual Monthly Income
Report run on 08312018 1058 AM Page 2 of 2 demo_by_prov_detrdf Report run byRSHQALL Dispose of this report so that it can not be read or reconstructed
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Demographics of Clients OAA Registered Served Only PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 City All Cities Program All Programs Service All Services County ALL COUNTIES Table OAA Registered Services Only Low Income Medium Income
Total Persons Served 0
Agelt 60 Years
Age 60 - 64
Age 65 - 74
Age 75 - 84
Age 85+
0
0
0
0
0
0
0
0
0
0
Monthly Income
0 -
-Higher than
Unknown
0
0
0
0
0
0
0
0
Total
Average
0
000
0 Total 0 0
Ethnicity Hispanic
Other
Unknown
0
0
0
0
0
0
Living Situation
Alone
Null
Policy Change
0
0
0
0
0
0
Total 0 0 Unknown
With Caregiver
0
0
0
0
Race Asian 0 0
With Other
With Other Caregiver
0
0
0
0
American Indian Alaska Native
Black
0
0
0
0Total Living Situation 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority
White
0
0
0
0 Limited English Proficiency
Multiple
Unknown
Total Race
0
0
0
0
0
0
Yes
No
Unknown
0
0
0
0
0
0
Total 0 0
Sex Male
Female
Unknown
0
0
0
0
0
0
Total 0 0
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Disaster Assistance Clients for a Provider PSA ALL Provider All Providers Location 0000 Worker All Workers City All Cities Zip Code All Zip Codes Sort By ZIP
Provider 1036 Provider Name Location 0000 Worker CIRTS18634
Need Care Client Name Address City Zip County Phone Asst Reg Situation Relat Care phone Care Name
34946 N WO DA 000 SAINT JAMES DRIVE CENTRAL (025) 101-0620 Test NameTest Name SAINT LUCIE (005) 100-0369 Y
Client is active and no assessment information is available Special Shelter and Special Registry are unknown
Report run on 08312018 1102 AM Page 1 of 8 disaster_by_provrdf
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
Total by PSA 0
Report run on 08312018 1111 AM Page 1 of 5 eheap_exceptionsrdf
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
ALACH BAKER BAY BRADF BREVA BROWA CALHO CHARL CITRUS CLAY COLLIE COLUM DESOT DIXIE DUVAL ESCAM FLAGL FRANK GADSDAssisted Household Report UA ORD RD RD UN OTTE R BIA O BIA ER LIN EN
1 of Household Assisted 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Households AssistedWith Gross Income
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C 100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D 125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
3 Households with at leastOne member
A 60 Years or older 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B Disabled 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C Age 5 years or under 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D Under 60 Years Old 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Undup Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Assisted
Applicant Household Report
of Applicant Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Energy Assisted Household Report
County of Assisted
Households
Households Assisted By Poverty Level
Under 75 75 - 100 101 - 125 126 - 150 Over 150 60 Years or older
At least one member who is
Age 5 years Age 2 years Age 3 years Disabled or younger and younger through 5
Under 60 Years Old
Undup Households
Assisted
Energy Assistance Total
Report run on 08312018 1107 AM Page 1 of 3 eheap_summaryrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Unduplicated Total 0 0
County of Assisted
Households Under 75 75 - 100
Households Assisted By Poverty Level
101 - 125 126 - 150 Over 150 60 Years or older Disabled
Age 5 years or younger
Age 2 years and younger
Age 3 years through 5
Under 60 Years Old
At least one member who is
Undup Households
Assisted
Other Assisted Household Report
Other Assistance Total
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Applicant Household Report
County of Applicant
Households Under 75 75 - 100 101 - 125 126 - 150 Over 150 Income data
unavailable
Total 0
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01
Enrollment Active Consumer Count by Program PSA ALL Provider ALL PROVIDERS
County Description Program Count of Clients
BREVARD
ADI
CCE
HCE
LSP
NDP
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
MLTC
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
31
57
44
5
62
123
141
26
9
7
5
40
5
50
67
129
2
19
42
29
1
233
79
63
8
2
14
3
37
14
47
3
3
33
127
10
02
03
04
ALACHUA
BAKER
BAY
BRADFORD
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Enrollment Terminations with Reasons PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 Program All Programs Program Status ALL Program Status Worker ALL WORKERS
Last First Program Medicaid Provider Start End Name Name Client ID Status Description Worker Number Program Location Enrollment Enrollment
Count 0
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Enrollments with Care Plan Report
PSA ALL Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTIVE STATUS Care Plan Service ALL SERVICES Care Plan Start 01012017 Care Plan End 12312017
Care Plan Care Plan Care Plan Client Name
Unduplicated Client Count 0
Client ID Program Status Worker Start Date End Date Service
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PSA CLIENT_ID CLIENT_NAME OWNER PROVIDER_ID ASSESSMENT_DATE ASSESSOR_NAME MEDICAID_NUMBER CAREGIVER_CHANGE ENVIRONMENT_CHANGE HEALTH_CHANGE INCOME_CHANGE SITUATION_CHANGE INITIAL_ASSM ANNUAL_ASSM SSN REFERRAL_SOURCE 1114 N N N N Y N 771771777 SELFFAMILY 812017 JANE CASEWORKER 2 1001141633 TEST TEST N
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Fixed Service Costs List PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Provider Location County Program Service Reimbursement Unit Rate Provider Cost Per Unit Begin Valid End Valid
Count 0
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4062380426 Test Name ACTV 04112012 CIRTS23407 N 55 2
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4061608826 Test Name ACTV 08102011 CIRTS18634 Y 7 3
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4062615533 Test Name ACTV 10032013 CIRTS20804 Y 6 3
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start Enrollment
End Enrollment Worker
Worker Active
Medicaid Number
Most Recent Nutr Score Rank
O3C2 1036 4062466582 Test Name ACTV 10262010 CIRTS23407 N 105 2
Total for Location 113
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PSA
APCL Clients With No Services ALL Owner All Owners Provider ALL PROVIDERS
Start Date 01012017 End Date 12312017
Includes Clients Receiving Only CM INSC SCAS CA REFE Services
PSA Client ID Client Name Owner Provider Program
Count 0
Unduplicated Clients Count 0
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APCL Clients With Services PSA ALL Owner All Owners Provider ALL PROVIDERS Start Date 01012017 End Date 12312017
Exclude CM CA INSC REFE SCAS
PSA Client ID Name Owner Provider Program 10 4062527553 Test Name 1539 1929 CCE
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APCL Clients With Services PSA ALL Owner All Owners Provider ALL PROVIDERS Start Date 01012017 End Date 12312017
Exclude CM CA INSC REFE SCAS
PSA Client ID Name Owner Provider Program 11 4062732638 Test Name 1177 1177 LTCC
Total 21067
Unduplicated clients count 12460
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APS Assessments PSA ALL Risk Level ALL Owner All Owners Referral Date From 01012017 To 12312017
Order by Referral Date and Owner ID
PSA 03
Ref Date Owner ID Client ID Client Name Risk Level Asmt Type Asmt Date
03032017 1390 4062058415 L 701A 03302018 Test Name
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APS Assessments PSA ALL Risk Level ALL Owner All Owners Referral Date From 01012017 To 12312017
Order by Referral Date and Owner ID
12042017 1980 4061617559 H 701B 12072017 Test Name
Assessment Count for the PSA 52
PSA 04A
Ref Date Owner ID Client ID
09102017 4062308458
Client Name
Test Name
Risk Level
H
Asmt Type
O
Asmt Date
09162017
Assessment Count for the PSA 2
Risk Level H
M
L
Count of Assessments 138
23
21
Total Count of Assessments 182
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APS Repeat Referrals in a Time Range
PSA ALL Owner All Owners
Start Date 01012017 End Date 12312017
Current DOEA CIRTS Cirts SSN if Risk Date Created PSA Owner Abuse No different than DCF DCF SSN Name County Level Date of Birth Date Sent by DCF
Count 0
Unduplicated Client Count by PSA
PSA Count SSN
Total
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Assessed Prioritized Consumer List PSA ALL Provider ALL PROVIDERS Program AC County ALL COUNTIES
County Program Consumer Name Client ID
Total Count 0
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Assessment Due Report PSA 01 Start Date 01012017 End Date 08312018 Owner ALL PROVIDERS Worker ALL WORKERS Program Status ACTV and APCL Assessment Type Needed ALL
Overdue and missing assessments are always listed
Owner ID 1065
Client ID Client Name
Owner Assessor ID
Date of Birth
06281928
CIRTS28099
County of Service
GULF
Worker Name HARPER KENNY
Zip Assessment PSA Date
32534 01 01022014
Type
701A
Active Y
Nutr PriorityScore Score
11 58
Rank
5
Due Date
01022015
Status
701S OVERDUE
LTCC APPL Start Date
03252014 4062235673 Test name
Total Clients for Worker 1
Total Clients for Owner 1
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Assessment Due Report PSA 01 Start Date 01012017 End Date 08312018 Owner ALL PROVIDERS Worker ALL WORKERS Program Status ACTV and APCL Assessment Type Needed ALL
Overdue and missing assessments are always listed
Summary by PSA
PSA 01 701A Overdue 1
701B Overdue 213
701C Overdue 0
701S Overdue 157
No 701A 0
No 701B 2
No 701C 0
No 701S 0
701A Not Overdue 0
701B Not Overdue 0
701C Not Overdue 0
701S Not Overdue 0
701S Optional 0
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CIC Service Units and Costs Projections County SummaryPSA 99 Program CCE
Start Date 01012017 End Date 12312017
County LEON
Total Total Total Avg Max Projected
StateFederal Projected Reimbursement Provider Unduplicated Provider Service Share Service Units Unit Rate Cost Per Unit Client Count
Report Total
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CIC Service Units and Costs Projections Provider SummaryPSA ALL Provider ALL PROVIDERS Program FEDERALLY FUNDED (0101 TO 1231) Year 2017 From 01012017 To 12312017
PSA County Program Service Total State
Federal Share
Total Projected
Service Units
Avg Reimbursement
Unit Rate
Max Provider
Cost Per Unit
Total Projected Unduplicated Client Count
02 FRANKLIN O3C1 CONGREGATE MEALS $810300 1710 15
Program Total
County Total
$810300
$810300
GULF O3C1 CONGREGATE MEALS $25205 3 5
Program Total $25205
O3C2 HOME DELIVERED MEALS $25205 3 6
Program Total
County Total
$25205
$50411
LEON O3C1 CONGREGATE MEALS $621300 1311 15
CONGREGATE MEALS GUEST
CONGREGATE MEALS VOLUNTEERS
$252055
$277260
25
30
2
5
Program Total $1150615
O3C2 HOME DELIVERED MEAL GUEST $252055 25 3
Program Total $252055
OA3D PEARLS (SESSION 5)
PEARLS (SESSION 6)
PEARLS (SESSION 7)
PEARLS (SESSION 8)
$10247
$10247
$10247
$10247
10
10
10
10
3
3
3
3
Program Total $40988
OA3E RESPITE IN-HOME $200 2 2
Program Total
County Total
$200
$1443858
WAKULLA O3C2 EMERGENCY HOME DELIVERED SHELF MEALS
$8065604 14899 90
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CIC Service Units and Costs Projections - PSA Summary
PSA ALL Program CCE
Strat Date 01012017 End Date 12312017
Total
PSA County Provider Service
Total State Federal
Share
Total Projected
Service Units
Avg Reimbursement
Unit Rate
Max Projected Provider Unduplicated
Cost Per Unit Client Count
02 LEON SOUTHERN SERVICE CASE MANAGEMENT PROVIDER EMERGENCY HOME DELIVERED SHELF MEALS
$2175533
$602000
483
689
32
20
HOME DELIVERED MEALS $530262 993 5
MATERIAL AID $1994536 199
Provider Total $5302331
CountyTotal $5302331
WAKULLA SOUTHERN SERVICE CASE MANAGEMENT PROVIDER EMERGENCY HOME DELIVERED SHELF MEALS
$2175533
$1240200
483
689
32
5
MATERIAL AID $1994536 199
Provider Total $5410269
CountyTotal $5410269
PSA Total $10712599
05 PINELLAS BURSTEIN-APPLEBEE ADULT DAY CARE $000 0 $900 $1000 0
COUNSELING (MENTAL HEALTH COUNSELINGSCREENING) - INDIVIDUAL
Provider Total
$000
$000
0 $6600 $7700 0
CountyTotal $000
PSA Total $000
Report Total $10712599
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CID Service Units and Costs Projections - PSA SummaryPSA ALL Program CCE
Start Date 01012017 End Date 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
PSA County Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
02 LEON CASE MANAGEMENT $2175533 483
EMERGENCY HOME $602000 689DELIVERED SHELF MEALS HOME DELIVERED MEALS $530262 993
MATERIAL AID $1994536 199
County Total $5302331 2364
WAKULLA CASE MANAGEMENT $2175533 483
EMERGENCY HOME $1240200 689DELIVERED SHELF MEALS MATERIAL AID $1994536 199
County Total $5410269 1371
PSA Total $10712599 3735
05 PINELLAS ADULT DAY CARE $000 0
COUNSELING (MENTAL $000 0 HEALTH COUNSELINGSCREENING) - INDIVIDUAL
County Total $000 0
PSA Total $000 0
Report Total $10712599 3735
$900 $900 $900 $1000 $1000 $1000
$6600 $6600 $6600 $7700 $7700 $7700
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CID Service Units and Costs Projections County SummaryPSA 99
Program CCE County LEON
Start Date 01012017 End Date 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
Report Total
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CIE Service Units and Costs Projections - PSA Summary - All Programs
PSA 99 Program FEDERALLY FUNDED (0101 TO 1231) Year 2017 From 01012017 To 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
Program Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
Report Total
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CIE Service Units and Costs Projections - PSA Summary
PSA ALL Program CCE
Start Date 01012017 End Date 12312017
Avg High Low Total Total Avg High Low Provider Provider Provider
StateFederal Projected Reimbursement Reimbursement Reimbursement Cost Cost CostPSA
02
Service
CASE MANAGEMENT
Share
$4351066
Service Units
966
Unit Rate Unit Rate Unit Rate Per Unit Per Unit Per Unit
EMERGENCY HOME DELIVERED SHELF MEALS $1842200 1378
HOME DELIVERED MEALS $530262 993
MATERIAL AID $3989071 398
PSA Total $10712599 3735
05 ADULT DAY CARE $000 0 $900 $900 $900 $1000 $1000 $1000
COUNSELING (MENTAL HEALTH $000 0 $6600 $6600 $6600 $7700 $7700 $7700 COUNSELINGSCREENING) - INDIVIDUAL
PSA Total $000 0
Report Total $10712599 3735
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CAREGIVER SEARCH REPORT
SEARCH RESULTS FOR CONSUMERS
Criteria First Name Last Name SSN PSA ALL
Client Name Client SSN Caregiver Name Caregiver SSN
000000000 000000000 Test Name Test Name
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CARES Referrals in a Time Range PSA ALL
Start Date 01012017 End Date 12312017
Referred to ALL REFERRALS
Referring PSA Employee Name Client Name Client ID
Referral Imminent NH Admit Aging Date Risk Date Referred To Cares Provider Name Received Date
03A 4061561263 Test Name Test Name 09242017 Y 05292017 ARC or ADRC 09252017
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CARES Referrals in a Time Range PSA ALL
Start Date 01012017 End Date 12312017
Referred to ALL REFERRALS
Referring PSA Employee Name Client Name Client ID
Referral Date
Imminent Risk
NH Admit Date Referred To Cares Provider Name
Aging Received Date
04B Test Name Test Name 4061738075 04082017 N ARC or ADRC Test Name 04082017
Total Clients 110
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CARES Referrals not acknowledged by the Aging Network PSA ALL For Referrals after 01012017 Owner ID ALL Owners
Unduplicated Client count Cares Office Total Clients Count
Report Total
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
CIRTS Issue PSA Client ID Client Name Program
Program Status Start Provider Enrollment ID Provider Name
APCL CLIENT WITH DATE OF DEATH 08 4061759417 Test Name OA3B APCL 07232013 1141 WESTERN WORLD RADIO
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
Program Start Provider CIRTS Issue PSA Client ID Client Name Program Status Enrollment ID Provider Name
06 LTCC APCL 01242014 1514 4061713685 Test Name APCL CLIENT WITH DATE OF DEATH CENTRAL THE ORIGINAL HOUSE OF PIES
Count 503
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Civil Rights PSA ALL Provider ALL PROVIDERS Program AC Start Date 01012017 End Date 12312017 The Poverty Level for Single is The Poverty Level for Couple is Sort by County
County Unduplicated Count
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Client Information Report Start Date 01012017 End Date 12312017
Client ID 1001141246
Emergency
Client Name Test Name
Telephone () - Address 78 TEST STREET TALLAHASSEE FL 32399
Most Recent Caregiver Information Date Updated
Doctor
Comments
Client Demographic Information
Birth Date 06041940 Race W
Owner ID Ethnicity O
Most Recent Income Information
Ind Mon Inc Cpl Mon Inc
Ind Assets Couple Assets
Most Recent Assessment Information
Asmt Date Ref Risk Lvl
Asmt Site Spec Shel
AsmtType Spec Reg
Ref Date Primary CG
Ref Source Living Sit
Enrollment Information
Sex
Marital Status
F
S
Medicaid Number
ADL Score
ADL Count
IADL Score
IADL Count
Memory Score
Priority Score
Env Score
Nutr Score
Risk Score
Social Score
Rank
Provider Location Program Program Status Worker Start Date End Date
Care Plan Service Needed
Date Service Units Type Frq End Date
Care Plan Service Planned
Program Service Units Type Frq Start Date End Date
Services Received between 01012017 and 12312017
Service Billed Provider Location Worker Program Service Date Units Unit Type Amount
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Provider N
Client Service Units Report PSA ALL Provider ALL PROVIDERS Location 0000
Program ALL PROGRAMS Service ALL SERVICES Worker ALL WORKERS
City ALL CITIES Include Zero Unit N Include Aggregate N Calculated Amount equals the number of Units Provided times Fixed Cost if it existsService Start Date 01012017 Service End Date 12312017 If Fixed Cost does not exist Calculated
Group by PSA Provider Location Client Name County Worker Amount equals Billed Amount
Unduplicated Client Count 0 Grand Total 000 $000
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Clients In Common PSA All Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 County All Counties Worker All Workers
County JEFFERSON
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
MIAMI-DADE
0 0 0 0 0 0 0 0 0
4061539538 Test NameCounty Count
County
0 01
X
0 1
X
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
4061650856 Test Name X 4061486560 Test Name X 4062452921 Test Name X
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Clients Served Not Enrolled PSA ALL Start Date 01012017 End Date 12312017 Locations 0000 Provider All Providers
Service Service Min Serv Max Serv Program Start End Enrollment PSA Provider Location Program Consumer Name Client ID Service Date Date Status Enrollment Enrollment Provider
Count 0
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
4061472791 04
09
1092
1291
0072
0042
LTCC
LTCC
APCL
APCL
4062714543 06
06
1514
1762
0072
5006
LTCC
LTCC
APCL
APPL
4061802246 11
06
1177
1514
0179
0072
LTCC
LTCC
APCL
APCL
4061563719 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062644312 06
08
1514
1771
0072
0896
LTCC
LTCC
APCL
APCL
1001141670 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
1001141671 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
4062375003 07
05
05
07
1263
1755
1638
1263
0368
0072
0072
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062155124 06
06
1762
1514
0072
0072
LTCC
LTCC
APPL
APCL
4061743886 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0369
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4061499927 06
06
1514
1762
0072
5005
LTCC
LTCC
APCL
APPL
4061583524 08
06
1144
1514
0896
0072
LTCC
LTCC
APCL
APCL
4062694843 06
03
1514
1922
0072
0179
LTCC
LTCC
APCL
APCL
4062744517 07
06
1263
1514
0369
0072
LTCC
LTCC
APCL
APCL
4062005488 10
11
10
11
1929
1177
1164
1177
0072
0073
0179
0179
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
Total Count 15
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CODE DESCRIPTIONS Category ALL STATE TABLES
Code Description Active Available To Code Category
0 UNKNOWN Y CARES SUBJECTIVE_HEALTH_EVALUATION
01 ALACHUA Y COMMON COUNTIES
02 BAKER Y COMMON COUNTIES
03 BAY Y COMMON COUNTIES
04 BRADFORD Y COMMON COUNTIES
05 BREVARD Y COMMON COUNTIES
06 BROWARD Y COMMON COUNTIES
07 CALHOUN Y COMMON COUNTIES
08 CHARLOTTE Y COMMON COUNTIES
09 CITRUS Y COMMON COUNTIES
1 EXCELLENT Y CARES SUBJECTIVE_HEALTH_EVALUATION
10 CLAY Y COMMON COUNTIES
11 COLLIER Y COMMON COUNTIES
12 COLUMBIA Y COMMON COUNTIES
13 MIAMI-DADE Y COMMON COUNTIES
14 DESOTO Y COMMON COUNTIES
15 DIXIE Y COMMON COUNTIES
16 DUVAL Y COMMON COUNTIES
17 ESCAMBIA Y COMMON COUNTIES
18 FLAGLER Y COMMON COUNTIES
19 FRANKLIN Y COMMON COUNTIES
2 GOOD Y CARES SUBJECTIVE_HEALTH_EVALUATION
20 GADSDEN Y COMMON COUNTIES
21 GILCHRIST Y COMMON COUNTIES
22 GLADES Y COMMON COUNTIES
23 GULF Y COMMON COUNTIES
24 HAMILTON Y COMMON COUNTIES
25 HARDEE Y COMMON COUNTIES
26 HENDRY Y COMMON COUNTIES
27 HERNANDO Y COMMON COUNTIES
28 HIGHLANDS Y COMMON COUNTIES
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CONSUMER AGE VERIFICATION REPORT PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Program AC
Age at Start
Enroll or Start Enroll Provider Program Description Consumer Name Client ID DOB Svc date or Svc Date
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Contract Budget Information PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Program Service Provider Location County Served Provider Contract
Projected Service
Units Unit Measure
Projected Unduplicated
State Federal Share Client Count Begin Date End Date
Row Count 0 Amount Total
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Start Enroll Latest Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Date Asmt Date Worker
O3C1 1036 000 4061653427 Test CENTRAL 34982 W M 07091930 09102013 09102013 CIRTS20804 0 Name
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Start Enroll Date
Latest Asmt Date Worker
4061593624 Test Name CENTRAL 34946 B F 11261940 12012011 12312013 CIRTS23407
Count 164
Unduplicated Client Count 163
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Assessments After DOD Report
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Owner 1025
The shaded records indicate clients who have different DOBs andor different names
Assemt Current PSA Owner Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Owner Assessor
Provider Assessor
Assemt Date
Assemt Type
Unduplicated Count Total 0
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Open Enrollments
The Vital Statistics Data for 07192002 - 09112014PSA ALL Provider ALL Program Status ACTV Include MLTC ACTVS N
The shaded records indicate clients who have different DOBs andor different names
Enroll PSA
Enrollment Provider Loc Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Enroll Program Status
Enroll Program
Current Owner ID
02 1065 0072 4062244026 Test Name Test Name 10222004 03231917 03231917 ACTV CCE 1065
Count of enrollments for the Provider 1
Count of enrollments for the PSA 1
Count of enrollments for the Report 1
Unduplicated Count of Individuals with open enrollments and DOD PSA Total Clients Count
02 1
Total 1
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Unduplicated count of individuals with Services after DOD
PSA Total Clients Count
Report Total
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
List of Clients with PSA table entry for SERVICES_AFTER_DOD
Unduplicated Count Total 0
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Age
Provider
Total
Age lt 60 Age 60 - 64 Age 65 - 74 Age 75 - 84 Age 85+ Total Clients Avg Age
Total
Avg Age
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Ethnicity
Provider Hispanic Other Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Race
American Indian Native Hawaiian Other Provider Asian Alaska Native Black Pacific Islander Minority White Multiple Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Gender
Provider Male Female Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Monthly Income
Provider 0 - - Higher than Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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None
Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Total Persons Served 0
Age lt 60 Years 0 0
Age 60 - 64 0 0
Age 65 - 74 0 0
Age 75 - 84 0 0
Age 85+ 0 0
Total Age 0 0
Average 000
Ethnicity Hispanic 0 0
Other Ethnicity 0 0
Unknown Ethnicity 0 0
Total 0 0
Race Asian 0 0
American Indian Alaska Native 0 0
Black 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority 0 0
White 0 0
Multiple 0 0
Unknown 0 0
Total 0 0
Sex Male 0 0
Female 0 0
Unknown Sex 0 0
Total 0 0
Monthly Income 0 - 0 0
- 0 0
Higher than 0 0
Unknown 0 0
Total 0 0
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Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Client ID Date Of Birth Ethnicity Race Sex Individual Monthly Income
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Demographics of Clients OAA Registered Served Only PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 City All Cities Program All Programs Service All Services County ALL COUNTIES Table OAA Registered Services Only Low Income Medium Income
Total Persons Served 0
Agelt 60 Years
Age 60 - 64
Age 65 - 74
Age 75 - 84
Age 85+
0
0
0
0
0
0
0
0
0
0
Monthly Income
0 -
-Higher than
Unknown
0
0
0
0
0
0
0
0
Total
Average
0
000
0 Total 0 0
Ethnicity Hispanic
Other
Unknown
0
0
0
0
0
0
Living Situation
Alone
Null
Policy Change
0
0
0
0
0
0
Total 0 0 Unknown
With Caregiver
0
0
0
0
Race Asian 0 0
With Other
With Other Caregiver
0
0
0
0
American Indian Alaska Native
Black
0
0
0
0Total Living Situation 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority
White
0
0
0
0 Limited English Proficiency
Multiple
Unknown
Total Race
0
0
0
0
0
0
Yes
No
Unknown
0
0
0
0
0
0
Total 0 0
Sex Male
Female
Unknown
0
0
0
0
0
0
Total 0 0
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Disaster Assistance Clients for a Provider PSA ALL Provider All Providers Location 0000 Worker All Workers City All Cities Zip Code All Zip Codes Sort By ZIP
Provider 1036 Provider Name Location 0000 Worker CIRTS18634
Need Care Client Name Address City Zip County Phone Asst Reg Situation Relat Care phone Care Name
34946 N WO DA 000 SAINT JAMES DRIVE CENTRAL (025) 101-0620 Test NameTest Name SAINT LUCIE (005) 100-0369 Y
Client is active and no assessment information is available Special Shelter and Special Registry are unknown
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
Total by PSA 0
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
ALACH BAKER BAY BRADF BREVA BROWA CALHO CHARL CITRUS CLAY COLLIE COLUM DESOT DIXIE DUVAL ESCAM FLAGL FRANK GADSDAssisted Household Report UA ORD RD RD UN OTTE R BIA O BIA ER LIN EN
1 of Household Assisted 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Households AssistedWith Gross Income
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C 100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D 125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
3 Households with at leastOne member
A 60 Years or older 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B Disabled 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C Age 5 years or under 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D Under 60 Years Old 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Undup Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Assisted
Applicant Household Report
of Applicant Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Energy Assisted Household Report
County of Assisted
Households
Households Assisted By Poverty Level
Under 75 75 - 100 101 - 125 126 - 150 Over 150 60 Years or older
At least one member who is
Age 5 years Age 2 years Age 3 years Disabled or younger and younger through 5
Under 60 Years Old
Undup Households
Assisted
Energy Assistance Total
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Unduplicated Total 0 0
County of Assisted
Households Under 75 75 - 100
Households Assisted By Poverty Level
101 - 125 126 - 150 Over 150 60 Years or older Disabled
Age 5 years or younger
Age 2 years and younger
Age 3 years through 5
Under 60 Years Old
At least one member who is
Undup Households
Assisted
Other Assisted Household Report
Other Assistance Total
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Applicant Household Report
County of Applicant
Households Under 75 75 - 100 101 - 125 126 - 150 Over 150 Income data
unavailable
Total 0
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01
Enrollment Active Consumer Count by Program PSA ALL Provider ALL PROVIDERS
County Description Program Count of Clients
BREVARD
ADI
CCE
HCE
LSP
NDP
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
MLTC
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
31
57
44
5
62
123
141
26
9
7
5
40
5
50
67
129
2
19
42
29
1
233
79
63
8
2
14
3
37
14
47
3
3
33
127
10
02
03
04
ALACHUA
BAKER
BAY
BRADFORD
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Enrollment Terminations with Reasons PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 Program All Programs Program Status ALL Program Status Worker ALL WORKERS
Last First Program Medicaid Provider Start End Name Name Client ID Status Description Worker Number Program Location Enrollment Enrollment
Count 0
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Enrollments with Care Plan Report
PSA ALL Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTIVE STATUS Care Plan Service ALL SERVICES Care Plan Start 01012017 Care Plan End 12312017
Care Plan Care Plan Care Plan Client Name
Unduplicated Client Count 0
Client ID Program Status Worker Start Date End Date Service
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PSA CLIENT_ID CLIENT_NAME OWNER PROVIDER_ID ASSESSMENT_DATE ASSESSOR_NAME MEDICAID_NUMBER CAREGIVER_CHANGE ENVIRONMENT_CHANGE HEALTH_CHANGE INCOME_CHANGE SITUATION_CHANGE INITIAL_ASSM ANNUAL_ASSM SSN REFERRAL_SOURCE 1114 N N N N Y N 771771777 SELFFAMILY 812017 JANE CASEWORKER 2 1001141633 TEST TEST N
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Fixed Service Costs List PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Provider Location County Program Service Reimbursement Unit Rate Provider Cost Per Unit Begin Valid End Valid
Count 0
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4061608826 Test Name ACTV 08102011 CIRTS18634 Y 7 3
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4062615533 Test Name ACTV 10032013 CIRTS20804 Y 6 3
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start Enrollment
End Enrollment Worker
Worker Active
Medicaid Number
Most Recent Nutr Score Rank
O3C2 1036 4062466582 Test Name ACTV 10262010 CIRTS23407 N 105 2
Total for Location 113
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PSA
APCL Clients With No Services ALL Owner All Owners Provider ALL PROVIDERS
Start Date 01012017 End Date 12312017
Includes Clients Receiving Only CM INSC SCAS CA REFE Services
PSA Client ID Client Name Owner Provider Program
Count 0
Unduplicated Clients Count 0
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APCL Clients With Services PSA ALL Owner All Owners Provider ALL PROVIDERS Start Date 01012017 End Date 12312017
Exclude CM CA INSC REFE SCAS
PSA Client ID Name Owner Provider Program 10 4062527553 Test Name 1539 1929 CCE
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APCL Clients With Services PSA ALL Owner All Owners Provider ALL PROVIDERS Start Date 01012017 End Date 12312017
Exclude CM CA INSC REFE SCAS
PSA Client ID Name Owner Provider Program 11 4062732638 Test Name 1177 1177 LTCC
Total 21067
Unduplicated clients count 12460
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APS Assessments PSA ALL Risk Level ALL Owner All Owners Referral Date From 01012017 To 12312017
Order by Referral Date and Owner ID
PSA 03
Ref Date Owner ID Client ID Client Name Risk Level Asmt Type Asmt Date
03032017 1390 4062058415 L 701A 03302018 Test Name
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APS Assessments PSA ALL Risk Level ALL Owner All Owners Referral Date From 01012017 To 12312017
Order by Referral Date and Owner ID
12042017 1980 4061617559 H 701B 12072017 Test Name
Assessment Count for the PSA 52
PSA 04A
Ref Date Owner ID Client ID
09102017 4062308458
Client Name
Test Name
Risk Level
H
Asmt Type
O
Asmt Date
09162017
Assessment Count for the PSA 2
Risk Level H
M
L
Count of Assessments 138
23
21
Total Count of Assessments 182
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APS Repeat Referrals in a Time Range
PSA ALL Owner All Owners
Start Date 01012017 End Date 12312017
Current DOEA CIRTS Cirts SSN if Risk Date Created PSA Owner Abuse No different than DCF DCF SSN Name County Level Date of Birth Date Sent by DCF
Count 0
Unduplicated Client Count by PSA
PSA Count SSN
Total
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Assessed Prioritized Consumer List PSA ALL Provider ALL PROVIDERS Program AC County ALL COUNTIES
County Program Consumer Name Client ID
Total Count 0
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Assessment Due Report PSA 01 Start Date 01012017 End Date 08312018 Owner ALL PROVIDERS Worker ALL WORKERS Program Status ACTV and APCL Assessment Type Needed ALL
Overdue and missing assessments are always listed
Owner ID 1065
Client ID Client Name
Owner Assessor ID
Date of Birth
06281928
CIRTS28099
County of Service
GULF
Worker Name HARPER KENNY
Zip Assessment PSA Date
32534 01 01022014
Type
701A
Active Y
Nutr PriorityScore Score
11 58
Rank
5
Due Date
01022015
Status
701S OVERDUE
LTCC APPL Start Date
03252014 4062235673 Test name
Total Clients for Worker 1
Total Clients for Owner 1
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Assessment Due Report PSA 01 Start Date 01012017 End Date 08312018 Owner ALL PROVIDERS Worker ALL WORKERS Program Status ACTV and APCL Assessment Type Needed ALL
Overdue and missing assessments are always listed
Summary by PSA
PSA 01 701A Overdue 1
701B Overdue 213
701C Overdue 0
701S Overdue 157
No 701A 0
No 701B 2
No 701C 0
No 701S 0
701A Not Overdue 0
701B Not Overdue 0
701C Not Overdue 0
701S Not Overdue 0
701S Optional 0
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CIC Service Units and Costs Projections County SummaryPSA 99 Program CCE
Start Date 01012017 End Date 12312017
County LEON
Total Total Total Avg Max Projected
StateFederal Projected Reimbursement Provider Unduplicated Provider Service Share Service Units Unit Rate Cost Per Unit Client Count
Report Total
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CIC Service Units and Costs Projections Provider SummaryPSA ALL Provider ALL PROVIDERS Program FEDERALLY FUNDED (0101 TO 1231) Year 2017 From 01012017 To 12312017
PSA County Program Service Total State
Federal Share
Total Projected
Service Units
Avg Reimbursement
Unit Rate
Max Provider
Cost Per Unit
Total Projected Unduplicated Client Count
02 FRANKLIN O3C1 CONGREGATE MEALS $810300 1710 15
Program Total
County Total
$810300
$810300
GULF O3C1 CONGREGATE MEALS $25205 3 5
Program Total $25205
O3C2 HOME DELIVERED MEALS $25205 3 6
Program Total
County Total
$25205
$50411
LEON O3C1 CONGREGATE MEALS $621300 1311 15
CONGREGATE MEALS GUEST
CONGREGATE MEALS VOLUNTEERS
$252055
$277260
25
30
2
5
Program Total $1150615
O3C2 HOME DELIVERED MEAL GUEST $252055 25 3
Program Total $252055
OA3D PEARLS (SESSION 5)
PEARLS (SESSION 6)
PEARLS (SESSION 7)
PEARLS (SESSION 8)
$10247
$10247
$10247
$10247
10
10
10
10
3
3
3
3
Program Total $40988
OA3E RESPITE IN-HOME $200 2 2
Program Total
County Total
$200
$1443858
WAKULLA O3C2 EMERGENCY HOME DELIVERED SHELF MEALS
$8065604 14899 90
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CIC Service Units and Costs Projections - PSA Summary
PSA ALL Program CCE
Strat Date 01012017 End Date 12312017
Total
PSA County Provider Service
Total State Federal
Share
Total Projected
Service Units
Avg Reimbursement
Unit Rate
Max Projected Provider Unduplicated
Cost Per Unit Client Count
02 LEON SOUTHERN SERVICE CASE MANAGEMENT PROVIDER EMERGENCY HOME DELIVERED SHELF MEALS
$2175533
$602000
483
689
32
20
HOME DELIVERED MEALS $530262 993 5
MATERIAL AID $1994536 199
Provider Total $5302331
CountyTotal $5302331
WAKULLA SOUTHERN SERVICE CASE MANAGEMENT PROVIDER EMERGENCY HOME DELIVERED SHELF MEALS
$2175533
$1240200
483
689
32
5
MATERIAL AID $1994536 199
Provider Total $5410269
CountyTotal $5410269
PSA Total $10712599
05 PINELLAS BURSTEIN-APPLEBEE ADULT DAY CARE $000 0 $900 $1000 0
COUNSELING (MENTAL HEALTH COUNSELINGSCREENING) - INDIVIDUAL
Provider Total
$000
$000
0 $6600 $7700 0
CountyTotal $000
PSA Total $000
Report Total $10712599
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CID Service Units and Costs Projections - PSA SummaryPSA ALL Program CCE
Start Date 01012017 End Date 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
PSA County Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
02 LEON CASE MANAGEMENT $2175533 483
EMERGENCY HOME $602000 689DELIVERED SHELF MEALS HOME DELIVERED MEALS $530262 993
MATERIAL AID $1994536 199
County Total $5302331 2364
WAKULLA CASE MANAGEMENT $2175533 483
EMERGENCY HOME $1240200 689DELIVERED SHELF MEALS MATERIAL AID $1994536 199
County Total $5410269 1371
PSA Total $10712599 3735
05 PINELLAS ADULT DAY CARE $000 0
COUNSELING (MENTAL $000 0 HEALTH COUNSELINGSCREENING) - INDIVIDUAL
County Total $000 0
PSA Total $000 0
Report Total $10712599 3735
$900 $900 $900 $1000 $1000 $1000
$6600 $6600 $6600 $7700 $7700 $7700
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CID Service Units and Costs Projections County SummaryPSA 99
Program CCE County LEON
Start Date 01012017 End Date 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
Report Total
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CIE Service Units and Costs Projections - PSA Summary - All Programs
PSA 99 Program FEDERALLY FUNDED (0101 TO 1231) Year 2017 From 01012017 To 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
Program Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
Report Total
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CIE Service Units and Costs Projections - PSA Summary
PSA ALL Program CCE
Start Date 01012017 End Date 12312017
Avg High Low Total Total Avg High Low Provider Provider Provider
StateFederal Projected Reimbursement Reimbursement Reimbursement Cost Cost CostPSA
02
Service
CASE MANAGEMENT
Share
$4351066
Service Units
966
Unit Rate Unit Rate Unit Rate Per Unit Per Unit Per Unit
EMERGENCY HOME DELIVERED SHELF MEALS $1842200 1378
HOME DELIVERED MEALS $530262 993
MATERIAL AID $3989071 398
PSA Total $10712599 3735
05 ADULT DAY CARE $000 0 $900 $900 $900 $1000 $1000 $1000
COUNSELING (MENTAL HEALTH $000 0 $6600 $6600 $6600 $7700 $7700 $7700 COUNSELINGSCREENING) - INDIVIDUAL
PSA Total $000 0
Report Total $10712599 3735
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CAREGIVER SEARCH REPORT
SEARCH RESULTS FOR CONSUMERS
Criteria First Name Last Name SSN PSA ALL
Client Name Client SSN Caregiver Name Caregiver SSN
000000000 000000000 Test Name Test Name
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CARES Referrals in a Time Range PSA ALL
Start Date 01012017 End Date 12312017
Referred to ALL REFERRALS
Referring PSA Employee Name Client Name Client ID
Referral Imminent NH Admit Aging Date Risk Date Referred To Cares Provider Name Received Date
03A 4061561263 Test Name Test Name 09242017 Y 05292017 ARC or ADRC 09252017
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CARES Referrals in a Time Range PSA ALL
Start Date 01012017 End Date 12312017
Referred to ALL REFERRALS
Referring PSA Employee Name Client Name Client ID
Referral Date
Imminent Risk
NH Admit Date Referred To Cares Provider Name
Aging Received Date
04B Test Name Test Name 4061738075 04082017 N ARC or ADRC Test Name 04082017
Total Clients 110
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CARES Referrals not acknowledged by the Aging Network PSA ALL For Referrals after 01012017 Owner ID ALL Owners
Unduplicated Client count Cares Office Total Clients Count
Report Total
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
CIRTS Issue PSA Client ID Client Name Program
Program Status Start Provider Enrollment ID Provider Name
APCL CLIENT WITH DATE OF DEATH 08 4061759417 Test Name OA3B APCL 07232013 1141 WESTERN WORLD RADIO
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
Program Start Provider CIRTS Issue PSA Client ID Client Name Program Status Enrollment ID Provider Name
06 LTCC APCL 01242014 1514 4061713685 Test Name APCL CLIENT WITH DATE OF DEATH CENTRAL THE ORIGINAL HOUSE OF PIES
Count 503
Report run on 08312018 0224 PM Page 22 of 22 data_cleanuprdf Report run by RSHQALL Dispose of this report so that it can not be read or reconstructed
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Civil Rights PSA ALL Provider ALL PROVIDERS Program AC Start Date 01012017 End Date 12312017 The Poverty Level for Single is The Poverty Level for Couple is Sort by County
County Unduplicated Count
Report run on 08312018 1055 AM Page 1 of 1 civil_rightsrdf
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Client Information Report Start Date 01012017 End Date 12312017
Client ID 1001141246
Emergency
Client Name Test Name
Telephone () - Address 78 TEST STREET TALLAHASSEE FL 32399
Most Recent Caregiver Information Date Updated
Doctor
Comments
Client Demographic Information
Birth Date 06041940 Race W
Owner ID Ethnicity O
Most Recent Income Information
Ind Mon Inc Cpl Mon Inc
Ind Assets Couple Assets
Most Recent Assessment Information
Asmt Date Ref Risk Lvl
Asmt Site Spec Shel
AsmtType Spec Reg
Ref Date Primary CG
Ref Source Living Sit
Enrollment Information
Sex
Marital Status
F
S
Medicaid Number
ADL Score
ADL Count
IADL Score
IADL Count
Memory Score
Priority Score
Env Score
Nutr Score
Risk Score
Social Score
Rank
Provider Location Program Program Status Worker Start Date End Date
Care Plan Service Needed
Date Service Units Type Frq End Date
Care Plan Service Planned
Program Service Units Type Frq Start Date End Date
Services Received between 01012017 and 12312017
Service Billed Provider Location Worker Program Service Date Units Unit Type Amount
Report run on 08312018 0159 PM Page 1 of 1 client_info_formrdf
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Provider N
Client Service Units Report PSA ALL Provider ALL PROVIDERS Location 0000
Program ALL PROGRAMS Service ALL SERVICES Worker ALL WORKERS
City ALL CITIES Include Zero Unit N Include Aggregate N Calculated Amount equals the number of Units Provided times Fixed Cost if it existsService Start Date 01012017 Service End Date 12312017 If Fixed Cost does not exist Calculated
Group by PSA Provider Location Client Name County Worker Amount equals Billed Amount
Unduplicated Client Count 0 Grand Total 000 $000
Report run on 08312018 0234 PM Page 1 of 1 clnt_serv_unitsrdf
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Clients In Common PSA All Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 County All Counties Worker All Workers
County JEFFERSON
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
MIAMI-DADE
0 0 0 0 0 0 0 0 0
4061539538 Test NameCounty Count
County
0 01
X
0 1
X
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
4061650856 Test Name X 4061486560 Test Name X 4062452921 Test Name X
Report run on 08312018 1148 AM clients_commonrdfPage 1 of 4 Report run by RSHQALL Dispose of this Report so that it can not be read or reconstructed
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Clients Served Not Enrolled PSA ALL Start Date 01012017 End Date 12312017 Locations 0000 Provider All Providers
Service Service Min Serv Max Serv Program Start End Enrollment PSA Provider Location Program Consumer Name Client ID Service Date Date Status Enrollment Enrollment Provider
Count 0
Report run on 08312018 0201 PM Page 1 of 1 clnts_serv_no_enrrdf
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
4061472791 04
09
1092
1291
0072
0042
LTCC
LTCC
APCL
APCL
4062714543 06
06
1514
1762
0072
5006
LTCC
LTCC
APCL
APPL
4061802246 11
06
1177
1514
0179
0072
LTCC
LTCC
APCL
APCL
4061563719 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062644312 06
08
1514
1771
0072
0896
LTCC
LTCC
APCL
APCL
1001141670 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
1001141671 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
4062375003 07
05
05
07
1263
1755
1638
1263
0368
0072
0072
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062155124 06
06
1762
1514
0072
0072
LTCC
LTCC
APPL
APCL
4061743886 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0369
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4061499927 06
06
1514
1762
0072
5005
LTCC
LTCC
APCL
APPL
4061583524 08
06
1144
1514
0896
0072
LTCC
LTCC
APCL
APCL
4062694843 06
03
1514
1922
0072
0179
LTCC
LTCC
APCL
APCL
4062744517 07
06
1263
1514
0369
0072
LTCC
LTCC
APCL
APCL
4062005488 10
11
10
11
1929
1177
1164
1177
0072
0073
0179
0179
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
Report run on 08312018 0200 PM Page 1 of 2 clnts_mult_enrollrdf
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
Total Count 15
Report run on 08312018 0200 PM Page 2 of 2 clnts_mult_enrollrdf
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CODE DESCRIPTIONS Category ALL STATE TABLES
Code Description Active Available To Code Category
0 UNKNOWN Y CARES SUBJECTIVE_HEALTH_EVALUATION
01 ALACHUA Y COMMON COUNTIES
02 BAKER Y COMMON COUNTIES
03 BAY Y COMMON COUNTIES
04 BRADFORD Y COMMON COUNTIES
05 BREVARD Y COMMON COUNTIES
06 BROWARD Y COMMON COUNTIES
07 CALHOUN Y COMMON COUNTIES
08 CHARLOTTE Y COMMON COUNTIES
09 CITRUS Y COMMON COUNTIES
1 EXCELLENT Y CARES SUBJECTIVE_HEALTH_EVALUATION
10 CLAY Y COMMON COUNTIES
11 COLLIER Y COMMON COUNTIES
12 COLUMBIA Y COMMON COUNTIES
13 MIAMI-DADE Y COMMON COUNTIES
14 DESOTO Y COMMON COUNTIES
15 DIXIE Y COMMON COUNTIES
16 DUVAL Y COMMON COUNTIES
17 ESCAMBIA Y COMMON COUNTIES
18 FLAGLER Y COMMON COUNTIES
19 FRANKLIN Y COMMON COUNTIES
2 GOOD Y CARES SUBJECTIVE_HEALTH_EVALUATION
20 GADSDEN Y COMMON COUNTIES
21 GILCHRIST Y COMMON COUNTIES
22 GLADES Y COMMON COUNTIES
23 GULF Y COMMON COUNTIES
24 HAMILTON Y COMMON COUNTIES
25 HARDEE Y COMMON COUNTIES
26 HENDRY Y COMMON COUNTIES
27 HERNANDO Y COMMON COUNTIES
28 HIGHLANDS Y COMMON COUNTIES
Report run on 08312018 0140 PM Page 1 of 45 state_codesrdf Report run by RSHQALL Dispose of this report so that it cannot be read or reconstructed
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CONSUMER AGE VERIFICATION REPORT PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Program AC
Age at Start
Enroll or Start Enroll Provider Program Description Consumer Name Client ID DOB Svc date or Svc Date
Report run on 08312018 0203 PM Page 1 of 1 age_verifyrdf
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Contract Budget Information PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Program Service Provider Location County Served Provider Contract
Projected Service
Units Unit Measure
Projected Unduplicated
State Federal Share Client Count Begin Date End Date
Row Count 0 Amount Total
Report run on 08312018 0233 PM Page 1 of 1 contract_budgetrdf
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Start Enroll Latest Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Date Asmt Date Worker
O3C1 1036 000 4061653427 Test CENTRAL 34982 W M 07091930 09102013 09102013 CIRTS20804 0 Name
Report run on 08312018 1133 AM Page 1 of 6 actv_by_progrdf
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Start Enroll Date
Latest Asmt Date Worker
4061593624 Test Name CENTRAL 34946 B F 11261940 12012011 12312013 CIRTS23407
Count 164
Unduplicated Client Count 163
Report run on 08312018 1133 AM Page 6 of 6 actv_by_progrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Assessments After DOD Report
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Owner 1025
The shaded records indicate clients who have different DOBs andor different names
Assemt Current PSA Owner Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Owner Assessor
Provider Assessor
Assemt Date
Assemt Type
Unduplicated Count Total 0
Report run on 08312018 0206 PM Page 1 of 1 vs_assmrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Open Enrollments
The Vital Statistics Data for 07192002 - 09112014PSA ALL Provider ALL Program Status ACTV Include MLTC ACTVS N
The shaded records indicate clients who have different DOBs andor different names
Enroll PSA
Enrollment Provider Loc Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Enroll Program Status
Enroll Program
Current Owner ID
02 1065 0072 4062244026 Test Name Test Name 10222004 03231917 03231917 ACTV CCE 1065
Count of enrollments for the Provider 1
Count of enrollments for the PSA 1
Count of enrollments for the Report 1
Unduplicated Count of Individuals with open enrollments and DOD PSA Total Clients Count
02 1
Total 1
Report run on 08312018 0205 PM Page 1 of 1 vs_open_enrollrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Report run on 08312018 0207 PM Page 1 of 3 vs_servicesrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Unduplicated count of individuals with Services after DOD
PSA Total Clients Count
Report Total
Report run on 08312018 0207 PM Page 2 of 3 vs_servicesrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
List of Clients with PSA table entry for SERVICES_AFTER_DOD
Unduplicated Count Total 0
Report run on 08312018 0207 PM Page 3 of 3 vs_servicesrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Age
Provider
Total
Age lt 60 Age 60 - 64 Age 65 - 74 Age 75 - 84 Age 85+ Total Clients Avg Age
Total
Avg Age
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 1 of 5 demo_all_prvrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Ethnicity
Provider Hispanic Other Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Race
American Indian Native Hawaiian Other Provider Asian Alaska Native Black Pacific Islander Minority White Multiple Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 3 of 5 demo_all_prvrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Gender
Provider Male Female Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 4 of 5 demo_all_prvrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Monthly Income
Provider 0 - - Higher than Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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None
Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Total Persons Served 0
Age lt 60 Years 0 0
Age 60 - 64 0 0
Age 65 - 74 0 0
Age 75 - 84 0 0
Age 85+ 0 0
Total Age 0 0
Average 000
Ethnicity Hispanic 0 0
Other Ethnicity 0 0
Unknown Ethnicity 0 0
Total 0 0
Race Asian 0 0
American Indian Alaska Native 0 0
Black 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority 0 0
White 0 0
Multiple 0 0
Unknown 0 0
Total 0 0
Sex Male 0 0
Female 0 0
Unknown Sex 0 0
Total 0 0
Monthly Income 0 - 0 0
- 0 0
Higher than 0 0
Unknown 0 0
Total 0 0
Report run on 08312018 1058 AM Page 1 of 2 demo_by_prov_detrdf Report run byRSHQALL Dispose of this report so that it can not be read or reconstructed
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Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Client ID Date Of Birth Ethnicity Race Sex Individual Monthly Income
Report run on 08312018 1058 AM Page 2 of 2 demo_by_prov_detrdf Report run byRSHQALL Dispose of this report so that it can not be read or reconstructed
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Demographics of Clients OAA Registered Served Only PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 City All Cities Program All Programs Service All Services County ALL COUNTIES Table OAA Registered Services Only Low Income Medium Income
Total Persons Served 0
Agelt 60 Years
Age 60 - 64
Age 65 - 74
Age 75 - 84
Age 85+
0
0
0
0
0
0
0
0
0
0
Monthly Income
0 -
-Higher than
Unknown
0
0
0
0
0
0
0
0
Total
Average
0
000
0 Total 0 0
Ethnicity Hispanic
Other
Unknown
0
0
0
0
0
0
Living Situation
Alone
Null
Policy Change
0
0
0
0
0
0
Total 0 0 Unknown
With Caregiver
0
0
0
0
Race Asian 0 0
With Other
With Other Caregiver
0
0
0
0
American Indian Alaska Native
Black
0
0
0
0Total Living Situation 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority
White
0
0
0
0 Limited English Proficiency
Multiple
Unknown
Total Race
0
0
0
0
0
0
Yes
No
Unknown
0
0
0
0
0
0
Total 0 0
Sex Male
Female
Unknown
0
0
0
0
0
0
Total 0 0
Report run on 08312018 1056 AM Page 1 of 1 demo_by_provrdf
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Disaster Assistance Clients for a Provider PSA ALL Provider All Providers Location 0000 Worker All Workers City All Cities Zip Code All Zip Codes Sort By ZIP
Provider 1036 Provider Name Location 0000 Worker CIRTS18634
Need Care Client Name Address City Zip County Phone Asst Reg Situation Relat Care phone Care Name
34946 N WO DA 000 SAINT JAMES DRIVE CENTRAL (025) 101-0620 Test NameTest Name SAINT LUCIE (005) 100-0369 Y
Client is active and no assessment information is available Special Shelter and Special Registry are unknown
Report run on 08312018 1102 AM Page 1 of 8 disaster_by_provrdf
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
Total by PSA 0
Report run on 08312018 1111 AM Page 1 of 5 eheap_exceptionsrdf
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
ALACH BAKER BAY BRADF BREVA BROWA CALHO CHARL CITRUS CLAY COLLIE COLUM DESOT DIXIE DUVAL ESCAM FLAGL FRANK GADSDAssisted Household Report UA ORD RD RD UN OTTE R BIA O BIA ER LIN EN
1 of Household Assisted 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Households AssistedWith Gross Income
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C 100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D 125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
3 Households with at leastOne member
A 60 Years or older 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B Disabled 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C Age 5 years or under 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D Under 60 Years Old 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Undup Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Assisted
Applicant Household Report
of Applicant Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Energy Assisted Household Report
County of Assisted
Households
Households Assisted By Poverty Level
Under 75 75 - 100 101 - 125 126 - 150 Over 150 60 Years or older
At least one member who is
Age 5 years Age 2 years Age 3 years Disabled or younger and younger through 5
Under 60 Years Old
Undup Households
Assisted
Energy Assistance Total
Report run on 08312018 1107 AM Page 1 of 3 eheap_summaryrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Unduplicated Total 0 0
County of Assisted
Households Under 75 75 - 100
Households Assisted By Poverty Level
101 - 125 126 - 150 Over 150 60 Years or older Disabled
Age 5 years or younger
Age 2 years and younger
Age 3 years through 5
Under 60 Years Old
At least one member who is
Undup Households
Assisted
Other Assisted Household Report
Other Assistance Total
Report run on 08312018 1107 AM Page 2 of 3 eheap_summaryrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Applicant Household Report
County of Applicant
Households Under 75 75 - 100 101 - 125 126 - 150 Over 150 Income data
unavailable
Total 0
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01
Enrollment Active Consumer Count by Program PSA ALL Provider ALL PROVIDERS
County Description Program Count of Clients
BREVARD
ADI
CCE
HCE
LSP
NDP
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
MLTC
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
31
57
44
5
62
123
141
26
9
7
5
40
5
50
67
129
2
19
42
29
1
233
79
63
8
2
14
3
37
14
47
3
3
33
127
10
02
03
04
ALACHUA
BAKER
BAY
BRADFORD
Report run on 08312018 1148 AM Page 1 of 18 actv_countrdf
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Enrollment Terminations with Reasons PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 Program All Programs Program Status ALL Program Status Worker ALL WORKERS
Last First Program Medicaid Provider Start End Name Name Client ID Status Description Worker Number Program Location Enrollment Enrollment
Count 0
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Enrollments with Care Plan Report
PSA ALL Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTIVE STATUS Care Plan Service ALL SERVICES Care Plan Start 01012017 Care Plan End 12312017
Care Plan Care Plan Care Plan Client Name
Unduplicated Client Count 0
Client ID Program Status Worker Start Date End Date Service
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PSA CLIENT_ID CLIENT_NAME OWNER PROVIDER_ID ASSESSMENT_DATE ASSESSOR_NAME MEDICAID_NUMBER CAREGIVER_CHANGE ENVIRONMENT_CHANGE HEALTH_CHANGE INCOME_CHANGE SITUATION_CHANGE INITIAL_ASSM ANNUAL_ASSM SSN REFERRAL_SOURCE 1114 N N N N Y N 771771777 SELFFAMILY 812017 JANE CASEWORKER 2 1001141633 TEST TEST N
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Fixed Service Costs List PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Provider Location County Program Service Reimbursement Unit Rate Provider Cost Per Unit Begin Valid End Valid
Count 0
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start End Worker Medicaid Most Recent Enrollment Enrollment Worker Active Number Nutr Score Rank
O3C2 1036 4062615533 Test Name ACTV 10032013 CIRTS20804 Y 6 3
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start Enrollment
End Enrollment Worker
Worker Active
Medicaid Number
Most Recent Nutr Score Rank
O3C2 1036 4062466582 Test Name ACTV 10262010 CIRTS23407 N 105 2
Total for Location 113
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PSA
APCL Clients With No Services ALL Owner All Owners Provider ALL PROVIDERS
Start Date 01012017 End Date 12312017
Includes Clients Receiving Only CM INSC SCAS CA REFE Services
PSA Client ID Client Name Owner Provider Program
Count 0
Unduplicated Clients Count 0
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APCL Clients With Services PSA ALL Owner All Owners Provider ALL PROVIDERS Start Date 01012017 End Date 12312017
Exclude CM CA INSC REFE SCAS
PSA Client ID Name Owner Provider Program 10 4062527553 Test Name 1539 1929 CCE
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APCL Clients With Services PSA ALL Owner All Owners Provider ALL PROVIDERS Start Date 01012017 End Date 12312017
Exclude CM CA INSC REFE SCAS
PSA Client ID Name Owner Provider Program 11 4062732638 Test Name 1177 1177 LTCC
Total 21067
Unduplicated clients count 12460
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APS Assessments PSA ALL Risk Level ALL Owner All Owners Referral Date From 01012017 To 12312017
Order by Referral Date and Owner ID
PSA 03
Ref Date Owner ID Client ID Client Name Risk Level Asmt Type Asmt Date
03032017 1390 4062058415 L 701A 03302018 Test Name
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APS Assessments PSA ALL Risk Level ALL Owner All Owners Referral Date From 01012017 To 12312017
Order by Referral Date and Owner ID
12042017 1980 4061617559 H 701B 12072017 Test Name
Assessment Count for the PSA 52
PSA 04A
Ref Date Owner ID Client ID
09102017 4062308458
Client Name
Test Name
Risk Level
H
Asmt Type
O
Asmt Date
09162017
Assessment Count for the PSA 2
Risk Level H
M
L
Count of Assessments 138
23
21
Total Count of Assessments 182
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APS Repeat Referrals in a Time Range
PSA ALL Owner All Owners
Start Date 01012017 End Date 12312017
Current DOEA CIRTS Cirts SSN if Risk Date Created PSA Owner Abuse No different than DCF DCF SSN Name County Level Date of Birth Date Sent by DCF
Count 0
Unduplicated Client Count by PSA
PSA Count SSN
Total
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Assessed Prioritized Consumer List PSA ALL Provider ALL PROVIDERS Program AC County ALL COUNTIES
County Program Consumer Name Client ID
Total Count 0
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Assessment Due Report PSA 01 Start Date 01012017 End Date 08312018 Owner ALL PROVIDERS Worker ALL WORKERS Program Status ACTV and APCL Assessment Type Needed ALL
Overdue and missing assessments are always listed
Owner ID 1065
Client ID Client Name
Owner Assessor ID
Date of Birth
06281928
CIRTS28099
County of Service
GULF
Worker Name HARPER KENNY
Zip Assessment PSA Date
32534 01 01022014
Type
701A
Active Y
Nutr PriorityScore Score
11 58
Rank
5
Due Date
01022015
Status
701S OVERDUE
LTCC APPL Start Date
03252014 4062235673 Test name
Total Clients for Worker 1
Total Clients for Owner 1
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Assessment Due Report PSA 01 Start Date 01012017 End Date 08312018 Owner ALL PROVIDERS Worker ALL WORKERS Program Status ACTV and APCL Assessment Type Needed ALL
Overdue and missing assessments are always listed
Summary by PSA
PSA 01 701A Overdue 1
701B Overdue 213
701C Overdue 0
701S Overdue 157
No 701A 0
No 701B 2
No 701C 0
No 701S 0
701A Not Overdue 0
701B Not Overdue 0
701C Not Overdue 0
701S Not Overdue 0
701S Optional 0
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CIC Service Units and Costs Projections County SummaryPSA 99 Program CCE
Start Date 01012017 End Date 12312017
County LEON
Total Total Total Avg Max Projected
StateFederal Projected Reimbursement Provider Unduplicated Provider Service Share Service Units Unit Rate Cost Per Unit Client Count
Report Total
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CIC Service Units and Costs Projections Provider SummaryPSA ALL Provider ALL PROVIDERS Program FEDERALLY FUNDED (0101 TO 1231) Year 2017 From 01012017 To 12312017
PSA County Program Service Total State
Federal Share
Total Projected
Service Units
Avg Reimbursement
Unit Rate
Max Provider
Cost Per Unit
Total Projected Unduplicated Client Count
02 FRANKLIN O3C1 CONGREGATE MEALS $810300 1710 15
Program Total
County Total
$810300
$810300
GULF O3C1 CONGREGATE MEALS $25205 3 5
Program Total $25205
O3C2 HOME DELIVERED MEALS $25205 3 6
Program Total
County Total
$25205
$50411
LEON O3C1 CONGREGATE MEALS $621300 1311 15
CONGREGATE MEALS GUEST
CONGREGATE MEALS VOLUNTEERS
$252055
$277260
25
30
2
5
Program Total $1150615
O3C2 HOME DELIVERED MEAL GUEST $252055 25 3
Program Total $252055
OA3D PEARLS (SESSION 5)
PEARLS (SESSION 6)
PEARLS (SESSION 7)
PEARLS (SESSION 8)
$10247
$10247
$10247
$10247
10
10
10
10
3
3
3
3
Program Total $40988
OA3E RESPITE IN-HOME $200 2 2
Program Total
County Total
$200
$1443858
WAKULLA O3C2 EMERGENCY HOME DELIVERED SHELF MEALS
$8065604 14899 90
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CIC Service Units and Costs Projections - PSA Summary
PSA ALL Program CCE
Strat Date 01012017 End Date 12312017
Total
PSA County Provider Service
Total State Federal
Share
Total Projected
Service Units
Avg Reimbursement
Unit Rate
Max Projected Provider Unduplicated
Cost Per Unit Client Count
02 LEON SOUTHERN SERVICE CASE MANAGEMENT PROVIDER EMERGENCY HOME DELIVERED SHELF MEALS
$2175533
$602000
483
689
32
20
HOME DELIVERED MEALS $530262 993 5
MATERIAL AID $1994536 199
Provider Total $5302331
CountyTotal $5302331
WAKULLA SOUTHERN SERVICE CASE MANAGEMENT PROVIDER EMERGENCY HOME DELIVERED SHELF MEALS
$2175533
$1240200
483
689
32
5
MATERIAL AID $1994536 199
Provider Total $5410269
CountyTotal $5410269
PSA Total $10712599
05 PINELLAS BURSTEIN-APPLEBEE ADULT DAY CARE $000 0 $900 $1000 0
COUNSELING (MENTAL HEALTH COUNSELINGSCREENING) - INDIVIDUAL
Provider Total
$000
$000
0 $6600 $7700 0
CountyTotal $000
PSA Total $000
Report Total $10712599
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CID Service Units and Costs Projections - PSA SummaryPSA ALL Program CCE
Start Date 01012017 End Date 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
PSA County Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
02 LEON CASE MANAGEMENT $2175533 483
EMERGENCY HOME $602000 689DELIVERED SHELF MEALS HOME DELIVERED MEALS $530262 993
MATERIAL AID $1994536 199
County Total $5302331 2364
WAKULLA CASE MANAGEMENT $2175533 483
EMERGENCY HOME $1240200 689DELIVERED SHELF MEALS MATERIAL AID $1994536 199
County Total $5410269 1371
PSA Total $10712599 3735
05 PINELLAS ADULT DAY CARE $000 0
COUNSELING (MENTAL $000 0 HEALTH COUNSELINGSCREENING) - INDIVIDUAL
County Total $000 0
PSA Total $000 0
Report Total $10712599 3735
$900 $900 $900 $1000 $1000 $1000
$6600 $6600 $6600 $7700 $7700 $7700
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CID Service Units and Costs Projections County SummaryPSA 99
Program CCE County LEON
Start Date 01012017 End Date 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
Report Total
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CIE Service Units and Costs Projections - PSA Summary - All Programs
PSA 99 Program FEDERALLY FUNDED (0101 TO 1231) Year 2017 From 01012017 To 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
Program Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
Report Total
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CIE Service Units and Costs Projections - PSA Summary
PSA ALL Program CCE
Start Date 01012017 End Date 12312017
Avg High Low Total Total Avg High Low Provider Provider Provider
StateFederal Projected Reimbursement Reimbursement Reimbursement Cost Cost CostPSA
02
Service
CASE MANAGEMENT
Share
$4351066
Service Units
966
Unit Rate Unit Rate Unit Rate Per Unit Per Unit Per Unit
EMERGENCY HOME DELIVERED SHELF MEALS $1842200 1378
HOME DELIVERED MEALS $530262 993
MATERIAL AID $3989071 398
PSA Total $10712599 3735
05 ADULT DAY CARE $000 0 $900 $900 $900 $1000 $1000 $1000
COUNSELING (MENTAL HEALTH $000 0 $6600 $6600 $6600 $7700 $7700 $7700 COUNSELINGSCREENING) - INDIVIDUAL
PSA Total $000 0
Report Total $10712599 3735
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CAREGIVER SEARCH REPORT
SEARCH RESULTS FOR CONSUMERS
Criteria First Name Last Name SSN PSA ALL
Client Name Client SSN Caregiver Name Caregiver SSN
000000000 000000000 Test Name Test Name
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CARES Referrals in a Time Range PSA ALL
Start Date 01012017 End Date 12312017
Referred to ALL REFERRALS
Referring PSA Employee Name Client Name Client ID
Referral Imminent NH Admit Aging Date Risk Date Referred To Cares Provider Name Received Date
03A 4061561263 Test Name Test Name 09242017 Y 05292017 ARC or ADRC 09252017
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CARES Referrals in a Time Range PSA ALL
Start Date 01012017 End Date 12312017
Referred to ALL REFERRALS
Referring PSA Employee Name Client Name Client ID
Referral Date
Imminent Risk
NH Admit Date Referred To Cares Provider Name
Aging Received Date
04B Test Name Test Name 4061738075 04082017 N ARC or ADRC Test Name 04082017
Total Clients 110
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CARES Referrals not acknowledged by the Aging Network PSA ALL For Referrals after 01012017 Owner ID ALL Owners
Unduplicated Client count Cares Office Total Clients Count
Report Total
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
CIRTS Issue PSA Client ID Client Name Program
Program Status Start Provider Enrollment ID Provider Name
APCL CLIENT WITH DATE OF DEATH 08 4061759417 Test Name OA3B APCL 07232013 1141 WESTERN WORLD RADIO
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
Program Start Provider CIRTS Issue PSA Client ID Client Name Program Status Enrollment ID Provider Name
06 LTCC APCL 01242014 1514 4061713685 Test Name APCL CLIENT WITH DATE OF DEATH CENTRAL THE ORIGINAL HOUSE OF PIES
Count 503
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Civil Rights PSA ALL Provider ALL PROVIDERS Program AC Start Date 01012017 End Date 12312017 The Poverty Level for Single is The Poverty Level for Couple is Sort by County
County Unduplicated Count
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Client Information Report Start Date 01012017 End Date 12312017
Client ID 1001141246
Emergency
Client Name Test Name
Telephone () - Address 78 TEST STREET TALLAHASSEE FL 32399
Most Recent Caregiver Information Date Updated
Doctor
Comments
Client Demographic Information
Birth Date 06041940 Race W
Owner ID Ethnicity O
Most Recent Income Information
Ind Mon Inc Cpl Mon Inc
Ind Assets Couple Assets
Most Recent Assessment Information
Asmt Date Ref Risk Lvl
Asmt Site Spec Shel
AsmtType Spec Reg
Ref Date Primary CG
Ref Source Living Sit
Enrollment Information
Sex
Marital Status
F
S
Medicaid Number
ADL Score
ADL Count
IADL Score
IADL Count
Memory Score
Priority Score
Env Score
Nutr Score
Risk Score
Social Score
Rank
Provider Location Program Program Status Worker Start Date End Date
Care Plan Service Needed
Date Service Units Type Frq End Date
Care Plan Service Planned
Program Service Units Type Frq Start Date End Date
Services Received between 01012017 and 12312017
Service Billed Provider Location Worker Program Service Date Units Unit Type Amount
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Provider N
Client Service Units Report PSA ALL Provider ALL PROVIDERS Location 0000
Program ALL PROGRAMS Service ALL SERVICES Worker ALL WORKERS
City ALL CITIES Include Zero Unit N Include Aggregate N Calculated Amount equals the number of Units Provided times Fixed Cost if it existsService Start Date 01012017 Service End Date 12312017 If Fixed Cost does not exist Calculated
Group by PSA Provider Location Client Name County Worker Amount equals Billed Amount
Unduplicated Client Count 0 Grand Total 000 $000
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Clients In Common PSA All Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 County All Counties Worker All Workers
County JEFFERSON
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
MIAMI-DADE
0 0 0 0 0 0 0 0 0
4061539538 Test NameCounty Count
County
0 01
X
0 1
X
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
4061650856 Test Name X 4061486560 Test Name X 4062452921 Test Name X
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Clients Served Not Enrolled PSA ALL Start Date 01012017 End Date 12312017 Locations 0000 Provider All Providers
Service Service Min Serv Max Serv Program Start End Enrollment PSA Provider Location Program Consumer Name Client ID Service Date Date Status Enrollment Enrollment Provider
Count 0
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
4061472791 04
09
1092
1291
0072
0042
LTCC
LTCC
APCL
APCL
4062714543 06
06
1514
1762
0072
5006
LTCC
LTCC
APCL
APPL
4061802246 11
06
1177
1514
0179
0072
LTCC
LTCC
APCL
APCL
4061563719 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062644312 06
08
1514
1771
0072
0896
LTCC
LTCC
APCL
APCL
1001141670 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
1001141671 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
4062375003 07
05
05
07
1263
1755
1638
1263
0368
0072
0072
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062155124 06
06
1762
1514
0072
0072
LTCC
LTCC
APPL
APCL
4061743886 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0369
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4061499927 06
06
1514
1762
0072
5005
LTCC
LTCC
APCL
APPL
4061583524 08
06
1144
1514
0896
0072
LTCC
LTCC
APCL
APCL
4062694843 06
03
1514
1922
0072
0179
LTCC
LTCC
APCL
APCL
4062744517 07
06
1263
1514
0369
0072
LTCC
LTCC
APCL
APCL
4062005488 10
11
10
11
1929
1177
1164
1177
0072
0073
0179
0179
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
Total Count 15
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CODE DESCRIPTIONS Category ALL STATE TABLES
Code Description Active Available To Code Category
0 UNKNOWN Y CARES SUBJECTIVE_HEALTH_EVALUATION
01 ALACHUA Y COMMON COUNTIES
02 BAKER Y COMMON COUNTIES
03 BAY Y COMMON COUNTIES
04 BRADFORD Y COMMON COUNTIES
05 BREVARD Y COMMON COUNTIES
06 BROWARD Y COMMON COUNTIES
07 CALHOUN Y COMMON COUNTIES
08 CHARLOTTE Y COMMON COUNTIES
09 CITRUS Y COMMON COUNTIES
1 EXCELLENT Y CARES SUBJECTIVE_HEALTH_EVALUATION
10 CLAY Y COMMON COUNTIES
11 COLLIER Y COMMON COUNTIES
12 COLUMBIA Y COMMON COUNTIES
13 MIAMI-DADE Y COMMON COUNTIES
14 DESOTO Y COMMON COUNTIES
15 DIXIE Y COMMON COUNTIES
16 DUVAL Y COMMON COUNTIES
17 ESCAMBIA Y COMMON COUNTIES
18 FLAGLER Y COMMON COUNTIES
19 FRANKLIN Y COMMON COUNTIES
2 GOOD Y CARES SUBJECTIVE_HEALTH_EVALUATION
20 GADSDEN Y COMMON COUNTIES
21 GILCHRIST Y COMMON COUNTIES
22 GLADES Y COMMON COUNTIES
23 GULF Y COMMON COUNTIES
24 HAMILTON Y COMMON COUNTIES
25 HARDEE Y COMMON COUNTIES
26 HENDRY Y COMMON COUNTIES
27 HERNANDO Y COMMON COUNTIES
28 HIGHLANDS Y COMMON COUNTIES
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CONSUMER AGE VERIFICATION REPORT PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Program AC
Age at Start
Enroll or Start Enroll Provider Program Description Consumer Name Client ID DOB Svc date or Svc Date
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Contract Budget Information PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Program Service Provider Location County Served Provider Contract
Projected Service
Units Unit Measure
Projected Unduplicated
State Federal Share Client Count Begin Date End Date
Row Count 0 Amount Total
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Start Enroll Latest Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Date Asmt Date Worker
O3C1 1036 000 4061653427 Test CENTRAL 34982 W M 07091930 09102013 09102013 CIRTS20804 0 Name
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Start Enroll Date
Latest Asmt Date Worker
4061593624 Test Name CENTRAL 34946 B F 11261940 12012011 12312013 CIRTS23407
Count 164
Unduplicated Client Count 163
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Assessments After DOD Report
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Owner 1025
The shaded records indicate clients who have different DOBs andor different names
Assemt Current PSA Owner Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Owner Assessor
Provider Assessor
Assemt Date
Assemt Type
Unduplicated Count Total 0
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Open Enrollments
The Vital Statistics Data for 07192002 - 09112014PSA ALL Provider ALL Program Status ACTV Include MLTC ACTVS N
The shaded records indicate clients who have different DOBs andor different names
Enroll PSA
Enrollment Provider Loc Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Enroll Program Status
Enroll Program
Current Owner ID
02 1065 0072 4062244026 Test Name Test Name 10222004 03231917 03231917 ACTV CCE 1065
Count of enrollments for the Provider 1
Count of enrollments for the PSA 1
Count of enrollments for the Report 1
Unduplicated Count of Individuals with open enrollments and DOD PSA Total Clients Count
02 1
Total 1
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Unduplicated count of individuals with Services after DOD
PSA Total Clients Count
Report Total
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
List of Clients with PSA table entry for SERVICES_AFTER_DOD
Unduplicated Count Total 0
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Age
Provider
Total
Age lt 60 Age 60 - 64 Age 65 - 74 Age 75 - 84 Age 85+ Total Clients Avg Age
Total
Avg Age
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Ethnicity
Provider Hispanic Other Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Race
American Indian Native Hawaiian Other Provider Asian Alaska Native Black Pacific Islander Minority White Multiple Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Gender
Provider Male Female Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Monthly Income
Provider 0 - - Higher than Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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None
Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Total Persons Served 0
Age lt 60 Years 0 0
Age 60 - 64 0 0
Age 65 - 74 0 0
Age 75 - 84 0 0
Age 85+ 0 0
Total Age 0 0
Average 000
Ethnicity Hispanic 0 0
Other Ethnicity 0 0
Unknown Ethnicity 0 0
Total 0 0
Race Asian 0 0
American Indian Alaska Native 0 0
Black 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority 0 0
White 0 0
Multiple 0 0
Unknown 0 0
Total 0 0
Sex Male 0 0
Female 0 0
Unknown Sex 0 0
Total 0 0
Monthly Income 0 - 0 0
- 0 0
Higher than 0 0
Unknown 0 0
Total 0 0
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Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Client ID Date Of Birth Ethnicity Race Sex Individual Monthly Income
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Demographics of Clients OAA Registered Served Only PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 City All Cities Program All Programs Service All Services County ALL COUNTIES Table OAA Registered Services Only Low Income Medium Income
Total Persons Served 0
Agelt 60 Years
Age 60 - 64
Age 65 - 74
Age 75 - 84
Age 85+
0
0
0
0
0
0
0
0
0
0
Monthly Income
0 -
-Higher than
Unknown
0
0
0
0
0
0
0
0
Total
Average
0
000
0 Total 0 0
Ethnicity Hispanic
Other
Unknown
0
0
0
0
0
0
Living Situation
Alone
Null
Policy Change
0
0
0
0
0
0
Total 0 0 Unknown
With Caregiver
0
0
0
0
Race Asian 0 0
With Other
With Other Caregiver
0
0
0
0
American Indian Alaska Native
Black
0
0
0
0Total Living Situation 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority
White
0
0
0
0 Limited English Proficiency
Multiple
Unknown
Total Race
0
0
0
0
0
0
Yes
No
Unknown
0
0
0
0
0
0
Total 0 0
Sex Male
Female
Unknown
0
0
0
0
0
0
Total 0 0
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Disaster Assistance Clients for a Provider PSA ALL Provider All Providers Location 0000 Worker All Workers City All Cities Zip Code All Zip Codes Sort By ZIP
Provider 1036 Provider Name Location 0000 Worker CIRTS18634
Need Care Client Name Address City Zip County Phone Asst Reg Situation Relat Care phone Care Name
34946 N WO DA 000 SAINT JAMES DRIVE CENTRAL (025) 101-0620 Test NameTest Name SAINT LUCIE (005) 100-0369 Y
Client is active and no assessment information is available Special Shelter and Special Registry are unknown
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
Total by PSA 0
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
ALACH BAKER BAY BRADF BREVA BROWA CALHO CHARL CITRUS CLAY COLLIE COLUM DESOT DIXIE DUVAL ESCAM FLAGL FRANK GADSDAssisted Household Report UA ORD RD RD UN OTTE R BIA O BIA ER LIN EN
1 of Household Assisted 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Households AssistedWith Gross Income
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C 100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D 125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
3 Households with at leastOne member
A 60 Years or older 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B Disabled 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C Age 5 years or under 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D Under 60 Years Old 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Undup Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Assisted
Applicant Household Report
of Applicant Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Energy Assisted Household Report
County of Assisted
Households
Households Assisted By Poverty Level
Under 75 75 - 100 101 - 125 126 - 150 Over 150 60 Years or older
At least one member who is
Age 5 years Age 2 years Age 3 years Disabled or younger and younger through 5
Under 60 Years Old
Undup Households
Assisted
Energy Assistance Total
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Unduplicated Total 0 0
County of Assisted
Households Under 75 75 - 100
Households Assisted By Poverty Level
101 - 125 126 - 150 Over 150 60 Years or older Disabled
Age 5 years or younger
Age 2 years and younger
Age 3 years through 5
Under 60 Years Old
At least one member who is
Undup Households
Assisted
Other Assisted Household Report
Other Assistance Total
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Applicant Household Report
County of Applicant
Households Under 75 75 - 100 101 - 125 126 - 150 Over 150 Income data
unavailable
Total 0
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01
Enrollment Active Consumer Count by Program PSA ALL Provider ALL PROVIDERS
County Description Program Count of Clients
BREVARD
ADI
CCE
HCE
LSP
NDP
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
MLTC
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
31
57
44
5
62
123
141
26
9
7
5
40
5
50
67
129
2
19
42
29
1
233
79
63
8
2
14
3
37
14
47
3
3
33
127
10
02
03
04
ALACHUA
BAKER
BAY
BRADFORD
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Enrollment Terminations with Reasons PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 Program All Programs Program Status ALL Program Status Worker ALL WORKERS
Last First Program Medicaid Provider Start End Name Name Client ID Status Description Worker Number Program Location Enrollment Enrollment
Count 0
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Enrollments with Care Plan Report
PSA ALL Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTIVE STATUS Care Plan Service ALL SERVICES Care Plan Start 01012017 Care Plan End 12312017
Care Plan Care Plan Care Plan Client Name
Unduplicated Client Count 0
Client ID Program Status Worker Start Date End Date Service
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PSA CLIENT_ID CLIENT_NAME OWNER PROVIDER_ID ASSESSMENT_DATE ASSESSOR_NAME MEDICAID_NUMBER CAREGIVER_CHANGE ENVIRONMENT_CHANGE HEALTH_CHANGE INCOME_CHANGE SITUATION_CHANGE INITIAL_ASSM ANNUAL_ASSM SSN REFERRAL_SOURCE 1114 N N N N Y N 771771777 SELFFAMILY 812017 JANE CASEWORKER 2 1001141633 TEST TEST N
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Fixed Service Costs List PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Provider Location County Program Service Reimbursement Unit Rate Provider Cost Per Unit Begin Valid End Valid
Count 0
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All Enrollments For a Date Range PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTV
Group by Program Provider Location SSN or Client ID
Program Provider Location Client ID Client Name Program Status
Start Enrollment
End Enrollment Worker
Worker Active
Medicaid Number
Most Recent Nutr Score Rank
O3C2 1036 4062466582 Test Name ACTV 10262010 CIRTS23407 N 105 2
Total for Location 113
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PSA
APCL Clients With No Services ALL Owner All Owners Provider ALL PROVIDERS
Start Date 01012017 End Date 12312017
Includes Clients Receiving Only CM INSC SCAS CA REFE Services
PSA Client ID Client Name Owner Provider Program
Count 0
Unduplicated Clients Count 0
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APCL Clients With Services PSA ALL Owner All Owners Provider ALL PROVIDERS Start Date 01012017 End Date 12312017
Exclude CM CA INSC REFE SCAS
PSA Client ID Name Owner Provider Program 10 4062527553 Test Name 1539 1929 CCE
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APCL Clients With Services PSA ALL Owner All Owners Provider ALL PROVIDERS Start Date 01012017 End Date 12312017
Exclude CM CA INSC REFE SCAS
PSA Client ID Name Owner Provider Program 11 4062732638 Test Name 1177 1177 LTCC
Total 21067
Unduplicated clients count 12460
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APS Assessments PSA ALL Risk Level ALL Owner All Owners Referral Date From 01012017 To 12312017
Order by Referral Date and Owner ID
PSA 03
Ref Date Owner ID Client ID Client Name Risk Level Asmt Type Asmt Date
03032017 1390 4062058415 L 701A 03302018 Test Name
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APS Assessments PSA ALL Risk Level ALL Owner All Owners Referral Date From 01012017 To 12312017
Order by Referral Date and Owner ID
12042017 1980 4061617559 H 701B 12072017 Test Name
Assessment Count for the PSA 52
PSA 04A
Ref Date Owner ID Client ID
09102017 4062308458
Client Name
Test Name
Risk Level
H
Asmt Type
O
Asmt Date
09162017
Assessment Count for the PSA 2
Risk Level H
M
L
Count of Assessments 138
23
21
Total Count of Assessments 182
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APS Repeat Referrals in a Time Range
PSA ALL Owner All Owners
Start Date 01012017 End Date 12312017
Current DOEA CIRTS Cirts SSN if Risk Date Created PSA Owner Abuse No different than DCF DCF SSN Name County Level Date of Birth Date Sent by DCF
Count 0
Unduplicated Client Count by PSA
PSA Count SSN
Total
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Assessed Prioritized Consumer List PSA ALL Provider ALL PROVIDERS Program AC County ALL COUNTIES
County Program Consumer Name Client ID
Total Count 0
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Assessment Due Report PSA 01 Start Date 01012017 End Date 08312018 Owner ALL PROVIDERS Worker ALL WORKERS Program Status ACTV and APCL Assessment Type Needed ALL
Overdue and missing assessments are always listed
Owner ID 1065
Client ID Client Name
Owner Assessor ID
Date of Birth
06281928
CIRTS28099
County of Service
GULF
Worker Name HARPER KENNY
Zip Assessment PSA Date
32534 01 01022014
Type
701A
Active Y
Nutr PriorityScore Score
11 58
Rank
5
Due Date
01022015
Status
701S OVERDUE
LTCC APPL Start Date
03252014 4062235673 Test name
Total Clients for Worker 1
Total Clients for Owner 1
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Assessment Due Report PSA 01 Start Date 01012017 End Date 08312018 Owner ALL PROVIDERS Worker ALL WORKERS Program Status ACTV and APCL Assessment Type Needed ALL
Overdue and missing assessments are always listed
Summary by PSA
PSA 01 701A Overdue 1
701B Overdue 213
701C Overdue 0
701S Overdue 157
No 701A 0
No 701B 2
No 701C 0
No 701S 0
701A Not Overdue 0
701B Not Overdue 0
701C Not Overdue 0
701S Not Overdue 0
701S Optional 0
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CIC Service Units and Costs Projections County SummaryPSA 99 Program CCE
Start Date 01012017 End Date 12312017
County LEON
Total Total Total Avg Max Projected
StateFederal Projected Reimbursement Provider Unduplicated Provider Service Share Service Units Unit Rate Cost Per Unit Client Count
Report Total
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CIC Service Units and Costs Projections Provider SummaryPSA ALL Provider ALL PROVIDERS Program FEDERALLY FUNDED (0101 TO 1231) Year 2017 From 01012017 To 12312017
PSA County Program Service Total State
Federal Share
Total Projected
Service Units
Avg Reimbursement
Unit Rate
Max Provider
Cost Per Unit
Total Projected Unduplicated Client Count
02 FRANKLIN O3C1 CONGREGATE MEALS $810300 1710 15
Program Total
County Total
$810300
$810300
GULF O3C1 CONGREGATE MEALS $25205 3 5
Program Total $25205
O3C2 HOME DELIVERED MEALS $25205 3 6
Program Total
County Total
$25205
$50411
LEON O3C1 CONGREGATE MEALS $621300 1311 15
CONGREGATE MEALS GUEST
CONGREGATE MEALS VOLUNTEERS
$252055
$277260
25
30
2
5
Program Total $1150615
O3C2 HOME DELIVERED MEAL GUEST $252055 25 3
Program Total $252055
OA3D PEARLS (SESSION 5)
PEARLS (SESSION 6)
PEARLS (SESSION 7)
PEARLS (SESSION 8)
$10247
$10247
$10247
$10247
10
10
10
10
3
3
3
3
Program Total $40988
OA3E RESPITE IN-HOME $200 2 2
Program Total
County Total
$200
$1443858
WAKULLA O3C2 EMERGENCY HOME DELIVERED SHELF MEALS
$8065604 14899 90
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CIC Service Units and Costs Projections - PSA Summary
PSA ALL Program CCE
Strat Date 01012017 End Date 12312017
Total
PSA County Provider Service
Total State Federal
Share
Total Projected
Service Units
Avg Reimbursement
Unit Rate
Max Projected Provider Unduplicated
Cost Per Unit Client Count
02 LEON SOUTHERN SERVICE CASE MANAGEMENT PROVIDER EMERGENCY HOME DELIVERED SHELF MEALS
$2175533
$602000
483
689
32
20
HOME DELIVERED MEALS $530262 993 5
MATERIAL AID $1994536 199
Provider Total $5302331
CountyTotal $5302331
WAKULLA SOUTHERN SERVICE CASE MANAGEMENT PROVIDER EMERGENCY HOME DELIVERED SHELF MEALS
$2175533
$1240200
483
689
32
5
MATERIAL AID $1994536 199
Provider Total $5410269
CountyTotal $5410269
PSA Total $10712599
05 PINELLAS BURSTEIN-APPLEBEE ADULT DAY CARE $000 0 $900 $1000 0
COUNSELING (MENTAL HEALTH COUNSELINGSCREENING) - INDIVIDUAL
Provider Total
$000
$000
0 $6600 $7700 0
CountyTotal $000
PSA Total $000
Report Total $10712599
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CID Service Units and Costs Projections - PSA SummaryPSA ALL Program CCE
Start Date 01012017 End Date 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
PSA County Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
02 LEON CASE MANAGEMENT $2175533 483
EMERGENCY HOME $602000 689DELIVERED SHELF MEALS HOME DELIVERED MEALS $530262 993
MATERIAL AID $1994536 199
County Total $5302331 2364
WAKULLA CASE MANAGEMENT $2175533 483
EMERGENCY HOME $1240200 689DELIVERED SHELF MEALS MATERIAL AID $1994536 199
County Total $5410269 1371
PSA Total $10712599 3735
05 PINELLAS ADULT DAY CARE $000 0
COUNSELING (MENTAL $000 0 HEALTH COUNSELINGSCREENING) - INDIVIDUAL
County Total $000 0
PSA Total $000 0
Report Total $10712599 3735
$900 $900 $900 $1000 $1000 $1000
$6600 $6600 $6600 $7700 $7700 $7700
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CID Service Units and Costs Projections County SummaryPSA 99
Program CCE County LEON
Start Date 01012017 End Date 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
Report Total
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CIE Service Units and Costs Projections - PSA Summary - All Programs
PSA 99 Program FEDERALLY FUNDED (0101 TO 1231) Year 2017 From 01012017 To 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
Program Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
Report Total
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CIE Service Units and Costs Projections - PSA Summary
PSA ALL Program CCE
Start Date 01012017 End Date 12312017
Avg High Low Total Total Avg High Low Provider Provider Provider
StateFederal Projected Reimbursement Reimbursement Reimbursement Cost Cost CostPSA
02
Service
CASE MANAGEMENT
Share
$4351066
Service Units
966
Unit Rate Unit Rate Unit Rate Per Unit Per Unit Per Unit
EMERGENCY HOME DELIVERED SHELF MEALS $1842200 1378
HOME DELIVERED MEALS $530262 993
MATERIAL AID $3989071 398
PSA Total $10712599 3735
05 ADULT DAY CARE $000 0 $900 $900 $900 $1000 $1000 $1000
COUNSELING (MENTAL HEALTH $000 0 $6600 $6600 $6600 $7700 $7700 $7700 COUNSELINGSCREENING) - INDIVIDUAL
PSA Total $000 0
Report Total $10712599 3735
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CAREGIVER SEARCH REPORT
SEARCH RESULTS FOR CONSUMERS
Criteria First Name Last Name SSN PSA ALL
Client Name Client SSN Caregiver Name Caregiver SSN
000000000 000000000 Test Name Test Name
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CARES Referrals in a Time Range PSA ALL
Start Date 01012017 End Date 12312017
Referred to ALL REFERRALS
Referring PSA Employee Name Client Name Client ID
Referral Imminent NH Admit Aging Date Risk Date Referred To Cares Provider Name Received Date
03A 4061561263 Test Name Test Name 09242017 Y 05292017 ARC or ADRC 09252017
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CARES Referrals in a Time Range PSA ALL
Start Date 01012017 End Date 12312017
Referred to ALL REFERRALS
Referring PSA Employee Name Client Name Client ID
Referral Date
Imminent Risk
NH Admit Date Referred To Cares Provider Name
Aging Received Date
04B Test Name Test Name 4061738075 04082017 N ARC or ADRC Test Name 04082017
Total Clients 110
Report run on 08312018 0139 PM Page 5 of 5 cares_referralsrdf
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CARES Referrals not acknowledged by the Aging Network PSA ALL For Referrals after 01012017 Owner ID ALL Owners
Unduplicated Client count Cares Office Total Clients Count
Report Total
Report run on 08312018 0158 PM Page 1 of 1 cares_not_ackrdf
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
CIRTS Issue PSA Client ID Client Name Program
Program Status Start Provider Enrollment ID Provider Name
APCL CLIENT WITH DATE OF DEATH 08 4061759417 Test Name OA3B APCL 07232013 1141 WESTERN WORLD RADIO
Report run on 08312018 0224 PM
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
Program Start Provider CIRTS Issue PSA Client ID Client Name Program Status Enrollment ID Provider Name
06 LTCC APCL 01242014 1514 4061713685 Test Name APCL CLIENT WITH DATE OF DEATH CENTRAL THE ORIGINAL HOUSE OF PIES
Count 503
Report run on 08312018 0224 PM Page 22 of 22 data_cleanuprdf Report run by RSHQALL Dispose of this report so that it can not be read or reconstructed
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Civil Rights PSA ALL Provider ALL PROVIDERS Program AC Start Date 01012017 End Date 12312017 The Poverty Level for Single is The Poverty Level for Couple is Sort by County
County Unduplicated Count
Report run on 08312018 1055 AM Page 1 of 1 civil_rightsrdf
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Client Information Report Start Date 01012017 End Date 12312017
Client ID 1001141246
Emergency
Client Name Test Name
Telephone () - Address 78 TEST STREET TALLAHASSEE FL 32399
Most Recent Caregiver Information Date Updated
Doctor
Comments
Client Demographic Information
Birth Date 06041940 Race W
Owner ID Ethnicity O
Most Recent Income Information
Ind Mon Inc Cpl Mon Inc
Ind Assets Couple Assets
Most Recent Assessment Information
Asmt Date Ref Risk Lvl
Asmt Site Spec Shel
AsmtType Spec Reg
Ref Date Primary CG
Ref Source Living Sit
Enrollment Information
Sex
Marital Status
F
S
Medicaid Number
ADL Score
ADL Count
IADL Score
IADL Count
Memory Score
Priority Score
Env Score
Nutr Score
Risk Score
Social Score
Rank
Provider Location Program Program Status Worker Start Date End Date
Care Plan Service Needed
Date Service Units Type Frq End Date
Care Plan Service Planned
Program Service Units Type Frq Start Date End Date
Services Received between 01012017 and 12312017
Service Billed Provider Location Worker Program Service Date Units Unit Type Amount
Report run on 08312018 0159 PM Page 1 of 1 client_info_formrdf
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Provider N
Client Service Units Report PSA ALL Provider ALL PROVIDERS Location 0000
Program ALL PROGRAMS Service ALL SERVICES Worker ALL WORKERS
City ALL CITIES Include Zero Unit N Include Aggregate N Calculated Amount equals the number of Units Provided times Fixed Cost if it existsService Start Date 01012017 Service End Date 12312017 If Fixed Cost does not exist Calculated
Group by PSA Provider Location Client Name County Worker Amount equals Billed Amount
Unduplicated Client Count 0 Grand Total 000 $000
Report run on 08312018 0234 PM Page 1 of 1 clnt_serv_unitsrdf
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Clients In Common PSA All Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 County All Counties Worker All Workers
County JEFFERSON
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
MIAMI-DADE
0 0 0 0 0 0 0 0 0
4061539538 Test NameCounty Count
County
0 01
X
0 1
X
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
4061650856 Test Name X 4061486560 Test Name X 4062452921 Test Name X
Report run on 08312018 1148 AM clients_commonrdfPage 1 of 4 Report run by RSHQALL Dispose of this Report so that it can not be read or reconstructed
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Clients Served Not Enrolled PSA ALL Start Date 01012017 End Date 12312017 Locations 0000 Provider All Providers
Service Service Min Serv Max Serv Program Start End Enrollment PSA Provider Location Program Consumer Name Client ID Service Date Date Status Enrollment Enrollment Provider
Count 0
Report run on 08312018 0201 PM Page 1 of 1 clnts_serv_no_enrrdf
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
4061472791 04
09
1092
1291
0072
0042
LTCC
LTCC
APCL
APCL
4062714543 06
06
1514
1762
0072
5006
LTCC
LTCC
APCL
APPL
4061802246 11
06
1177
1514
0179
0072
LTCC
LTCC
APCL
APCL
4061563719 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062644312 06
08
1514
1771
0072
0896
LTCC
LTCC
APCL
APCL
1001141670 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
1001141671 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
4062375003 07
05
05
07
1263
1755
1638
1263
0368
0072
0072
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062155124 06
06
1762
1514
0072
0072
LTCC
LTCC
APPL
APCL
4061743886 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0369
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4061499927 06
06
1514
1762
0072
5005
LTCC
LTCC
APCL
APPL
4061583524 08
06
1144
1514
0896
0072
LTCC
LTCC
APCL
APCL
4062694843 06
03
1514
1922
0072
0179
LTCC
LTCC
APCL
APCL
4062744517 07
06
1263
1514
0369
0072
LTCC
LTCC
APCL
APCL
4062005488 10
11
10
11
1929
1177
1164
1177
0072
0073
0179
0179
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
Report run on 08312018 0200 PM Page 1 of 2 clnts_mult_enrollrdf
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
Total Count 15
Report run on 08312018 0200 PM Page 2 of 2 clnts_mult_enrollrdf
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CODE DESCRIPTIONS Category ALL STATE TABLES
Code Description Active Available To Code Category
0 UNKNOWN Y CARES SUBJECTIVE_HEALTH_EVALUATION
01 ALACHUA Y COMMON COUNTIES
02 BAKER Y COMMON COUNTIES
03 BAY Y COMMON COUNTIES
04 BRADFORD Y COMMON COUNTIES
05 BREVARD Y COMMON COUNTIES
06 BROWARD Y COMMON COUNTIES
07 CALHOUN Y COMMON COUNTIES
08 CHARLOTTE Y COMMON COUNTIES
09 CITRUS Y COMMON COUNTIES
1 EXCELLENT Y CARES SUBJECTIVE_HEALTH_EVALUATION
10 CLAY Y COMMON COUNTIES
11 COLLIER Y COMMON COUNTIES
12 COLUMBIA Y COMMON COUNTIES
13 MIAMI-DADE Y COMMON COUNTIES
14 DESOTO Y COMMON COUNTIES
15 DIXIE Y COMMON COUNTIES
16 DUVAL Y COMMON COUNTIES
17 ESCAMBIA Y COMMON COUNTIES
18 FLAGLER Y COMMON COUNTIES
19 FRANKLIN Y COMMON COUNTIES
2 GOOD Y CARES SUBJECTIVE_HEALTH_EVALUATION
20 GADSDEN Y COMMON COUNTIES
21 GILCHRIST Y COMMON COUNTIES
22 GLADES Y COMMON COUNTIES
23 GULF Y COMMON COUNTIES
24 HAMILTON Y COMMON COUNTIES
25 HARDEE Y COMMON COUNTIES
26 HENDRY Y COMMON COUNTIES
27 HERNANDO Y COMMON COUNTIES
28 HIGHLANDS Y COMMON COUNTIES
Report run on 08312018 0140 PM Page 1 of 45 state_codesrdf Report run by RSHQALL Dispose of this report so that it cannot be read or reconstructed
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CONSUMER AGE VERIFICATION REPORT PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Program AC
Age at Start
Enroll or Start Enroll Provider Program Description Consumer Name Client ID DOB Svc date or Svc Date
Report run on 08312018 0203 PM Page 1 of 1 age_verifyrdf
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Contract Budget Information PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Program Service Provider Location County Served Provider Contract
Projected Service
Units Unit Measure
Projected Unduplicated
State Federal Share Client Count Begin Date End Date
Row Count 0 Amount Total
Report run on 08312018 0233 PM Page 1 of 1 contract_budgetrdf
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Start Enroll Latest Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Date Asmt Date Worker
O3C1 1036 000 4061653427 Test CENTRAL 34982 W M 07091930 09102013 09102013 CIRTS20804 0 Name
Report run on 08312018 1133 AM Page 1 of 6 actv_by_progrdf
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Start Enroll Date
Latest Asmt Date Worker
4061593624 Test Name CENTRAL 34946 B F 11261940 12012011 12312013 CIRTS23407
Count 164
Unduplicated Client Count 163
Report run on 08312018 1133 AM Page 6 of 6 actv_by_progrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Assessments After DOD Report
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Owner 1025
The shaded records indicate clients who have different DOBs andor different names
Assemt Current PSA Owner Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Owner Assessor
Provider Assessor
Assemt Date
Assemt Type
Unduplicated Count Total 0
Report run on 08312018 0206 PM Page 1 of 1 vs_assmrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Open Enrollments
The Vital Statistics Data for 07192002 - 09112014PSA ALL Provider ALL Program Status ACTV Include MLTC ACTVS N
The shaded records indicate clients who have different DOBs andor different names
Enroll PSA
Enrollment Provider Loc Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Enroll Program Status
Enroll Program
Current Owner ID
02 1065 0072 4062244026 Test Name Test Name 10222004 03231917 03231917 ACTV CCE 1065
Count of enrollments for the Provider 1
Count of enrollments for the PSA 1
Count of enrollments for the Report 1
Unduplicated Count of Individuals with open enrollments and DOD PSA Total Clients Count
02 1
Total 1
Report run on 08312018 0205 PM Page 1 of 1 vs_open_enrollrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Report run on 08312018 0207 PM Page 1 of 3 vs_servicesrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Unduplicated count of individuals with Services after DOD
PSA Total Clients Count
Report Total
Report run on 08312018 0207 PM Page 2 of 3 vs_servicesrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
List of Clients with PSA table entry for SERVICES_AFTER_DOD
Unduplicated Count Total 0
Report run on 08312018 0207 PM Page 3 of 3 vs_servicesrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Age
Provider
Total
Age lt 60 Age 60 - 64 Age 65 - 74 Age 75 - 84 Age 85+ Total Clients Avg Age
Total
Avg Age
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 1 of 5 demo_all_prvrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Ethnicity
Provider Hispanic Other Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Race
American Indian Native Hawaiian Other Provider Asian Alaska Native Black Pacific Islander Minority White Multiple Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Gender
Provider Male Female Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 4 of 5 demo_all_prvrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Monthly Income
Provider 0 - - Higher than Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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None
Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Total Persons Served 0
Age lt 60 Years 0 0
Age 60 - 64 0 0
Age 65 - 74 0 0
Age 75 - 84 0 0
Age 85+ 0 0
Total Age 0 0
Average 000
Ethnicity Hispanic 0 0
Other Ethnicity 0 0
Unknown Ethnicity 0 0
Total 0 0
Race Asian 0 0
American Indian Alaska Native 0 0
Black 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority 0 0
White 0 0
Multiple 0 0
Unknown 0 0
Total 0 0
Sex Male 0 0
Female 0 0
Unknown Sex 0 0
Total 0 0
Monthly Income 0 - 0 0
- 0 0
Higher than 0 0
Unknown 0 0
Total 0 0
Report run on 08312018 1058 AM Page 1 of 2 demo_by_prov_detrdf Report run byRSHQALL Dispose of this report so that it can not be read or reconstructed
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Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Client ID Date Of Birth Ethnicity Race Sex Individual Monthly Income
Report run on 08312018 1058 AM Page 2 of 2 demo_by_prov_detrdf Report run byRSHQALL Dispose of this report so that it can not be read or reconstructed
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Demographics of Clients OAA Registered Served Only PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 City All Cities Program All Programs Service All Services County ALL COUNTIES Table OAA Registered Services Only Low Income Medium Income
Total Persons Served 0
Agelt 60 Years
Age 60 - 64
Age 65 - 74
Age 75 - 84
Age 85+
0
0
0
0
0
0
0
0
0
0
Monthly Income
0 -
-Higher than
Unknown
0
0
0
0
0
0
0
0
Total
Average
0
000
0 Total 0 0
Ethnicity Hispanic
Other
Unknown
0
0
0
0
0
0
Living Situation
Alone
Null
Policy Change
0
0
0
0
0
0
Total 0 0 Unknown
With Caregiver
0
0
0
0
Race Asian 0 0
With Other
With Other Caregiver
0
0
0
0
American Indian Alaska Native
Black
0
0
0
0Total Living Situation 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority
White
0
0
0
0 Limited English Proficiency
Multiple
Unknown
Total Race
0
0
0
0
0
0
Yes
No
Unknown
0
0
0
0
0
0
Total 0 0
Sex Male
Female
Unknown
0
0
0
0
0
0
Total 0 0
Report run on 08312018 1056 AM Page 1 of 1 demo_by_provrdf
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Disaster Assistance Clients for a Provider PSA ALL Provider All Providers Location 0000 Worker All Workers City All Cities Zip Code All Zip Codes Sort By ZIP
Provider 1036 Provider Name Location 0000 Worker CIRTS18634
Need Care Client Name Address City Zip County Phone Asst Reg Situation Relat Care phone Care Name
34946 N WO DA 000 SAINT JAMES DRIVE CENTRAL (025) 101-0620 Test NameTest Name SAINT LUCIE (005) 100-0369 Y
Client is active and no assessment information is available Special Shelter and Special Registry are unknown
Report run on 08312018 1102 AM Page 1 of 8 disaster_by_provrdf
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
Total by PSA 0
Report run on 08312018 1111 AM Page 1 of 5 eheap_exceptionsrdf
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
ALACH BAKER BAY BRADF BREVA BROWA CALHO CHARL CITRUS CLAY COLLIE COLUM DESOT DIXIE DUVAL ESCAM FLAGL FRANK GADSDAssisted Household Report UA ORD RD RD UN OTTE R BIA O BIA ER LIN EN
1 of Household Assisted 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Households AssistedWith Gross Income
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C 100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D 125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
3 Households with at leastOne member
A 60 Years or older 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B Disabled 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C Age 5 years or under 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D Under 60 Years Old 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Undup Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Assisted
Applicant Household Report
of Applicant Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Energy Assisted Household Report
County of Assisted
Households
Households Assisted By Poverty Level
Under 75 75 - 100 101 - 125 126 - 150 Over 150 60 Years or older
At least one member who is
Age 5 years Age 2 years Age 3 years Disabled or younger and younger through 5
Under 60 Years Old
Undup Households
Assisted
Energy Assistance Total
Report run on 08312018 1107 AM Page 1 of 3 eheap_summaryrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Unduplicated Total 0 0
County of Assisted
Households Under 75 75 - 100
Households Assisted By Poverty Level
101 - 125 126 - 150 Over 150 60 Years or older Disabled
Age 5 years or younger
Age 2 years and younger
Age 3 years through 5
Under 60 Years Old
At least one member who is
Undup Households
Assisted
Other Assisted Household Report
Other Assistance Total
Report run on 08312018 1107 AM Page 2 of 3 eheap_summaryrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Applicant Household Report
County of Applicant
Households Under 75 75 - 100 101 - 125 126 - 150 Over 150 Income data
unavailable
Total 0
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01
Enrollment Active Consumer Count by Program PSA ALL Provider ALL PROVIDERS
County Description Program Count of Clients
BREVARD
ADI
CCE
HCE
LSP
NDP
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
MLTC
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
31
57
44
5
62
123
141
26
9
7
5
40
5
50
67
129
2
19
42
29
1
233
79
63
8
2
14
3
37
14
47
3
3
33
127
10
02
03
04
ALACHUA
BAKER
BAY
BRADFORD
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Enrollment Terminations with Reasons PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 Program All Programs Program Status ALL Program Status Worker ALL WORKERS
Last First Program Medicaid Provider Start End Name Name Client ID Status Description Worker Number Program Location Enrollment Enrollment
Count 0
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Enrollments with Care Plan Report
PSA ALL Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTIVE STATUS Care Plan Service ALL SERVICES Care Plan Start 01012017 Care Plan End 12312017
Care Plan Care Plan Care Plan Client Name
Unduplicated Client Count 0
Client ID Program Status Worker Start Date End Date Service
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PSA CLIENT_ID CLIENT_NAME OWNER PROVIDER_ID ASSESSMENT_DATE ASSESSOR_NAME MEDICAID_NUMBER CAREGIVER_CHANGE ENVIRONMENT_CHANGE HEALTH_CHANGE INCOME_CHANGE SITUATION_CHANGE INITIAL_ASSM ANNUAL_ASSM SSN REFERRAL_SOURCE 1114 N N N N Y N 771771777 SELFFAMILY 812017 JANE CASEWORKER 2 1001141633 TEST TEST N
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Fixed Service Costs List PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Provider Location County Program Service Reimbursement Unit Rate Provider Cost Per Unit Begin Valid End Valid
Count 0
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PSA
APCL Clients With No Services ALL Owner All Owners Provider ALL PROVIDERS
Start Date 01012017 End Date 12312017
Includes Clients Receiving Only CM INSC SCAS CA REFE Services
PSA Client ID Client Name Owner Provider Program
Count 0
Unduplicated Clients Count 0
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APCL Clients With Services PSA ALL Owner All Owners Provider ALL PROVIDERS Start Date 01012017 End Date 12312017
Exclude CM CA INSC REFE SCAS
PSA Client ID Name Owner Provider Program 10 4062527553 Test Name 1539 1929 CCE
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APCL Clients With Services PSA ALL Owner All Owners Provider ALL PROVIDERS Start Date 01012017 End Date 12312017
Exclude CM CA INSC REFE SCAS
PSA Client ID Name Owner Provider Program 11 4062732638 Test Name 1177 1177 LTCC
Total 21067
Unduplicated clients count 12460
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APS Assessments PSA ALL Risk Level ALL Owner All Owners Referral Date From 01012017 To 12312017
Order by Referral Date and Owner ID
PSA 03
Ref Date Owner ID Client ID Client Name Risk Level Asmt Type Asmt Date
03032017 1390 4062058415 L 701A 03302018 Test Name
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APS Assessments PSA ALL Risk Level ALL Owner All Owners Referral Date From 01012017 To 12312017
Order by Referral Date and Owner ID
12042017 1980 4061617559 H 701B 12072017 Test Name
Assessment Count for the PSA 52
PSA 04A
Ref Date Owner ID Client ID
09102017 4062308458
Client Name
Test Name
Risk Level
H
Asmt Type
O
Asmt Date
09162017
Assessment Count for the PSA 2
Risk Level H
M
L
Count of Assessments 138
23
21
Total Count of Assessments 182
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APS Repeat Referrals in a Time Range
PSA ALL Owner All Owners
Start Date 01012017 End Date 12312017
Current DOEA CIRTS Cirts SSN if Risk Date Created PSA Owner Abuse No different than DCF DCF SSN Name County Level Date of Birth Date Sent by DCF
Count 0
Unduplicated Client Count by PSA
PSA Count SSN
Total
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Assessed Prioritized Consumer List PSA ALL Provider ALL PROVIDERS Program AC County ALL COUNTIES
County Program Consumer Name Client ID
Total Count 0
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Assessment Due Report PSA 01 Start Date 01012017 End Date 08312018 Owner ALL PROVIDERS Worker ALL WORKERS Program Status ACTV and APCL Assessment Type Needed ALL
Overdue and missing assessments are always listed
Owner ID 1065
Client ID Client Name
Owner Assessor ID
Date of Birth
06281928
CIRTS28099
County of Service
GULF
Worker Name HARPER KENNY
Zip Assessment PSA Date
32534 01 01022014
Type
701A
Active Y
Nutr PriorityScore Score
11 58
Rank
5
Due Date
01022015
Status
701S OVERDUE
LTCC APPL Start Date
03252014 4062235673 Test name
Total Clients for Worker 1
Total Clients for Owner 1
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Assessment Due Report PSA 01 Start Date 01012017 End Date 08312018 Owner ALL PROVIDERS Worker ALL WORKERS Program Status ACTV and APCL Assessment Type Needed ALL
Overdue and missing assessments are always listed
Summary by PSA
PSA 01 701A Overdue 1
701B Overdue 213
701C Overdue 0
701S Overdue 157
No 701A 0
No 701B 2
No 701C 0
No 701S 0
701A Not Overdue 0
701B Not Overdue 0
701C Not Overdue 0
701S Not Overdue 0
701S Optional 0
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CIC Service Units and Costs Projections County SummaryPSA 99 Program CCE
Start Date 01012017 End Date 12312017
County LEON
Total Total Total Avg Max Projected
StateFederal Projected Reimbursement Provider Unduplicated Provider Service Share Service Units Unit Rate Cost Per Unit Client Count
Report Total
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CIC Service Units and Costs Projections Provider SummaryPSA ALL Provider ALL PROVIDERS Program FEDERALLY FUNDED (0101 TO 1231) Year 2017 From 01012017 To 12312017
PSA County Program Service Total State
Federal Share
Total Projected
Service Units
Avg Reimbursement
Unit Rate
Max Provider
Cost Per Unit
Total Projected Unduplicated Client Count
02 FRANKLIN O3C1 CONGREGATE MEALS $810300 1710 15
Program Total
County Total
$810300
$810300
GULF O3C1 CONGREGATE MEALS $25205 3 5
Program Total $25205
O3C2 HOME DELIVERED MEALS $25205 3 6
Program Total
County Total
$25205
$50411
LEON O3C1 CONGREGATE MEALS $621300 1311 15
CONGREGATE MEALS GUEST
CONGREGATE MEALS VOLUNTEERS
$252055
$277260
25
30
2
5
Program Total $1150615
O3C2 HOME DELIVERED MEAL GUEST $252055 25 3
Program Total $252055
OA3D PEARLS (SESSION 5)
PEARLS (SESSION 6)
PEARLS (SESSION 7)
PEARLS (SESSION 8)
$10247
$10247
$10247
$10247
10
10
10
10
3
3
3
3
Program Total $40988
OA3E RESPITE IN-HOME $200 2 2
Program Total
County Total
$200
$1443858
WAKULLA O3C2 EMERGENCY HOME DELIVERED SHELF MEALS
$8065604 14899 90
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CIC Service Units and Costs Projections - PSA Summary
PSA ALL Program CCE
Strat Date 01012017 End Date 12312017
Total
PSA County Provider Service
Total State Federal
Share
Total Projected
Service Units
Avg Reimbursement
Unit Rate
Max Projected Provider Unduplicated
Cost Per Unit Client Count
02 LEON SOUTHERN SERVICE CASE MANAGEMENT PROVIDER EMERGENCY HOME DELIVERED SHELF MEALS
$2175533
$602000
483
689
32
20
HOME DELIVERED MEALS $530262 993 5
MATERIAL AID $1994536 199
Provider Total $5302331
CountyTotal $5302331
WAKULLA SOUTHERN SERVICE CASE MANAGEMENT PROVIDER EMERGENCY HOME DELIVERED SHELF MEALS
$2175533
$1240200
483
689
32
5
MATERIAL AID $1994536 199
Provider Total $5410269
CountyTotal $5410269
PSA Total $10712599
05 PINELLAS BURSTEIN-APPLEBEE ADULT DAY CARE $000 0 $900 $1000 0
COUNSELING (MENTAL HEALTH COUNSELINGSCREENING) - INDIVIDUAL
Provider Total
$000
$000
0 $6600 $7700 0
CountyTotal $000
PSA Total $000
Report Total $10712599
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CID Service Units and Costs Projections - PSA SummaryPSA ALL Program CCE
Start Date 01012017 End Date 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
PSA County Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
02 LEON CASE MANAGEMENT $2175533 483
EMERGENCY HOME $602000 689DELIVERED SHELF MEALS HOME DELIVERED MEALS $530262 993
MATERIAL AID $1994536 199
County Total $5302331 2364
WAKULLA CASE MANAGEMENT $2175533 483
EMERGENCY HOME $1240200 689DELIVERED SHELF MEALS MATERIAL AID $1994536 199
County Total $5410269 1371
PSA Total $10712599 3735
05 PINELLAS ADULT DAY CARE $000 0
COUNSELING (MENTAL $000 0 HEALTH COUNSELINGSCREENING) - INDIVIDUAL
County Total $000 0
PSA Total $000 0
Report Total $10712599 3735
$900 $900 $900 $1000 $1000 $1000
$6600 $6600 $6600 $7700 $7700 $7700
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CID Service Units and Costs Projections County SummaryPSA 99
Program CCE County LEON
Start Date 01012017 End Date 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
Report Total
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CIE Service Units and Costs Projections - PSA Summary - All Programs
PSA 99 Program FEDERALLY FUNDED (0101 TO 1231) Year 2017 From 01012017 To 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
Program Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
Report Total
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CIE Service Units and Costs Projections - PSA Summary
PSA ALL Program CCE
Start Date 01012017 End Date 12312017
Avg High Low Total Total Avg High Low Provider Provider Provider
StateFederal Projected Reimbursement Reimbursement Reimbursement Cost Cost CostPSA
02
Service
CASE MANAGEMENT
Share
$4351066
Service Units
966
Unit Rate Unit Rate Unit Rate Per Unit Per Unit Per Unit
EMERGENCY HOME DELIVERED SHELF MEALS $1842200 1378
HOME DELIVERED MEALS $530262 993
MATERIAL AID $3989071 398
PSA Total $10712599 3735
05 ADULT DAY CARE $000 0 $900 $900 $900 $1000 $1000 $1000
COUNSELING (MENTAL HEALTH $000 0 $6600 $6600 $6600 $7700 $7700 $7700 COUNSELINGSCREENING) - INDIVIDUAL
PSA Total $000 0
Report Total $10712599 3735
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CAREGIVER SEARCH REPORT
SEARCH RESULTS FOR CONSUMERS
Criteria First Name Last Name SSN PSA ALL
Client Name Client SSN Caregiver Name Caregiver SSN
000000000 000000000 Test Name Test Name
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CARES Referrals in a Time Range PSA ALL
Start Date 01012017 End Date 12312017
Referred to ALL REFERRALS
Referring PSA Employee Name Client Name Client ID
Referral Imminent NH Admit Aging Date Risk Date Referred To Cares Provider Name Received Date
03A 4061561263 Test Name Test Name 09242017 Y 05292017 ARC or ADRC 09252017
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CARES Referrals in a Time Range PSA ALL
Start Date 01012017 End Date 12312017
Referred to ALL REFERRALS
Referring PSA Employee Name Client Name Client ID
Referral Date
Imminent Risk
NH Admit Date Referred To Cares Provider Name
Aging Received Date
04B Test Name Test Name 4061738075 04082017 N ARC or ADRC Test Name 04082017
Total Clients 110
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CARES Referrals not acknowledged by the Aging Network PSA ALL For Referrals after 01012017 Owner ID ALL Owners
Unduplicated Client count Cares Office Total Clients Count
Report Total
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
CIRTS Issue PSA Client ID Client Name Program
Program Status Start Provider Enrollment ID Provider Name
APCL CLIENT WITH DATE OF DEATH 08 4061759417 Test Name OA3B APCL 07232013 1141 WESTERN WORLD RADIO
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
Program Start Provider CIRTS Issue PSA Client ID Client Name Program Status Enrollment ID Provider Name
06 LTCC APCL 01242014 1514 4061713685 Test Name APCL CLIENT WITH DATE OF DEATH CENTRAL THE ORIGINAL HOUSE OF PIES
Count 503
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Civil Rights PSA ALL Provider ALL PROVIDERS Program AC Start Date 01012017 End Date 12312017 The Poverty Level for Single is The Poverty Level for Couple is Sort by County
County Unduplicated Count
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Client Information Report Start Date 01012017 End Date 12312017
Client ID 1001141246
Emergency
Client Name Test Name
Telephone () - Address 78 TEST STREET TALLAHASSEE FL 32399
Most Recent Caregiver Information Date Updated
Doctor
Comments
Client Demographic Information
Birth Date 06041940 Race W
Owner ID Ethnicity O
Most Recent Income Information
Ind Mon Inc Cpl Mon Inc
Ind Assets Couple Assets
Most Recent Assessment Information
Asmt Date Ref Risk Lvl
Asmt Site Spec Shel
AsmtType Spec Reg
Ref Date Primary CG
Ref Source Living Sit
Enrollment Information
Sex
Marital Status
F
S
Medicaid Number
ADL Score
ADL Count
IADL Score
IADL Count
Memory Score
Priority Score
Env Score
Nutr Score
Risk Score
Social Score
Rank
Provider Location Program Program Status Worker Start Date End Date
Care Plan Service Needed
Date Service Units Type Frq End Date
Care Plan Service Planned
Program Service Units Type Frq Start Date End Date
Services Received between 01012017 and 12312017
Service Billed Provider Location Worker Program Service Date Units Unit Type Amount
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Provider N
Client Service Units Report PSA ALL Provider ALL PROVIDERS Location 0000
Program ALL PROGRAMS Service ALL SERVICES Worker ALL WORKERS
City ALL CITIES Include Zero Unit N Include Aggregate N Calculated Amount equals the number of Units Provided times Fixed Cost if it existsService Start Date 01012017 Service End Date 12312017 If Fixed Cost does not exist Calculated
Group by PSA Provider Location Client Name County Worker Amount equals Billed Amount
Unduplicated Client Count 0 Grand Total 000 $000
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Clients In Common PSA All Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 County All Counties Worker All Workers
County JEFFERSON
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
MIAMI-DADE
0 0 0 0 0 0 0 0 0
4061539538 Test NameCounty Count
County
0 01
X
0 1
X
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
4061650856 Test Name X 4061486560 Test Name X 4062452921 Test Name X
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Clients Served Not Enrolled PSA ALL Start Date 01012017 End Date 12312017 Locations 0000 Provider All Providers
Service Service Min Serv Max Serv Program Start End Enrollment PSA Provider Location Program Consumer Name Client ID Service Date Date Status Enrollment Enrollment Provider
Count 0
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
4061472791 04
09
1092
1291
0072
0042
LTCC
LTCC
APCL
APCL
4062714543 06
06
1514
1762
0072
5006
LTCC
LTCC
APCL
APPL
4061802246 11
06
1177
1514
0179
0072
LTCC
LTCC
APCL
APCL
4061563719 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062644312 06
08
1514
1771
0072
0896
LTCC
LTCC
APCL
APCL
1001141670 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
1001141671 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
4062375003 07
05
05
07
1263
1755
1638
1263
0368
0072
0072
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062155124 06
06
1762
1514
0072
0072
LTCC
LTCC
APPL
APCL
4061743886 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0369
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4061499927 06
06
1514
1762
0072
5005
LTCC
LTCC
APCL
APPL
4061583524 08
06
1144
1514
0896
0072
LTCC
LTCC
APCL
APCL
4062694843 06
03
1514
1922
0072
0179
LTCC
LTCC
APCL
APCL
4062744517 07
06
1263
1514
0369
0072
LTCC
LTCC
APCL
APCL
4062005488 10
11
10
11
1929
1177
1164
1177
0072
0073
0179
0179
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
Total Count 15
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CODE DESCRIPTIONS Category ALL STATE TABLES
Code Description Active Available To Code Category
0 UNKNOWN Y CARES SUBJECTIVE_HEALTH_EVALUATION
01 ALACHUA Y COMMON COUNTIES
02 BAKER Y COMMON COUNTIES
03 BAY Y COMMON COUNTIES
04 BRADFORD Y COMMON COUNTIES
05 BREVARD Y COMMON COUNTIES
06 BROWARD Y COMMON COUNTIES
07 CALHOUN Y COMMON COUNTIES
08 CHARLOTTE Y COMMON COUNTIES
09 CITRUS Y COMMON COUNTIES
1 EXCELLENT Y CARES SUBJECTIVE_HEALTH_EVALUATION
10 CLAY Y COMMON COUNTIES
11 COLLIER Y COMMON COUNTIES
12 COLUMBIA Y COMMON COUNTIES
13 MIAMI-DADE Y COMMON COUNTIES
14 DESOTO Y COMMON COUNTIES
15 DIXIE Y COMMON COUNTIES
16 DUVAL Y COMMON COUNTIES
17 ESCAMBIA Y COMMON COUNTIES
18 FLAGLER Y COMMON COUNTIES
19 FRANKLIN Y COMMON COUNTIES
2 GOOD Y CARES SUBJECTIVE_HEALTH_EVALUATION
20 GADSDEN Y COMMON COUNTIES
21 GILCHRIST Y COMMON COUNTIES
22 GLADES Y COMMON COUNTIES
23 GULF Y COMMON COUNTIES
24 HAMILTON Y COMMON COUNTIES
25 HARDEE Y COMMON COUNTIES
26 HENDRY Y COMMON COUNTIES
27 HERNANDO Y COMMON COUNTIES
28 HIGHLANDS Y COMMON COUNTIES
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CONSUMER AGE VERIFICATION REPORT PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Program AC
Age at Start
Enroll or Start Enroll Provider Program Description Consumer Name Client ID DOB Svc date or Svc Date
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Contract Budget Information PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Program Service Provider Location County Served Provider Contract
Projected Service
Units Unit Measure
Projected Unduplicated
State Federal Share Client Count Begin Date End Date
Row Count 0 Amount Total
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Start Enroll Latest Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Date Asmt Date Worker
O3C1 1036 000 4061653427 Test CENTRAL 34982 W M 07091930 09102013 09102013 CIRTS20804 0 Name
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Start Enroll Date
Latest Asmt Date Worker
4061593624 Test Name CENTRAL 34946 B F 11261940 12012011 12312013 CIRTS23407
Count 164
Unduplicated Client Count 163
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Assessments After DOD Report
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Owner 1025
The shaded records indicate clients who have different DOBs andor different names
Assemt Current PSA Owner Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Owner Assessor
Provider Assessor
Assemt Date
Assemt Type
Unduplicated Count Total 0
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Open Enrollments
The Vital Statistics Data for 07192002 - 09112014PSA ALL Provider ALL Program Status ACTV Include MLTC ACTVS N
The shaded records indicate clients who have different DOBs andor different names
Enroll PSA
Enrollment Provider Loc Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Enroll Program Status
Enroll Program
Current Owner ID
02 1065 0072 4062244026 Test Name Test Name 10222004 03231917 03231917 ACTV CCE 1065
Count of enrollments for the Provider 1
Count of enrollments for the PSA 1
Count of enrollments for the Report 1
Unduplicated Count of Individuals with open enrollments and DOD PSA Total Clients Count
02 1
Total 1
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Unduplicated count of individuals with Services after DOD
PSA Total Clients Count
Report Total
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
List of Clients with PSA table entry for SERVICES_AFTER_DOD
Unduplicated Count Total 0
Report run on 08312018 0207 PM Page 3 of 3 vs_servicesrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Age
Provider
Total
Age lt 60 Age 60 - 64 Age 65 - 74 Age 75 - 84 Age 85+ Total Clients Avg Age
Total
Avg Age
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Ethnicity
Provider Hispanic Other Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Race
American Indian Native Hawaiian Other Provider Asian Alaska Native Black Pacific Islander Minority White Multiple Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Gender
Provider Male Female Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Monthly Income
Provider 0 - - Higher than Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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None
Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Total Persons Served 0
Age lt 60 Years 0 0
Age 60 - 64 0 0
Age 65 - 74 0 0
Age 75 - 84 0 0
Age 85+ 0 0
Total Age 0 0
Average 000
Ethnicity Hispanic 0 0
Other Ethnicity 0 0
Unknown Ethnicity 0 0
Total 0 0
Race Asian 0 0
American Indian Alaska Native 0 0
Black 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority 0 0
White 0 0
Multiple 0 0
Unknown 0 0
Total 0 0
Sex Male 0 0
Female 0 0
Unknown Sex 0 0
Total 0 0
Monthly Income 0 - 0 0
- 0 0
Higher than 0 0
Unknown 0 0
Total 0 0
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Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Client ID Date Of Birth Ethnicity Race Sex Individual Monthly Income
Report run on 08312018 1058 AM Page 2 of 2 demo_by_prov_detrdf Report run byRSHQALL Dispose of this report so that it can not be read or reconstructed
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Demographics of Clients OAA Registered Served Only PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 City All Cities Program All Programs Service All Services County ALL COUNTIES Table OAA Registered Services Only Low Income Medium Income
Total Persons Served 0
Agelt 60 Years
Age 60 - 64
Age 65 - 74
Age 75 - 84
Age 85+
0
0
0
0
0
0
0
0
0
0
Monthly Income
0 -
-Higher than
Unknown
0
0
0
0
0
0
0
0
Total
Average
0
000
0 Total 0 0
Ethnicity Hispanic
Other
Unknown
0
0
0
0
0
0
Living Situation
Alone
Null
Policy Change
0
0
0
0
0
0
Total 0 0 Unknown
With Caregiver
0
0
0
0
Race Asian 0 0
With Other
With Other Caregiver
0
0
0
0
American Indian Alaska Native
Black
0
0
0
0Total Living Situation 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority
White
0
0
0
0 Limited English Proficiency
Multiple
Unknown
Total Race
0
0
0
0
0
0
Yes
No
Unknown
0
0
0
0
0
0
Total 0 0
Sex Male
Female
Unknown
0
0
0
0
0
0
Total 0 0
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Disaster Assistance Clients for a Provider PSA ALL Provider All Providers Location 0000 Worker All Workers City All Cities Zip Code All Zip Codes Sort By ZIP
Provider 1036 Provider Name Location 0000 Worker CIRTS18634
Need Care Client Name Address City Zip County Phone Asst Reg Situation Relat Care phone Care Name
34946 N WO DA 000 SAINT JAMES DRIVE CENTRAL (025) 101-0620 Test NameTest Name SAINT LUCIE (005) 100-0369 Y
Client is active and no assessment information is available Special Shelter and Special Registry are unknown
Report run on 08312018 1102 AM Page 1 of 8 disaster_by_provrdf
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
Total by PSA 0
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
ALACH BAKER BAY BRADF BREVA BROWA CALHO CHARL CITRUS CLAY COLLIE COLUM DESOT DIXIE DUVAL ESCAM FLAGL FRANK GADSDAssisted Household Report UA ORD RD RD UN OTTE R BIA O BIA ER LIN EN
1 of Household Assisted 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Households AssistedWith Gross Income
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C 100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D 125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
3 Households with at leastOne member
A 60 Years or older 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B Disabled 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C Age 5 years or under 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D Under 60 Years Old 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Undup Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Assisted
Applicant Household Report
of Applicant Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Energy Assisted Household Report
County of Assisted
Households
Households Assisted By Poverty Level
Under 75 75 - 100 101 - 125 126 - 150 Over 150 60 Years or older
At least one member who is
Age 5 years Age 2 years Age 3 years Disabled or younger and younger through 5
Under 60 Years Old
Undup Households
Assisted
Energy Assistance Total
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Unduplicated Total 0 0
County of Assisted
Households Under 75 75 - 100
Households Assisted By Poverty Level
101 - 125 126 - 150 Over 150 60 Years or older Disabled
Age 5 years or younger
Age 2 years and younger
Age 3 years through 5
Under 60 Years Old
At least one member who is
Undup Households
Assisted
Other Assisted Household Report
Other Assistance Total
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Applicant Household Report
County of Applicant
Households Under 75 75 - 100 101 - 125 126 - 150 Over 150 Income data
unavailable
Total 0
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01
Enrollment Active Consumer Count by Program PSA ALL Provider ALL PROVIDERS
County Description Program Count of Clients
BREVARD
ADI
CCE
HCE
LSP
NDP
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
MLTC
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
31
57
44
5
62
123
141
26
9
7
5
40
5
50
67
129
2
19
42
29
1
233
79
63
8
2
14
3
37
14
47
3
3
33
127
10
02
03
04
ALACHUA
BAKER
BAY
BRADFORD
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Enrollment Terminations with Reasons PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 Program All Programs Program Status ALL Program Status Worker ALL WORKERS
Last First Program Medicaid Provider Start End Name Name Client ID Status Description Worker Number Program Location Enrollment Enrollment
Count 0
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Enrollments with Care Plan Report
PSA ALL Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTIVE STATUS Care Plan Service ALL SERVICES Care Plan Start 01012017 Care Plan End 12312017
Care Plan Care Plan Care Plan Client Name
Unduplicated Client Count 0
Client ID Program Status Worker Start Date End Date Service
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PSA CLIENT_ID CLIENT_NAME OWNER PROVIDER_ID ASSESSMENT_DATE ASSESSOR_NAME MEDICAID_NUMBER CAREGIVER_CHANGE ENVIRONMENT_CHANGE HEALTH_CHANGE INCOME_CHANGE SITUATION_CHANGE INITIAL_ASSM ANNUAL_ASSM SSN REFERRAL_SOURCE 1114 N N N N Y N 771771777 SELFFAMILY 812017 JANE CASEWORKER 2 1001141633 TEST TEST N
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Fixed Service Costs List PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Provider Location County Program Service Reimbursement Unit Rate Provider Cost Per Unit Begin Valid End Valid
Count 0
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APCL Clients With Services PSA ALL Owner All Owners Provider ALL PROVIDERS Start Date 01012017 End Date 12312017
Exclude CM CA INSC REFE SCAS
PSA Client ID Name Owner Provider Program 10 4062527553 Test Name 1539 1929 CCE
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APCL Clients With Services PSA ALL Owner All Owners Provider ALL PROVIDERS Start Date 01012017 End Date 12312017
Exclude CM CA INSC REFE SCAS
PSA Client ID Name Owner Provider Program 11 4062732638 Test Name 1177 1177 LTCC
Total 21067
Unduplicated clients count 12460
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APS Assessments PSA ALL Risk Level ALL Owner All Owners Referral Date From 01012017 To 12312017
Order by Referral Date and Owner ID
PSA 03
Ref Date Owner ID Client ID Client Name Risk Level Asmt Type Asmt Date
03032017 1390 4062058415 L 701A 03302018 Test Name
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APS Assessments PSA ALL Risk Level ALL Owner All Owners Referral Date From 01012017 To 12312017
Order by Referral Date and Owner ID
12042017 1980 4061617559 H 701B 12072017 Test Name
Assessment Count for the PSA 52
PSA 04A
Ref Date Owner ID Client ID
09102017 4062308458
Client Name
Test Name
Risk Level
H
Asmt Type
O
Asmt Date
09162017
Assessment Count for the PSA 2
Risk Level H
M
L
Count of Assessments 138
23
21
Total Count of Assessments 182
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APS Repeat Referrals in a Time Range
PSA ALL Owner All Owners
Start Date 01012017 End Date 12312017
Current DOEA CIRTS Cirts SSN if Risk Date Created PSA Owner Abuse No different than DCF DCF SSN Name County Level Date of Birth Date Sent by DCF
Count 0
Unduplicated Client Count by PSA
PSA Count SSN
Total
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Assessed Prioritized Consumer List PSA ALL Provider ALL PROVIDERS Program AC County ALL COUNTIES
County Program Consumer Name Client ID
Total Count 0
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Assessment Due Report PSA 01 Start Date 01012017 End Date 08312018 Owner ALL PROVIDERS Worker ALL WORKERS Program Status ACTV and APCL Assessment Type Needed ALL
Overdue and missing assessments are always listed
Owner ID 1065
Client ID Client Name
Owner Assessor ID
Date of Birth
06281928
CIRTS28099
County of Service
GULF
Worker Name HARPER KENNY
Zip Assessment PSA Date
32534 01 01022014
Type
701A
Active Y
Nutr PriorityScore Score
11 58
Rank
5
Due Date
01022015
Status
701S OVERDUE
LTCC APPL Start Date
03252014 4062235673 Test name
Total Clients for Worker 1
Total Clients for Owner 1
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Assessment Due Report PSA 01 Start Date 01012017 End Date 08312018 Owner ALL PROVIDERS Worker ALL WORKERS Program Status ACTV and APCL Assessment Type Needed ALL
Overdue and missing assessments are always listed
Summary by PSA
PSA 01 701A Overdue 1
701B Overdue 213
701C Overdue 0
701S Overdue 157
No 701A 0
No 701B 2
No 701C 0
No 701S 0
701A Not Overdue 0
701B Not Overdue 0
701C Not Overdue 0
701S Not Overdue 0
701S Optional 0
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CIC Service Units and Costs Projections County SummaryPSA 99 Program CCE
Start Date 01012017 End Date 12312017
County LEON
Total Total Total Avg Max Projected
StateFederal Projected Reimbursement Provider Unduplicated Provider Service Share Service Units Unit Rate Cost Per Unit Client Count
Report Total
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CIC Service Units and Costs Projections Provider SummaryPSA ALL Provider ALL PROVIDERS Program FEDERALLY FUNDED (0101 TO 1231) Year 2017 From 01012017 To 12312017
PSA County Program Service Total State
Federal Share
Total Projected
Service Units
Avg Reimbursement
Unit Rate
Max Provider
Cost Per Unit
Total Projected Unduplicated Client Count
02 FRANKLIN O3C1 CONGREGATE MEALS $810300 1710 15
Program Total
County Total
$810300
$810300
GULF O3C1 CONGREGATE MEALS $25205 3 5
Program Total $25205
O3C2 HOME DELIVERED MEALS $25205 3 6
Program Total
County Total
$25205
$50411
LEON O3C1 CONGREGATE MEALS $621300 1311 15
CONGREGATE MEALS GUEST
CONGREGATE MEALS VOLUNTEERS
$252055
$277260
25
30
2
5
Program Total $1150615
O3C2 HOME DELIVERED MEAL GUEST $252055 25 3
Program Total $252055
OA3D PEARLS (SESSION 5)
PEARLS (SESSION 6)
PEARLS (SESSION 7)
PEARLS (SESSION 8)
$10247
$10247
$10247
$10247
10
10
10
10
3
3
3
3
Program Total $40988
OA3E RESPITE IN-HOME $200 2 2
Program Total
County Total
$200
$1443858
WAKULLA O3C2 EMERGENCY HOME DELIVERED SHELF MEALS
$8065604 14899 90
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CIC Service Units and Costs Projections - PSA Summary
PSA ALL Program CCE
Strat Date 01012017 End Date 12312017
Total
PSA County Provider Service
Total State Federal
Share
Total Projected
Service Units
Avg Reimbursement
Unit Rate
Max Projected Provider Unduplicated
Cost Per Unit Client Count
02 LEON SOUTHERN SERVICE CASE MANAGEMENT PROVIDER EMERGENCY HOME DELIVERED SHELF MEALS
$2175533
$602000
483
689
32
20
HOME DELIVERED MEALS $530262 993 5
MATERIAL AID $1994536 199
Provider Total $5302331
CountyTotal $5302331
WAKULLA SOUTHERN SERVICE CASE MANAGEMENT PROVIDER EMERGENCY HOME DELIVERED SHELF MEALS
$2175533
$1240200
483
689
32
5
MATERIAL AID $1994536 199
Provider Total $5410269
CountyTotal $5410269
PSA Total $10712599
05 PINELLAS BURSTEIN-APPLEBEE ADULT DAY CARE $000 0 $900 $1000 0
COUNSELING (MENTAL HEALTH COUNSELINGSCREENING) - INDIVIDUAL
Provider Total
$000
$000
0 $6600 $7700 0
CountyTotal $000
PSA Total $000
Report Total $10712599
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CID Service Units and Costs Projections - PSA SummaryPSA ALL Program CCE
Start Date 01012017 End Date 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
PSA County Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
02 LEON CASE MANAGEMENT $2175533 483
EMERGENCY HOME $602000 689DELIVERED SHELF MEALS HOME DELIVERED MEALS $530262 993
MATERIAL AID $1994536 199
County Total $5302331 2364
WAKULLA CASE MANAGEMENT $2175533 483
EMERGENCY HOME $1240200 689DELIVERED SHELF MEALS MATERIAL AID $1994536 199
County Total $5410269 1371
PSA Total $10712599 3735
05 PINELLAS ADULT DAY CARE $000 0
COUNSELING (MENTAL $000 0 HEALTH COUNSELINGSCREENING) - INDIVIDUAL
County Total $000 0
PSA Total $000 0
Report Total $10712599 3735
$900 $900 $900 $1000 $1000 $1000
$6600 $6600 $6600 $7700 $7700 $7700
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CID Service Units and Costs Projections County SummaryPSA 99
Program CCE County LEON
Start Date 01012017 End Date 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
Report Total
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CIE Service Units and Costs Projections - PSA Summary - All Programs
PSA 99 Program FEDERALLY FUNDED (0101 TO 1231) Year 2017 From 01012017 To 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
Program Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
Report Total
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CIE Service Units and Costs Projections - PSA Summary
PSA ALL Program CCE
Start Date 01012017 End Date 12312017
Avg High Low Total Total Avg High Low Provider Provider Provider
StateFederal Projected Reimbursement Reimbursement Reimbursement Cost Cost CostPSA
02
Service
CASE MANAGEMENT
Share
$4351066
Service Units
966
Unit Rate Unit Rate Unit Rate Per Unit Per Unit Per Unit
EMERGENCY HOME DELIVERED SHELF MEALS $1842200 1378
HOME DELIVERED MEALS $530262 993
MATERIAL AID $3989071 398
PSA Total $10712599 3735
05 ADULT DAY CARE $000 0 $900 $900 $900 $1000 $1000 $1000
COUNSELING (MENTAL HEALTH $000 0 $6600 $6600 $6600 $7700 $7700 $7700 COUNSELINGSCREENING) - INDIVIDUAL
PSA Total $000 0
Report Total $10712599 3735
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CAREGIVER SEARCH REPORT
SEARCH RESULTS FOR CONSUMERS
Criteria First Name Last Name SSN PSA ALL
Client Name Client SSN Caregiver Name Caregiver SSN
000000000 000000000 Test Name Test Name
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CARES Referrals in a Time Range PSA ALL
Start Date 01012017 End Date 12312017
Referred to ALL REFERRALS
Referring PSA Employee Name Client Name Client ID
Referral Imminent NH Admit Aging Date Risk Date Referred To Cares Provider Name Received Date
03A 4061561263 Test Name Test Name 09242017 Y 05292017 ARC or ADRC 09252017
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CARES Referrals in a Time Range PSA ALL
Start Date 01012017 End Date 12312017
Referred to ALL REFERRALS
Referring PSA Employee Name Client Name Client ID
Referral Date
Imminent Risk
NH Admit Date Referred To Cares Provider Name
Aging Received Date
04B Test Name Test Name 4061738075 04082017 N ARC or ADRC Test Name 04082017
Total Clients 110
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CARES Referrals not acknowledged by the Aging Network PSA ALL For Referrals after 01012017 Owner ID ALL Owners
Unduplicated Client count Cares Office Total Clients Count
Report Total
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
CIRTS Issue PSA Client ID Client Name Program
Program Status Start Provider Enrollment ID Provider Name
APCL CLIENT WITH DATE OF DEATH 08 4061759417 Test Name OA3B APCL 07232013 1141 WESTERN WORLD RADIO
Report run on 08312018 0224 PM
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
Program Start Provider CIRTS Issue PSA Client ID Client Name Program Status Enrollment ID Provider Name
06 LTCC APCL 01242014 1514 4061713685 Test Name APCL CLIENT WITH DATE OF DEATH CENTRAL THE ORIGINAL HOUSE OF PIES
Count 503
Report run on 08312018 0224 PM Page 22 of 22 data_cleanuprdf Report run by RSHQALL Dispose of this report so that it can not be read or reconstructed
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Civil Rights PSA ALL Provider ALL PROVIDERS Program AC Start Date 01012017 End Date 12312017 The Poverty Level for Single is The Poverty Level for Couple is Sort by County
County Unduplicated Count
Report run on 08312018 1055 AM Page 1 of 1 civil_rightsrdf
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Client Information Report Start Date 01012017 End Date 12312017
Client ID 1001141246
Emergency
Client Name Test Name
Telephone () - Address 78 TEST STREET TALLAHASSEE FL 32399
Most Recent Caregiver Information Date Updated
Doctor
Comments
Client Demographic Information
Birth Date 06041940 Race W
Owner ID Ethnicity O
Most Recent Income Information
Ind Mon Inc Cpl Mon Inc
Ind Assets Couple Assets
Most Recent Assessment Information
Asmt Date Ref Risk Lvl
Asmt Site Spec Shel
AsmtType Spec Reg
Ref Date Primary CG
Ref Source Living Sit
Enrollment Information
Sex
Marital Status
F
S
Medicaid Number
ADL Score
ADL Count
IADL Score
IADL Count
Memory Score
Priority Score
Env Score
Nutr Score
Risk Score
Social Score
Rank
Provider Location Program Program Status Worker Start Date End Date
Care Plan Service Needed
Date Service Units Type Frq End Date
Care Plan Service Planned
Program Service Units Type Frq Start Date End Date
Services Received between 01012017 and 12312017
Service Billed Provider Location Worker Program Service Date Units Unit Type Amount
Report run on 08312018 0159 PM Page 1 of 1 client_info_formrdf
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Provider N
Client Service Units Report PSA ALL Provider ALL PROVIDERS Location 0000
Program ALL PROGRAMS Service ALL SERVICES Worker ALL WORKERS
City ALL CITIES Include Zero Unit N Include Aggregate N Calculated Amount equals the number of Units Provided times Fixed Cost if it existsService Start Date 01012017 Service End Date 12312017 If Fixed Cost does not exist Calculated
Group by PSA Provider Location Client Name County Worker Amount equals Billed Amount
Unduplicated Client Count 0 Grand Total 000 $000
Report run on 08312018 0234 PM Page 1 of 1 clnt_serv_unitsrdf
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Clients In Common PSA All Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 County All Counties Worker All Workers
County JEFFERSON
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
MIAMI-DADE
0 0 0 0 0 0 0 0 0
4061539538 Test NameCounty Count
County
0 01
X
0 1
X
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
4061650856 Test Name X 4061486560 Test Name X 4062452921 Test Name X
Report run on 08312018 1148 AM clients_commonrdfPage 1 of 4 Report run by RSHQALL Dispose of this Report so that it can not be read or reconstructed
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Clients Served Not Enrolled PSA ALL Start Date 01012017 End Date 12312017 Locations 0000 Provider All Providers
Service Service Min Serv Max Serv Program Start End Enrollment PSA Provider Location Program Consumer Name Client ID Service Date Date Status Enrollment Enrollment Provider
Count 0
Report run on 08312018 0201 PM Page 1 of 1 clnts_serv_no_enrrdf
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
4061472791 04
09
1092
1291
0072
0042
LTCC
LTCC
APCL
APCL
4062714543 06
06
1514
1762
0072
5006
LTCC
LTCC
APCL
APPL
4061802246 11
06
1177
1514
0179
0072
LTCC
LTCC
APCL
APCL
4061563719 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062644312 06
08
1514
1771
0072
0896
LTCC
LTCC
APCL
APCL
1001141670 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
1001141671 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
4062375003 07
05
05
07
1263
1755
1638
1263
0368
0072
0072
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062155124 06
06
1762
1514
0072
0072
LTCC
LTCC
APPL
APCL
4061743886 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0369
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4061499927 06
06
1514
1762
0072
5005
LTCC
LTCC
APCL
APPL
4061583524 08
06
1144
1514
0896
0072
LTCC
LTCC
APCL
APCL
4062694843 06
03
1514
1922
0072
0179
LTCC
LTCC
APCL
APCL
4062744517 07
06
1263
1514
0369
0072
LTCC
LTCC
APCL
APCL
4062005488 10
11
10
11
1929
1177
1164
1177
0072
0073
0179
0179
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
Report run on 08312018 0200 PM Page 1 of 2 clnts_mult_enrollrdf
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
Total Count 15
Report run on 08312018 0200 PM Page 2 of 2 clnts_mult_enrollrdf
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CODE DESCRIPTIONS Category ALL STATE TABLES
Code Description Active Available To Code Category
0 UNKNOWN Y CARES SUBJECTIVE_HEALTH_EVALUATION
01 ALACHUA Y COMMON COUNTIES
02 BAKER Y COMMON COUNTIES
03 BAY Y COMMON COUNTIES
04 BRADFORD Y COMMON COUNTIES
05 BREVARD Y COMMON COUNTIES
06 BROWARD Y COMMON COUNTIES
07 CALHOUN Y COMMON COUNTIES
08 CHARLOTTE Y COMMON COUNTIES
09 CITRUS Y COMMON COUNTIES
1 EXCELLENT Y CARES SUBJECTIVE_HEALTH_EVALUATION
10 CLAY Y COMMON COUNTIES
11 COLLIER Y COMMON COUNTIES
12 COLUMBIA Y COMMON COUNTIES
13 MIAMI-DADE Y COMMON COUNTIES
14 DESOTO Y COMMON COUNTIES
15 DIXIE Y COMMON COUNTIES
16 DUVAL Y COMMON COUNTIES
17 ESCAMBIA Y COMMON COUNTIES
18 FLAGLER Y COMMON COUNTIES
19 FRANKLIN Y COMMON COUNTIES
2 GOOD Y CARES SUBJECTIVE_HEALTH_EVALUATION
20 GADSDEN Y COMMON COUNTIES
21 GILCHRIST Y COMMON COUNTIES
22 GLADES Y COMMON COUNTIES
23 GULF Y COMMON COUNTIES
24 HAMILTON Y COMMON COUNTIES
25 HARDEE Y COMMON COUNTIES
26 HENDRY Y COMMON COUNTIES
27 HERNANDO Y COMMON COUNTIES
28 HIGHLANDS Y COMMON COUNTIES
Report run on 08312018 0140 PM Page 1 of 45 state_codesrdf Report run by RSHQALL Dispose of this report so that it cannot be read or reconstructed
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CONSUMER AGE VERIFICATION REPORT PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Program AC
Age at Start
Enroll or Start Enroll Provider Program Description Consumer Name Client ID DOB Svc date or Svc Date
Report run on 08312018 0203 PM Page 1 of 1 age_verifyrdf
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Contract Budget Information PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Program Service Provider Location County Served Provider Contract
Projected Service
Units Unit Measure
Projected Unduplicated
State Federal Share Client Count Begin Date End Date
Row Count 0 Amount Total
Report run on 08312018 0233 PM Page 1 of 1 contract_budgetrdf
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Start Enroll Latest Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Date Asmt Date Worker
O3C1 1036 000 4061653427 Test CENTRAL 34982 W M 07091930 09102013 09102013 CIRTS20804 0 Name
Report run on 08312018 1133 AM Page 1 of 6 actv_by_progrdf
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Start Enroll Date
Latest Asmt Date Worker
4061593624 Test Name CENTRAL 34946 B F 11261940 12012011 12312013 CIRTS23407
Count 164
Unduplicated Client Count 163
Report run on 08312018 1133 AM Page 6 of 6 actv_by_progrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Assessments After DOD Report
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Owner 1025
The shaded records indicate clients who have different DOBs andor different names
Assemt Current PSA Owner Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Owner Assessor
Provider Assessor
Assemt Date
Assemt Type
Unduplicated Count Total 0
Report run on 08312018 0206 PM Page 1 of 1 vs_assmrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Open Enrollments
The Vital Statistics Data for 07192002 - 09112014PSA ALL Provider ALL Program Status ACTV Include MLTC ACTVS N
The shaded records indicate clients who have different DOBs andor different names
Enroll PSA
Enrollment Provider Loc Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Enroll Program Status
Enroll Program
Current Owner ID
02 1065 0072 4062244026 Test Name Test Name 10222004 03231917 03231917 ACTV CCE 1065
Count of enrollments for the Provider 1
Count of enrollments for the PSA 1
Count of enrollments for the Report 1
Unduplicated Count of Individuals with open enrollments and DOD PSA Total Clients Count
02 1
Total 1
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Report run on 08312018 0207 PM Page 1 of 3 vs_servicesrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Unduplicated count of individuals with Services after DOD
PSA Total Clients Count
Report Total
Report run on 08312018 0207 PM Page 2 of 3 vs_servicesrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
List of Clients with PSA table entry for SERVICES_AFTER_DOD
Unduplicated Count Total 0
Report run on 08312018 0207 PM Page 3 of 3 vs_servicesrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Age
Provider
Total
Age lt 60 Age 60 - 64 Age 65 - 74 Age 75 - 84 Age 85+ Total Clients Avg Age
Total
Avg Age
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Ethnicity
Provider Hispanic Other Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Race
American Indian Native Hawaiian Other Provider Asian Alaska Native Black Pacific Islander Minority White Multiple Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Gender
Provider Male Female Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Monthly Income
Provider 0 - - Higher than Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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None
Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Total Persons Served 0
Age lt 60 Years 0 0
Age 60 - 64 0 0
Age 65 - 74 0 0
Age 75 - 84 0 0
Age 85+ 0 0
Total Age 0 0
Average 000
Ethnicity Hispanic 0 0
Other Ethnicity 0 0
Unknown Ethnicity 0 0
Total 0 0
Race Asian 0 0
American Indian Alaska Native 0 0
Black 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority 0 0
White 0 0
Multiple 0 0
Unknown 0 0
Total 0 0
Sex Male 0 0
Female 0 0
Unknown Sex 0 0
Total 0 0
Monthly Income 0 - 0 0
- 0 0
Higher than 0 0
Unknown 0 0
Total 0 0
Report run on 08312018 1058 AM Page 1 of 2 demo_by_prov_detrdf Report run byRSHQALL Dispose of this report so that it can not be read or reconstructed
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Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Client ID Date Of Birth Ethnicity Race Sex Individual Monthly Income
Report run on 08312018 1058 AM Page 2 of 2 demo_by_prov_detrdf Report run byRSHQALL Dispose of this report so that it can not be read or reconstructed
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Demographics of Clients OAA Registered Served Only PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 City All Cities Program All Programs Service All Services County ALL COUNTIES Table OAA Registered Services Only Low Income Medium Income
Total Persons Served 0
Agelt 60 Years
Age 60 - 64
Age 65 - 74
Age 75 - 84
Age 85+
0
0
0
0
0
0
0
0
0
0
Monthly Income
0 -
-Higher than
Unknown
0
0
0
0
0
0
0
0
Total
Average
0
000
0 Total 0 0
Ethnicity Hispanic
Other
Unknown
0
0
0
0
0
0
Living Situation
Alone
Null
Policy Change
0
0
0
0
0
0
Total 0 0 Unknown
With Caregiver
0
0
0
0
Race Asian 0 0
With Other
With Other Caregiver
0
0
0
0
American Indian Alaska Native
Black
0
0
0
0Total Living Situation 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority
White
0
0
0
0 Limited English Proficiency
Multiple
Unknown
Total Race
0
0
0
0
0
0
Yes
No
Unknown
0
0
0
0
0
0
Total 0 0
Sex Male
Female
Unknown
0
0
0
0
0
0
Total 0 0
Report run on 08312018 1056 AM Page 1 of 1 demo_by_provrdf
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Disaster Assistance Clients for a Provider PSA ALL Provider All Providers Location 0000 Worker All Workers City All Cities Zip Code All Zip Codes Sort By ZIP
Provider 1036 Provider Name Location 0000 Worker CIRTS18634
Need Care Client Name Address City Zip County Phone Asst Reg Situation Relat Care phone Care Name
34946 N WO DA 000 SAINT JAMES DRIVE CENTRAL (025) 101-0620 Test NameTest Name SAINT LUCIE (005) 100-0369 Y
Client is active and no assessment information is available Special Shelter and Special Registry are unknown
Report run on 08312018 1102 AM Page 1 of 8 disaster_by_provrdf
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
Total by PSA 0
Report run on 08312018 1111 AM Page 1 of 5 eheap_exceptionsrdf
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
ALACH BAKER BAY BRADF BREVA BROWA CALHO CHARL CITRUS CLAY COLLIE COLUM DESOT DIXIE DUVAL ESCAM FLAGL FRANK GADSDAssisted Household Report UA ORD RD RD UN OTTE R BIA O BIA ER LIN EN
1 of Household Assisted 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Households AssistedWith Gross Income
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C 100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D 125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
3 Households with at leastOne member
A 60 Years or older 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B Disabled 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C Age 5 years or under 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D Under 60 Years Old 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Undup Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Assisted
Applicant Household Report
of Applicant Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Energy Assisted Household Report
County of Assisted
Households
Households Assisted By Poverty Level
Under 75 75 - 100 101 - 125 126 - 150 Over 150 60 Years or older
At least one member who is
Age 5 years Age 2 years Age 3 years Disabled or younger and younger through 5
Under 60 Years Old
Undup Households
Assisted
Energy Assistance Total
Report run on 08312018 1107 AM Page 1 of 3 eheap_summaryrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Unduplicated Total 0 0
County of Assisted
Households Under 75 75 - 100
Households Assisted By Poverty Level
101 - 125 126 - 150 Over 150 60 Years or older Disabled
Age 5 years or younger
Age 2 years and younger
Age 3 years through 5
Under 60 Years Old
At least one member who is
Undup Households
Assisted
Other Assisted Household Report
Other Assistance Total
Report run on 08312018 1107 AM Page 2 of 3 eheap_summaryrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Applicant Household Report
County of Applicant
Households Under 75 75 - 100 101 - 125 126 - 150 Over 150 Income data
unavailable
Total 0
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01
Enrollment Active Consumer Count by Program PSA ALL Provider ALL PROVIDERS
County Description Program Count of Clients
BREVARD
ADI
CCE
HCE
LSP
NDP
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
MLTC
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
31
57
44
5
62
123
141
26
9
7
5
40
5
50
67
129
2
19
42
29
1
233
79
63
8
2
14
3
37
14
47
3
3
33
127
10
02
03
04
ALACHUA
BAKER
BAY
BRADFORD
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Enrollment Terminations with Reasons PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 Program All Programs Program Status ALL Program Status Worker ALL WORKERS
Last First Program Medicaid Provider Start End Name Name Client ID Status Description Worker Number Program Location Enrollment Enrollment
Count 0
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Enrollments with Care Plan Report
PSA ALL Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTIVE STATUS Care Plan Service ALL SERVICES Care Plan Start 01012017 Care Plan End 12312017
Care Plan Care Plan Care Plan Client Name
Unduplicated Client Count 0
Client ID Program Status Worker Start Date End Date Service
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PSA CLIENT_ID CLIENT_NAME OWNER PROVIDER_ID ASSESSMENT_DATE ASSESSOR_NAME MEDICAID_NUMBER CAREGIVER_CHANGE ENVIRONMENT_CHANGE HEALTH_CHANGE INCOME_CHANGE SITUATION_CHANGE INITIAL_ASSM ANNUAL_ASSM SSN REFERRAL_SOURCE 1114 N N N N Y N 771771777 SELFFAMILY 812017 JANE CASEWORKER 2 1001141633 TEST TEST N
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Fixed Service Costs List PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Provider Location County Program Service Reimbursement Unit Rate Provider Cost Per Unit Begin Valid End Valid
Count 0
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APCL Clients With Services PSA ALL Owner All Owners Provider ALL PROVIDERS Start Date 01012017 End Date 12312017
Exclude CM CA INSC REFE SCAS
PSA Client ID Name Owner Provider Program 11 4062732638 Test Name 1177 1177 LTCC
Total 21067
Unduplicated clients count 12460
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APS Assessments PSA ALL Risk Level ALL Owner All Owners Referral Date From 01012017 To 12312017
Order by Referral Date and Owner ID
PSA 03
Ref Date Owner ID Client ID Client Name Risk Level Asmt Type Asmt Date
03032017 1390 4062058415 L 701A 03302018 Test Name
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APS Assessments PSA ALL Risk Level ALL Owner All Owners Referral Date From 01012017 To 12312017
Order by Referral Date and Owner ID
12042017 1980 4061617559 H 701B 12072017 Test Name
Assessment Count for the PSA 52
PSA 04A
Ref Date Owner ID Client ID
09102017 4062308458
Client Name
Test Name
Risk Level
H
Asmt Type
O
Asmt Date
09162017
Assessment Count for the PSA 2
Risk Level H
M
L
Count of Assessments 138
23
21
Total Count of Assessments 182
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APS Repeat Referrals in a Time Range
PSA ALL Owner All Owners
Start Date 01012017 End Date 12312017
Current DOEA CIRTS Cirts SSN if Risk Date Created PSA Owner Abuse No different than DCF DCF SSN Name County Level Date of Birth Date Sent by DCF
Count 0
Unduplicated Client Count by PSA
PSA Count SSN
Total
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Assessed Prioritized Consumer List PSA ALL Provider ALL PROVIDERS Program AC County ALL COUNTIES
County Program Consumer Name Client ID
Total Count 0
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Assessment Due Report PSA 01 Start Date 01012017 End Date 08312018 Owner ALL PROVIDERS Worker ALL WORKERS Program Status ACTV and APCL Assessment Type Needed ALL
Overdue and missing assessments are always listed
Owner ID 1065
Client ID Client Name
Owner Assessor ID
Date of Birth
06281928
CIRTS28099
County of Service
GULF
Worker Name HARPER KENNY
Zip Assessment PSA Date
32534 01 01022014
Type
701A
Active Y
Nutr PriorityScore Score
11 58
Rank
5
Due Date
01022015
Status
701S OVERDUE
LTCC APPL Start Date
03252014 4062235673 Test name
Total Clients for Worker 1
Total Clients for Owner 1
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Assessment Due Report PSA 01 Start Date 01012017 End Date 08312018 Owner ALL PROVIDERS Worker ALL WORKERS Program Status ACTV and APCL Assessment Type Needed ALL
Overdue and missing assessments are always listed
Summary by PSA
PSA 01 701A Overdue 1
701B Overdue 213
701C Overdue 0
701S Overdue 157
No 701A 0
No 701B 2
No 701C 0
No 701S 0
701A Not Overdue 0
701B Not Overdue 0
701C Not Overdue 0
701S Not Overdue 0
701S Optional 0
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CIC Service Units and Costs Projections County SummaryPSA 99 Program CCE
Start Date 01012017 End Date 12312017
County LEON
Total Total Total Avg Max Projected
StateFederal Projected Reimbursement Provider Unduplicated Provider Service Share Service Units Unit Rate Cost Per Unit Client Count
Report Total
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CIC Service Units and Costs Projections Provider SummaryPSA ALL Provider ALL PROVIDERS Program FEDERALLY FUNDED (0101 TO 1231) Year 2017 From 01012017 To 12312017
PSA County Program Service Total State
Federal Share
Total Projected
Service Units
Avg Reimbursement
Unit Rate
Max Provider
Cost Per Unit
Total Projected Unduplicated Client Count
02 FRANKLIN O3C1 CONGREGATE MEALS $810300 1710 15
Program Total
County Total
$810300
$810300
GULF O3C1 CONGREGATE MEALS $25205 3 5
Program Total $25205
O3C2 HOME DELIVERED MEALS $25205 3 6
Program Total
County Total
$25205
$50411
LEON O3C1 CONGREGATE MEALS $621300 1311 15
CONGREGATE MEALS GUEST
CONGREGATE MEALS VOLUNTEERS
$252055
$277260
25
30
2
5
Program Total $1150615
O3C2 HOME DELIVERED MEAL GUEST $252055 25 3
Program Total $252055
OA3D PEARLS (SESSION 5)
PEARLS (SESSION 6)
PEARLS (SESSION 7)
PEARLS (SESSION 8)
$10247
$10247
$10247
$10247
10
10
10
10
3
3
3
3
Program Total $40988
OA3E RESPITE IN-HOME $200 2 2
Program Total
County Total
$200
$1443858
WAKULLA O3C2 EMERGENCY HOME DELIVERED SHELF MEALS
$8065604 14899 90
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CIC Service Units and Costs Projections - PSA Summary
PSA ALL Program CCE
Strat Date 01012017 End Date 12312017
Total
PSA County Provider Service
Total State Federal
Share
Total Projected
Service Units
Avg Reimbursement
Unit Rate
Max Projected Provider Unduplicated
Cost Per Unit Client Count
02 LEON SOUTHERN SERVICE CASE MANAGEMENT PROVIDER EMERGENCY HOME DELIVERED SHELF MEALS
$2175533
$602000
483
689
32
20
HOME DELIVERED MEALS $530262 993 5
MATERIAL AID $1994536 199
Provider Total $5302331
CountyTotal $5302331
WAKULLA SOUTHERN SERVICE CASE MANAGEMENT PROVIDER EMERGENCY HOME DELIVERED SHELF MEALS
$2175533
$1240200
483
689
32
5
MATERIAL AID $1994536 199
Provider Total $5410269
CountyTotal $5410269
PSA Total $10712599
05 PINELLAS BURSTEIN-APPLEBEE ADULT DAY CARE $000 0 $900 $1000 0
COUNSELING (MENTAL HEALTH COUNSELINGSCREENING) - INDIVIDUAL
Provider Total
$000
$000
0 $6600 $7700 0
CountyTotal $000
PSA Total $000
Report Total $10712599
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CID Service Units and Costs Projections - PSA SummaryPSA ALL Program CCE
Start Date 01012017 End Date 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
PSA County Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
02 LEON CASE MANAGEMENT $2175533 483
EMERGENCY HOME $602000 689DELIVERED SHELF MEALS HOME DELIVERED MEALS $530262 993
MATERIAL AID $1994536 199
County Total $5302331 2364
WAKULLA CASE MANAGEMENT $2175533 483
EMERGENCY HOME $1240200 689DELIVERED SHELF MEALS MATERIAL AID $1994536 199
County Total $5410269 1371
PSA Total $10712599 3735
05 PINELLAS ADULT DAY CARE $000 0
COUNSELING (MENTAL $000 0 HEALTH COUNSELINGSCREENING) - INDIVIDUAL
County Total $000 0
PSA Total $000 0
Report Total $10712599 3735
$900 $900 $900 $1000 $1000 $1000
$6600 $6600 $6600 $7700 $7700 $7700
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CID Service Units and Costs Projections County SummaryPSA 99
Program CCE County LEON
Start Date 01012017 End Date 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
Report Total
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CIE Service Units and Costs Projections - PSA Summary - All Programs
PSA 99 Program FEDERALLY FUNDED (0101 TO 1231) Year 2017 From 01012017 To 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
Program Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
Report Total
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CIE Service Units and Costs Projections - PSA Summary
PSA ALL Program CCE
Start Date 01012017 End Date 12312017
Avg High Low Total Total Avg High Low Provider Provider Provider
StateFederal Projected Reimbursement Reimbursement Reimbursement Cost Cost CostPSA
02
Service
CASE MANAGEMENT
Share
$4351066
Service Units
966
Unit Rate Unit Rate Unit Rate Per Unit Per Unit Per Unit
EMERGENCY HOME DELIVERED SHELF MEALS $1842200 1378
HOME DELIVERED MEALS $530262 993
MATERIAL AID $3989071 398
PSA Total $10712599 3735
05 ADULT DAY CARE $000 0 $900 $900 $900 $1000 $1000 $1000
COUNSELING (MENTAL HEALTH $000 0 $6600 $6600 $6600 $7700 $7700 $7700 COUNSELINGSCREENING) - INDIVIDUAL
PSA Total $000 0
Report Total $10712599 3735
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CAREGIVER SEARCH REPORT
SEARCH RESULTS FOR CONSUMERS
Criteria First Name Last Name SSN PSA ALL
Client Name Client SSN Caregiver Name Caregiver SSN
000000000 000000000 Test Name Test Name
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CARES Referrals in a Time Range PSA ALL
Start Date 01012017 End Date 12312017
Referred to ALL REFERRALS
Referring PSA Employee Name Client Name Client ID
Referral Imminent NH Admit Aging Date Risk Date Referred To Cares Provider Name Received Date
03A 4061561263 Test Name Test Name 09242017 Y 05292017 ARC or ADRC 09252017
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CARES Referrals in a Time Range PSA ALL
Start Date 01012017 End Date 12312017
Referred to ALL REFERRALS
Referring PSA Employee Name Client Name Client ID
Referral Date
Imminent Risk
NH Admit Date Referred To Cares Provider Name
Aging Received Date
04B Test Name Test Name 4061738075 04082017 N ARC or ADRC Test Name 04082017
Total Clients 110
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CARES Referrals not acknowledged by the Aging Network PSA ALL For Referrals after 01012017 Owner ID ALL Owners
Unduplicated Client count Cares Office Total Clients Count
Report Total
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
CIRTS Issue PSA Client ID Client Name Program
Program Status Start Provider Enrollment ID Provider Name
APCL CLIENT WITH DATE OF DEATH 08 4061759417 Test Name OA3B APCL 07232013 1141 WESTERN WORLD RADIO
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
Program Start Provider CIRTS Issue PSA Client ID Client Name Program Status Enrollment ID Provider Name
06 LTCC APCL 01242014 1514 4061713685 Test Name APCL CLIENT WITH DATE OF DEATH CENTRAL THE ORIGINAL HOUSE OF PIES
Count 503
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Civil Rights PSA ALL Provider ALL PROVIDERS Program AC Start Date 01012017 End Date 12312017 The Poverty Level for Single is The Poverty Level for Couple is Sort by County
County Unduplicated Count
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Client Information Report Start Date 01012017 End Date 12312017
Client ID 1001141246
Emergency
Client Name Test Name
Telephone () - Address 78 TEST STREET TALLAHASSEE FL 32399
Most Recent Caregiver Information Date Updated
Doctor
Comments
Client Demographic Information
Birth Date 06041940 Race W
Owner ID Ethnicity O
Most Recent Income Information
Ind Mon Inc Cpl Mon Inc
Ind Assets Couple Assets
Most Recent Assessment Information
Asmt Date Ref Risk Lvl
Asmt Site Spec Shel
AsmtType Spec Reg
Ref Date Primary CG
Ref Source Living Sit
Enrollment Information
Sex
Marital Status
F
S
Medicaid Number
ADL Score
ADL Count
IADL Score
IADL Count
Memory Score
Priority Score
Env Score
Nutr Score
Risk Score
Social Score
Rank
Provider Location Program Program Status Worker Start Date End Date
Care Plan Service Needed
Date Service Units Type Frq End Date
Care Plan Service Planned
Program Service Units Type Frq Start Date End Date
Services Received between 01012017 and 12312017
Service Billed Provider Location Worker Program Service Date Units Unit Type Amount
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Provider N
Client Service Units Report PSA ALL Provider ALL PROVIDERS Location 0000
Program ALL PROGRAMS Service ALL SERVICES Worker ALL WORKERS
City ALL CITIES Include Zero Unit N Include Aggregate N Calculated Amount equals the number of Units Provided times Fixed Cost if it existsService Start Date 01012017 Service End Date 12312017 If Fixed Cost does not exist Calculated
Group by PSA Provider Location Client Name County Worker Amount equals Billed Amount
Unduplicated Client Count 0 Grand Total 000 $000
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Clients In Common PSA All Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 County All Counties Worker All Workers
County JEFFERSON
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
MIAMI-DADE
0 0 0 0 0 0 0 0 0
4061539538 Test NameCounty Count
County
0 01
X
0 1
X
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
4061650856 Test Name X 4061486560 Test Name X 4062452921 Test Name X
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Clients Served Not Enrolled PSA ALL Start Date 01012017 End Date 12312017 Locations 0000 Provider All Providers
Service Service Min Serv Max Serv Program Start End Enrollment PSA Provider Location Program Consumer Name Client ID Service Date Date Status Enrollment Enrollment Provider
Count 0
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
4061472791 04
09
1092
1291
0072
0042
LTCC
LTCC
APCL
APCL
4062714543 06
06
1514
1762
0072
5006
LTCC
LTCC
APCL
APPL
4061802246 11
06
1177
1514
0179
0072
LTCC
LTCC
APCL
APCL
4061563719 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062644312 06
08
1514
1771
0072
0896
LTCC
LTCC
APCL
APCL
1001141670 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
1001141671 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
4062375003 07
05
05
07
1263
1755
1638
1263
0368
0072
0072
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062155124 06
06
1762
1514
0072
0072
LTCC
LTCC
APPL
APCL
4061743886 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0369
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4061499927 06
06
1514
1762
0072
5005
LTCC
LTCC
APCL
APPL
4061583524 08
06
1144
1514
0896
0072
LTCC
LTCC
APCL
APCL
4062694843 06
03
1514
1922
0072
0179
LTCC
LTCC
APCL
APCL
4062744517 07
06
1263
1514
0369
0072
LTCC
LTCC
APCL
APCL
4062005488 10
11
10
11
1929
1177
1164
1177
0072
0073
0179
0179
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
Total Count 15
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CODE DESCRIPTIONS Category ALL STATE TABLES
Code Description Active Available To Code Category
0 UNKNOWN Y CARES SUBJECTIVE_HEALTH_EVALUATION
01 ALACHUA Y COMMON COUNTIES
02 BAKER Y COMMON COUNTIES
03 BAY Y COMMON COUNTIES
04 BRADFORD Y COMMON COUNTIES
05 BREVARD Y COMMON COUNTIES
06 BROWARD Y COMMON COUNTIES
07 CALHOUN Y COMMON COUNTIES
08 CHARLOTTE Y COMMON COUNTIES
09 CITRUS Y COMMON COUNTIES
1 EXCELLENT Y CARES SUBJECTIVE_HEALTH_EVALUATION
10 CLAY Y COMMON COUNTIES
11 COLLIER Y COMMON COUNTIES
12 COLUMBIA Y COMMON COUNTIES
13 MIAMI-DADE Y COMMON COUNTIES
14 DESOTO Y COMMON COUNTIES
15 DIXIE Y COMMON COUNTIES
16 DUVAL Y COMMON COUNTIES
17 ESCAMBIA Y COMMON COUNTIES
18 FLAGLER Y COMMON COUNTIES
19 FRANKLIN Y COMMON COUNTIES
2 GOOD Y CARES SUBJECTIVE_HEALTH_EVALUATION
20 GADSDEN Y COMMON COUNTIES
21 GILCHRIST Y COMMON COUNTIES
22 GLADES Y COMMON COUNTIES
23 GULF Y COMMON COUNTIES
24 HAMILTON Y COMMON COUNTIES
25 HARDEE Y COMMON COUNTIES
26 HENDRY Y COMMON COUNTIES
27 HERNANDO Y COMMON COUNTIES
28 HIGHLANDS Y COMMON COUNTIES
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CONSUMER AGE VERIFICATION REPORT PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Program AC
Age at Start
Enroll or Start Enroll Provider Program Description Consumer Name Client ID DOB Svc date or Svc Date
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Contract Budget Information PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Program Service Provider Location County Served Provider Contract
Projected Service
Units Unit Measure
Projected Unduplicated
State Federal Share Client Count Begin Date End Date
Row Count 0 Amount Total
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Start Enroll Latest Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Date Asmt Date Worker
O3C1 1036 000 4061653427 Test CENTRAL 34982 W M 07091930 09102013 09102013 CIRTS20804 0 Name
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Start Enroll Date
Latest Asmt Date Worker
4061593624 Test Name CENTRAL 34946 B F 11261940 12012011 12312013 CIRTS23407
Count 164
Unduplicated Client Count 163
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Assessments After DOD Report
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Owner 1025
The shaded records indicate clients who have different DOBs andor different names
Assemt Current PSA Owner Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Owner Assessor
Provider Assessor
Assemt Date
Assemt Type
Unduplicated Count Total 0
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Open Enrollments
The Vital Statistics Data for 07192002 - 09112014PSA ALL Provider ALL Program Status ACTV Include MLTC ACTVS N
The shaded records indicate clients who have different DOBs andor different names
Enroll PSA
Enrollment Provider Loc Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Enroll Program Status
Enroll Program
Current Owner ID
02 1065 0072 4062244026 Test Name Test Name 10222004 03231917 03231917 ACTV CCE 1065
Count of enrollments for the Provider 1
Count of enrollments for the PSA 1
Count of enrollments for the Report 1
Unduplicated Count of Individuals with open enrollments and DOD PSA Total Clients Count
02 1
Total 1
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Unduplicated count of individuals with Services after DOD
PSA Total Clients Count
Report Total
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
List of Clients with PSA table entry for SERVICES_AFTER_DOD
Unduplicated Count Total 0
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Age
Provider
Total
Age lt 60 Age 60 - 64 Age 65 - 74 Age 75 - 84 Age 85+ Total Clients Avg Age
Total
Avg Age
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Ethnicity
Provider Hispanic Other Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Race
American Indian Native Hawaiian Other Provider Asian Alaska Native Black Pacific Islander Minority White Multiple Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Gender
Provider Male Female Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Monthly Income
Provider 0 - - Higher than Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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None
Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Total Persons Served 0
Age lt 60 Years 0 0
Age 60 - 64 0 0
Age 65 - 74 0 0
Age 75 - 84 0 0
Age 85+ 0 0
Total Age 0 0
Average 000
Ethnicity Hispanic 0 0
Other Ethnicity 0 0
Unknown Ethnicity 0 0
Total 0 0
Race Asian 0 0
American Indian Alaska Native 0 0
Black 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority 0 0
White 0 0
Multiple 0 0
Unknown 0 0
Total 0 0
Sex Male 0 0
Female 0 0
Unknown Sex 0 0
Total 0 0
Monthly Income 0 - 0 0
- 0 0
Higher than 0 0
Unknown 0 0
Total 0 0
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Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Client ID Date Of Birth Ethnicity Race Sex Individual Monthly Income
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Demographics of Clients OAA Registered Served Only PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 City All Cities Program All Programs Service All Services County ALL COUNTIES Table OAA Registered Services Only Low Income Medium Income
Total Persons Served 0
Agelt 60 Years
Age 60 - 64
Age 65 - 74
Age 75 - 84
Age 85+
0
0
0
0
0
0
0
0
0
0
Monthly Income
0 -
-Higher than
Unknown
0
0
0
0
0
0
0
0
Total
Average
0
000
0 Total 0 0
Ethnicity Hispanic
Other
Unknown
0
0
0
0
0
0
Living Situation
Alone
Null
Policy Change
0
0
0
0
0
0
Total 0 0 Unknown
With Caregiver
0
0
0
0
Race Asian 0 0
With Other
With Other Caregiver
0
0
0
0
American Indian Alaska Native
Black
0
0
0
0Total Living Situation 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority
White
0
0
0
0 Limited English Proficiency
Multiple
Unknown
Total Race
0
0
0
0
0
0
Yes
No
Unknown
0
0
0
0
0
0
Total 0 0
Sex Male
Female
Unknown
0
0
0
0
0
0
Total 0 0
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Disaster Assistance Clients for a Provider PSA ALL Provider All Providers Location 0000 Worker All Workers City All Cities Zip Code All Zip Codes Sort By ZIP
Provider 1036 Provider Name Location 0000 Worker CIRTS18634
Need Care Client Name Address City Zip County Phone Asst Reg Situation Relat Care phone Care Name
34946 N WO DA 000 SAINT JAMES DRIVE CENTRAL (025) 101-0620 Test NameTest Name SAINT LUCIE (005) 100-0369 Y
Client is active and no assessment information is available Special Shelter and Special Registry are unknown
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
Total by PSA 0
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
ALACH BAKER BAY BRADF BREVA BROWA CALHO CHARL CITRUS CLAY COLLIE COLUM DESOT DIXIE DUVAL ESCAM FLAGL FRANK GADSDAssisted Household Report UA ORD RD RD UN OTTE R BIA O BIA ER LIN EN
1 of Household Assisted 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Households AssistedWith Gross Income
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C 100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D 125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
3 Households with at leastOne member
A 60 Years or older 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B Disabled 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C Age 5 years or under 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D Under 60 Years Old 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Undup Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Assisted
Applicant Household Report
of Applicant Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Energy Assisted Household Report
County of Assisted
Households
Households Assisted By Poverty Level
Under 75 75 - 100 101 - 125 126 - 150 Over 150 60 Years or older
At least one member who is
Age 5 years Age 2 years Age 3 years Disabled or younger and younger through 5
Under 60 Years Old
Undup Households
Assisted
Energy Assistance Total
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Unduplicated Total 0 0
County of Assisted
Households Under 75 75 - 100
Households Assisted By Poverty Level
101 - 125 126 - 150 Over 150 60 Years or older Disabled
Age 5 years or younger
Age 2 years and younger
Age 3 years through 5
Under 60 Years Old
At least one member who is
Undup Households
Assisted
Other Assisted Household Report
Other Assistance Total
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Applicant Household Report
County of Applicant
Households Under 75 75 - 100 101 - 125 126 - 150 Over 150 Income data
unavailable
Total 0
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01
Enrollment Active Consumer Count by Program PSA ALL Provider ALL PROVIDERS
County Description Program Count of Clients
BREVARD
ADI
CCE
HCE
LSP
NDP
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
MLTC
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
31
57
44
5
62
123
141
26
9
7
5
40
5
50
67
129
2
19
42
29
1
233
79
63
8
2
14
3
37
14
47
3
3
33
127
10
02
03
04
ALACHUA
BAKER
BAY
BRADFORD
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Enrollment Terminations with Reasons PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 Program All Programs Program Status ALL Program Status Worker ALL WORKERS
Last First Program Medicaid Provider Start End Name Name Client ID Status Description Worker Number Program Location Enrollment Enrollment
Count 0
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Enrollments with Care Plan Report
PSA ALL Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTIVE STATUS Care Plan Service ALL SERVICES Care Plan Start 01012017 Care Plan End 12312017
Care Plan Care Plan Care Plan Client Name
Unduplicated Client Count 0
Client ID Program Status Worker Start Date End Date Service
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PSA CLIENT_ID CLIENT_NAME OWNER PROVIDER_ID ASSESSMENT_DATE ASSESSOR_NAME MEDICAID_NUMBER CAREGIVER_CHANGE ENVIRONMENT_CHANGE HEALTH_CHANGE INCOME_CHANGE SITUATION_CHANGE INITIAL_ASSM ANNUAL_ASSM SSN REFERRAL_SOURCE 1114 N N N N Y N 771771777 SELFFAMILY 812017 JANE CASEWORKER 2 1001141633 TEST TEST N
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Fixed Service Costs List PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Provider Location County Program Service Reimbursement Unit Rate Provider Cost Per Unit Begin Valid End Valid
Count 0
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APS Assessments PSA ALL Risk Level ALL Owner All Owners Referral Date From 01012017 To 12312017
Order by Referral Date and Owner ID
PSA 03
Ref Date Owner ID Client ID Client Name Risk Level Asmt Type Asmt Date
03032017 1390 4062058415 L 701A 03302018 Test Name
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APS Assessments PSA ALL Risk Level ALL Owner All Owners Referral Date From 01012017 To 12312017
Order by Referral Date and Owner ID
12042017 1980 4061617559 H 701B 12072017 Test Name
Assessment Count for the PSA 52
PSA 04A
Ref Date Owner ID Client ID
09102017 4062308458
Client Name
Test Name
Risk Level
H
Asmt Type
O
Asmt Date
09162017
Assessment Count for the PSA 2
Risk Level H
M
L
Count of Assessments 138
23
21
Total Count of Assessments 182
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APS Repeat Referrals in a Time Range
PSA ALL Owner All Owners
Start Date 01012017 End Date 12312017
Current DOEA CIRTS Cirts SSN if Risk Date Created PSA Owner Abuse No different than DCF DCF SSN Name County Level Date of Birth Date Sent by DCF
Count 0
Unduplicated Client Count by PSA
PSA Count SSN
Total
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Assessed Prioritized Consumer List PSA ALL Provider ALL PROVIDERS Program AC County ALL COUNTIES
County Program Consumer Name Client ID
Total Count 0
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Assessment Due Report PSA 01 Start Date 01012017 End Date 08312018 Owner ALL PROVIDERS Worker ALL WORKERS Program Status ACTV and APCL Assessment Type Needed ALL
Overdue and missing assessments are always listed
Owner ID 1065
Client ID Client Name
Owner Assessor ID
Date of Birth
06281928
CIRTS28099
County of Service
GULF
Worker Name HARPER KENNY
Zip Assessment PSA Date
32534 01 01022014
Type
701A
Active Y
Nutr PriorityScore Score
11 58
Rank
5
Due Date
01022015
Status
701S OVERDUE
LTCC APPL Start Date
03252014 4062235673 Test name
Total Clients for Worker 1
Total Clients for Owner 1
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Assessment Due Report PSA 01 Start Date 01012017 End Date 08312018 Owner ALL PROVIDERS Worker ALL WORKERS Program Status ACTV and APCL Assessment Type Needed ALL
Overdue and missing assessments are always listed
Summary by PSA
PSA 01 701A Overdue 1
701B Overdue 213
701C Overdue 0
701S Overdue 157
No 701A 0
No 701B 2
No 701C 0
No 701S 0
701A Not Overdue 0
701B Not Overdue 0
701C Not Overdue 0
701S Not Overdue 0
701S Optional 0
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CIC Service Units and Costs Projections County SummaryPSA 99 Program CCE
Start Date 01012017 End Date 12312017
County LEON
Total Total Total Avg Max Projected
StateFederal Projected Reimbursement Provider Unduplicated Provider Service Share Service Units Unit Rate Cost Per Unit Client Count
Report Total
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CIC Service Units and Costs Projections Provider SummaryPSA ALL Provider ALL PROVIDERS Program FEDERALLY FUNDED (0101 TO 1231) Year 2017 From 01012017 To 12312017
PSA County Program Service Total State
Federal Share
Total Projected
Service Units
Avg Reimbursement
Unit Rate
Max Provider
Cost Per Unit
Total Projected Unduplicated Client Count
02 FRANKLIN O3C1 CONGREGATE MEALS $810300 1710 15
Program Total
County Total
$810300
$810300
GULF O3C1 CONGREGATE MEALS $25205 3 5
Program Total $25205
O3C2 HOME DELIVERED MEALS $25205 3 6
Program Total
County Total
$25205
$50411
LEON O3C1 CONGREGATE MEALS $621300 1311 15
CONGREGATE MEALS GUEST
CONGREGATE MEALS VOLUNTEERS
$252055
$277260
25
30
2
5
Program Total $1150615
O3C2 HOME DELIVERED MEAL GUEST $252055 25 3
Program Total $252055
OA3D PEARLS (SESSION 5)
PEARLS (SESSION 6)
PEARLS (SESSION 7)
PEARLS (SESSION 8)
$10247
$10247
$10247
$10247
10
10
10
10
3
3
3
3
Program Total $40988
OA3E RESPITE IN-HOME $200 2 2
Program Total
County Total
$200
$1443858
WAKULLA O3C2 EMERGENCY HOME DELIVERED SHELF MEALS
$8065604 14899 90
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CIC Service Units and Costs Projections - PSA Summary
PSA ALL Program CCE
Strat Date 01012017 End Date 12312017
Total
PSA County Provider Service
Total State Federal
Share
Total Projected
Service Units
Avg Reimbursement
Unit Rate
Max Projected Provider Unduplicated
Cost Per Unit Client Count
02 LEON SOUTHERN SERVICE CASE MANAGEMENT PROVIDER EMERGENCY HOME DELIVERED SHELF MEALS
$2175533
$602000
483
689
32
20
HOME DELIVERED MEALS $530262 993 5
MATERIAL AID $1994536 199
Provider Total $5302331
CountyTotal $5302331
WAKULLA SOUTHERN SERVICE CASE MANAGEMENT PROVIDER EMERGENCY HOME DELIVERED SHELF MEALS
$2175533
$1240200
483
689
32
5
MATERIAL AID $1994536 199
Provider Total $5410269
CountyTotal $5410269
PSA Total $10712599
05 PINELLAS BURSTEIN-APPLEBEE ADULT DAY CARE $000 0 $900 $1000 0
COUNSELING (MENTAL HEALTH COUNSELINGSCREENING) - INDIVIDUAL
Provider Total
$000
$000
0 $6600 $7700 0
CountyTotal $000
PSA Total $000
Report Total $10712599
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CID Service Units and Costs Projections - PSA SummaryPSA ALL Program CCE
Start Date 01012017 End Date 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
PSA County Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
02 LEON CASE MANAGEMENT $2175533 483
EMERGENCY HOME $602000 689DELIVERED SHELF MEALS HOME DELIVERED MEALS $530262 993
MATERIAL AID $1994536 199
County Total $5302331 2364
WAKULLA CASE MANAGEMENT $2175533 483
EMERGENCY HOME $1240200 689DELIVERED SHELF MEALS MATERIAL AID $1994536 199
County Total $5410269 1371
PSA Total $10712599 3735
05 PINELLAS ADULT DAY CARE $000 0
COUNSELING (MENTAL $000 0 HEALTH COUNSELINGSCREENING) - INDIVIDUAL
County Total $000 0
PSA Total $000 0
Report Total $10712599 3735
$900 $900 $900 $1000 $1000 $1000
$6600 $6600 $6600 $7700 $7700 $7700
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CID Service Units and Costs Projections County SummaryPSA 99
Program CCE County LEON
Start Date 01012017 End Date 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
Report Total
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CIE Service Units and Costs Projections - PSA Summary - All Programs
PSA 99 Program FEDERALLY FUNDED (0101 TO 1231) Year 2017 From 01012017 To 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
Program Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
Report Total
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CIE Service Units and Costs Projections - PSA Summary
PSA ALL Program CCE
Start Date 01012017 End Date 12312017
Avg High Low Total Total Avg High Low Provider Provider Provider
StateFederal Projected Reimbursement Reimbursement Reimbursement Cost Cost CostPSA
02
Service
CASE MANAGEMENT
Share
$4351066
Service Units
966
Unit Rate Unit Rate Unit Rate Per Unit Per Unit Per Unit
EMERGENCY HOME DELIVERED SHELF MEALS $1842200 1378
HOME DELIVERED MEALS $530262 993
MATERIAL AID $3989071 398
PSA Total $10712599 3735
05 ADULT DAY CARE $000 0 $900 $900 $900 $1000 $1000 $1000
COUNSELING (MENTAL HEALTH $000 0 $6600 $6600 $6600 $7700 $7700 $7700 COUNSELINGSCREENING) - INDIVIDUAL
PSA Total $000 0
Report Total $10712599 3735
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CAREGIVER SEARCH REPORT
SEARCH RESULTS FOR CONSUMERS
Criteria First Name Last Name SSN PSA ALL
Client Name Client SSN Caregiver Name Caregiver SSN
000000000 000000000 Test Name Test Name
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CARES Referrals in a Time Range PSA ALL
Start Date 01012017 End Date 12312017
Referred to ALL REFERRALS
Referring PSA Employee Name Client Name Client ID
Referral Imminent NH Admit Aging Date Risk Date Referred To Cares Provider Name Received Date
03A 4061561263 Test Name Test Name 09242017 Y 05292017 ARC or ADRC 09252017
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CARES Referrals in a Time Range PSA ALL
Start Date 01012017 End Date 12312017
Referred to ALL REFERRALS
Referring PSA Employee Name Client Name Client ID
Referral Date
Imminent Risk
NH Admit Date Referred To Cares Provider Name
Aging Received Date
04B Test Name Test Name 4061738075 04082017 N ARC or ADRC Test Name 04082017
Total Clients 110
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CARES Referrals not acknowledged by the Aging Network PSA ALL For Referrals after 01012017 Owner ID ALL Owners
Unduplicated Client count Cares Office Total Clients Count
Report Total
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
CIRTS Issue PSA Client ID Client Name Program
Program Status Start Provider Enrollment ID Provider Name
APCL CLIENT WITH DATE OF DEATH 08 4061759417 Test Name OA3B APCL 07232013 1141 WESTERN WORLD RADIO
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
Program Start Provider CIRTS Issue PSA Client ID Client Name Program Status Enrollment ID Provider Name
06 LTCC APCL 01242014 1514 4061713685 Test Name APCL CLIENT WITH DATE OF DEATH CENTRAL THE ORIGINAL HOUSE OF PIES
Count 503
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Civil Rights PSA ALL Provider ALL PROVIDERS Program AC Start Date 01012017 End Date 12312017 The Poverty Level for Single is The Poverty Level for Couple is Sort by County
County Unduplicated Count
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Client Information Report Start Date 01012017 End Date 12312017
Client ID 1001141246
Emergency
Client Name Test Name
Telephone () - Address 78 TEST STREET TALLAHASSEE FL 32399
Most Recent Caregiver Information Date Updated
Doctor
Comments
Client Demographic Information
Birth Date 06041940 Race W
Owner ID Ethnicity O
Most Recent Income Information
Ind Mon Inc Cpl Mon Inc
Ind Assets Couple Assets
Most Recent Assessment Information
Asmt Date Ref Risk Lvl
Asmt Site Spec Shel
AsmtType Spec Reg
Ref Date Primary CG
Ref Source Living Sit
Enrollment Information
Sex
Marital Status
F
S
Medicaid Number
ADL Score
ADL Count
IADL Score
IADL Count
Memory Score
Priority Score
Env Score
Nutr Score
Risk Score
Social Score
Rank
Provider Location Program Program Status Worker Start Date End Date
Care Plan Service Needed
Date Service Units Type Frq End Date
Care Plan Service Planned
Program Service Units Type Frq Start Date End Date
Services Received between 01012017 and 12312017
Service Billed Provider Location Worker Program Service Date Units Unit Type Amount
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Provider N
Client Service Units Report PSA ALL Provider ALL PROVIDERS Location 0000
Program ALL PROGRAMS Service ALL SERVICES Worker ALL WORKERS
City ALL CITIES Include Zero Unit N Include Aggregate N Calculated Amount equals the number of Units Provided times Fixed Cost if it existsService Start Date 01012017 Service End Date 12312017 If Fixed Cost does not exist Calculated
Group by PSA Provider Location Client Name County Worker Amount equals Billed Amount
Unduplicated Client Count 0 Grand Total 000 $000
Report run on 08312018 0234 PM Page 1 of 1 clnt_serv_unitsrdf
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Clients In Common PSA All Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 County All Counties Worker All Workers
County JEFFERSON
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
MIAMI-DADE
0 0 0 0 0 0 0 0 0
4061539538 Test NameCounty Count
County
0 01
X
0 1
X
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
4061650856 Test Name X 4061486560 Test Name X 4062452921 Test Name X
Report run on 08312018 1148 AM clients_commonrdfPage 1 of 4 Report run by RSHQALL Dispose of this Report so that it can not be read or reconstructed
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Clients Served Not Enrolled PSA ALL Start Date 01012017 End Date 12312017 Locations 0000 Provider All Providers
Service Service Min Serv Max Serv Program Start End Enrollment PSA Provider Location Program Consumer Name Client ID Service Date Date Status Enrollment Enrollment Provider
Count 0
Report run on 08312018 0201 PM Page 1 of 1 clnts_serv_no_enrrdf
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
4061472791 04
09
1092
1291
0072
0042
LTCC
LTCC
APCL
APCL
4062714543 06
06
1514
1762
0072
5006
LTCC
LTCC
APCL
APPL
4061802246 11
06
1177
1514
0179
0072
LTCC
LTCC
APCL
APCL
4061563719 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062644312 06
08
1514
1771
0072
0896
LTCC
LTCC
APCL
APCL
1001141670 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
1001141671 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
4062375003 07
05
05
07
1263
1755
1638
1263
0368
0072
0072
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062155124 06
06
1762
1514
0072
0072
LTCC
LTCC
APPL
APCL
4061743886 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0369
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4061499927 06
06
1514
1762
0072
5005
LTCC
LTCC
APCL
APPL
4061583524 08
06
1144
1514
0896
0072
LTCC
LTCC
APCL
APCL
4062694843 06
03
1514
1922
0072
0179
LTCC
LTCC
APCL
APCL
4062744517 07
06
1263
1514
0369
0072
LTCC
LTCC
APCL
APCL
4062005488 10
11
10
11
1929
1177
1164
1177
0072
0073
0179
0179
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
Report run on 08312018 0200 PM Page 1 of 2 clnts_mult_enrollrdf
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
Total Count 15
Report run on 08312018 0200 PM Page 2 of 2 clnts_mult_enrollrdf
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CODE DESCRIPTIONS Category ALL STATE TABLES
Code Description Active Available To Code Category
0 UNKNOWN Y CARES SUBJECTIVE_HEALTH_EVALUATION
01 ALACHUA Y COMMON COUNTIES
02 BAKER Y COMMON COUNTIES
03 BAY Y COMMON COUNTIES
04 BRADFORD Y COMMON COUNTIES
05 BREVARD Y COMMON COUNTIES
06 BROWARD Y COMMON COUNTIES
07 CALHOUN Y COMMON COUNTIES
08 CHARLOTTE Y COMMON COUNTIES
09 CITRUS Y COMMON COUNTIES
1 EXCELLENT Y CARES SUBJECTIVE_HEALTH_EVALUATION
10 CLAY Y COMMON COUNTIES
11 COLLIER Y COMMON COUNTIES
12 COLUMBIA Y COMMON COUNTIES
13 MIAMI-DADE Y COMMON COUNTIES
14 DESOTO Y COMMON COUNTIES
15 DIXIE Y COMMON COUNTIES
16 DUVAL Y COMMON COUNTIES
17 ESCAMBIA Y COMMON COUNTIES
18 FLAGLER Y COMMON COUNTIES
19 FRANKLIN Y COMMON COUNTIES
2 GOOD Y CARES SUBJECTIVE_HEALTH_EVALUATION
20 GADSDEN Y COMMON COUNTIES
21 GILCHRIST Y COMMON COUNTIES
22 GLADES Y COMMON COUNTIES
23 GULF Y COMMON COUNTIES
24 HAMILTON Y COMMON COUNTIES
25 HARDEE Y COMMON COUNTIES
26 HENDRY Y COMMON COUNTIES
27 HERNANDO Y COMMON COUNTIES
28 HIGHLANDS Y COMMON COUNTIES
Report run on 08312018 0140 PM Page 1 of 45 state_codesrdf Report run by RSHQALL Dispose of this report so that it cannot be read or reconstructed
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CONSUMER AGE VERIFICATION REPORT PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Program AC
Age at Start
Enroll or Start Enroll Provider Program Description Consumer Name Client ID DOB Svc date or Svc Date
Report run on 08312018 0203 PM Page 1 of 1 age_verifyrdf
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Contract Budget Information PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Program Service Provider Location County Served Provider Contract
Projected Service
Units Unit Measure
Projected Unduplicated
State Federal Share Client Count Begin Date End Date
Row Count 0 Amount Total
Report run on 08312018 0233 PM Page 1 of 1 contract_budgetrdf
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Start Enroll Latest Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Date Asmt Date Worker
O3C1 1036 000 4061653427 Test CENTRAL 34982 W M 07091930 09102013 09102013 CIRTS20804 0 Name
Report run on 08312018 1133 AM Page 1 of 6 actv_by_progrdf
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Start Enroll Date
Latest Asmt Date Worker
4061593624 Test Name CENTRAL 34946 B F 11261940 12012011 12312013 CIRTS23407
Count 164
Unduplicated Client Count 163
Report run on 08312018 1133 AM Page 6 of 6 actv_by_progrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Assessments After DOD Report
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Owner 1025
The shaded records indicate clients who have different DOBs andor different names
Assemt Current PSA Owner Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Owner Assessor
Provider Assessor
Assemt Date
Assemt Type
Unduplicated Count Total 0
Report run on 08312018 0206 PM Page 1 of 1 vs_assmrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Open Enrollments
The Vital Statistics Data for 07192002 - 09112014PSA ALL Provider ALL Program Status ACTV Include MLTC ACTVS N
The shaded records indicate clients who have different DOBs andor different names
Enroll PSA
Enrollment Provider Loc Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Enroll Program Status
Enroll Program
Current Owner ID
02 1065 0072 4062244026 Test Name Test Name 10222004 03231917 03231917 ACTV CCE 1065
Count of enrollments for the Provider 1
Count of enrollments for the PSA 1
Count of enrollments for the Report 1
Unduplicated Count of Individuals with open enrollments and DOD PSA Total Clients Count
02 1
Total 1
Report run on 08312018 0205 PM Page 1 of 1 vs_open_enrollrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Report run on 08312018 0207 PM Page 1 of 3 vs_servicesrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Unduplicated count of individuals with Services after DOD
PSA Total Clients Count
Report Total
Report run on 08312018 0207 PM Page 2 of 3 vs_servicesrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
List of Clients with PSA table entry for SERVICES_AFTER_DOD
Unduplicated Count Total 0
Report run on 08312018 0207 PM Page 3 of 3 vs_servicesrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Age
Provider
Total
Age lt 60 Age 60 - 64 Age 65 - 74 Age 75 - 84 Age 85+ Total Clients Avg Age
Total
Avg Age
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 1 of 5 demo_all_prvrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Ethnicity
Provider Hispanic Other Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 2 of 5 demo_all_prvrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Race
American Indian Native Hawaiian Other Provider Asian Alaska Native Black Pacific Islander Minority White Multiple Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Gender
Provider Male Female Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 4 of 5 demo_all_prvrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Monthly Income
Provider 0 - - Higher than Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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None
Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Total Persons Served 0
Age lt 60 Years 0 0
Age 60 - 64 0 0
Age 65 - 74 0 0
Age 75 - 84 0 0
Age 85+ 0 0
Total Age 0 0
Average 000
Ethnicity Hispanic 0 0
Other Ethnicity 0 0
Unknown Ethnicity 0 0
Total 0 0
Race Asian 0 0
American Indian Alaska Native 0 0
Black 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority 0 0
White 0 0
Multiple 0 0
Unknown 0 0
Total 0 0
Sex Male 0 0
Female 0 0
Unknown Sex 0 0
Total 0 0
Monthly Income 0 - 0 0
- 0 0
Higher than 0 0
Unknown 0 0
Total 0 0
Report run on 08312018 1058 AM Page 1 of 2 demo_by_prov_detrdf Report run byRSHQALL Dispose of this report so that it can not be read or reconstructed
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Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Client ID Date Of Birth Ethnicity Race Sex Individual Monthly Income
Report run on 08312018 1058 AM Page 2 of 2 demo_by_prov_detrdf Report run byRSHQALL Dispose of this report so that it can not be read or reconstructed
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Demographics of Clients OAA Registered Served Only PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 City All Cities Program All Programs Service All Services County ALL COUNTIES Table OAA Registered Services Only Low Income Medium Income
Total Persons Served 0
Agelt 60 Years
Age 60 - 64
Age 65 - 74
Age 75 - 84
Age 85+
0
0
0
0
0
0
0
0
0
0
Monthly Income
0 -
-Higher than
Unknown
0
0
0
0
0
0
0
0
Total
Average
0
000
0 Total 0 0
Ethnicity Hispanic
Other
Unknown
0
0
0
0
0
0
Living Situation
Alone
Null
Policy Change
0
0
0
0
0
0
Total 0 0 Unknown
With Caregiver
0
0
0
0
Race Asian 0 0
With Other
With Other Caregiver
0
0
0
0
American Indian Alaska Native
Black
0
0
0
0Total Living Situation 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority
White
0
0
0
0 Limited English Proficiency
Multiple
Unknown
Total Race
0
0
0
0
0
0
Yes
No
Unknown
0
0
0
0
0
0
Total 0 0
Sex Male
Female
Unknown
0
0
0
0
0
0
Total 0 0
Report run on 08312018 1056 AM Page 1 of 1 demo_by_provrdf
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Disaster Assistance Clients for a Provider PSA ALL Provider All Providers Location 0000 Worker All Workers City All Cities Zip Code All Zip Codes Sort By ZIP
Provider 1036 Provider Name Location 0000 Worker CIRTS18634
Need Care Client Name Address City Zip County Phone Asst Reg Situation Relat Care phone Care Name
34946 N WO DA 000 SAINT JAMES DRIVE CENTRAL (025) 101-0620 Test NameTest Name SAINT LUCIE (005) 100-0369 Y
Client is active and no assessment information is available Special Shelter and Special Registry are unknown
Report run on 08312018 1102 AM Page 1 of 8 disaster_by_provrdf
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
Total by PSA 0
Report run on 08312018 1111 AM Page 1 of 5 eheap_exceptionsrdf
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
ALACH BAKER BAY BRADF BREVA BROWA CALHO CHARL CITRUS CLAY COLLIE COLUM DESOT DIXIE DUVAL ESCAM FLAGL FRANK GADSDAssisted Household Report UA ORD RD RD UN OTTE R BIA O BIA ER LIN EN
1 of Household Assisted 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Households AssistedWith Gross Income
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C 100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D 125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
3 Households with at leastOne member
A 60 Years or older 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B Disabled 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C Age 5 years or under 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D Under 60 Years Old 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Undup Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Assisted
Applicant Household Report
of Applicant Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Energy Assisted Household Report
County of Assisted
Households
Households Assisted By Poverty Level
Under 75 75 - 100 101 - 125 126 - 150 Over 150 60 Years or older
At least one member who is
Age 5 years Age 2 years Age 3 years Disabled or younger and younger through 5
Under 60 Years Old
Undup Households
Assisted
Energy Assistance Total
Report run on 08312018 1107 AM Page 1 of 3 eheap_summaryrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Unduplicated Total 0 0
County of Assisted
Households Under 75 75 - 100
Households Assisted By Poverty Level
101 - 125 126 - 150 Over 150 60 Years or older Disabled
Age 5 years or younger
Age 2 years and younger
Age 3 years through 5
Under 60 Years Old
At least one member who is
Undup Households
Assisted
Other Assisted Household Report
Other Assistance Total
Report run on 08312018 1107 AM Page 2 of 3 eheap_summaryrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Applicant Household Report
County of Applicant
Households Under 75 75 - 100 101 - 125 126 - 150 Over 150 Income data
unavailable
Total 0
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01
Enrollment Active Consumer Count by Program PSA ALL Provider ALL PROVIDERS
County Description Program Count of Clients
BREVARD
ADI
CCE
HCE
LSP
NDP
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
MLTC
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
31
57
44
5
62
123
141
26
9
7
5
40
5
50
67
129
2
19
42
29
1
233
79
63
8
2
14
3
37
14
47
3
3
33
127
10
02
03
04
ALACHUA
BAKER
BAY
BRADFORD
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Enrollment Terminations with Reasons PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 Program All Programs Program Status ALL Program Status Worker ALL WORKERS
Last First Program Medicaid Provider Start End Name Name Client ID Status Description Worker Number Program Location Enrollment Enrollment
Count 0
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Enrollments with Care Plan Report
PSA ALL Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTIVE STATUS Care Plan Service ALL SERVICES Care Plan Start 01012017 Care Plan End 12312017
Care Plan Care Plan Care Plan Client Name
Unduplicated Client Count 0
Client ID Program Status Worker Start Date End Date Service
Report run on 08312018 1054 AM Page 1 of 1 enroll_careplrdf Report run by RSHQALL Dispose of this report so that it cannot be read or reconstructed
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PSA CLIENT_ID CLIENT_NAME OWNER PROVIDER_ID ASSESSMENT_DATE ASSESSOR_NAME MEDICAID_NUMBER CAREGIVER_CHANGE ENVIRONMENT_CHANGE HEALTH_CHANGE INCOME_CHANGE SITUATION_CHANGE INITIAL_ASSM ANNUAL_ASSM SSN REFERRAL_SOURCE 1114 N N N N Y N 771771777 SELFFAMILY 812017 JANE CASEWORKER 2 1001141633 TEST TEST N
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Fixed Service Costs List PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Provider Location County Program Service Reimbursement Unit Rate Provider Cost Per Unit Begin Valid End Valid
Count 0
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APS Assessments PSA ALL Risk Level ALL Owner All Owners Referral Date From 01012017 To 12312017
Order by Referral Date and Owner ID
12042017 1980 4061617559 H 701B 12072017 Test Name
Assessment Count for the PSA 52
PSA 04A
Ref Date Owner ID Client ID
09102017 4062308458
Client Name
Test Name
Risk Level
H
Asmt Type
O
Asmt Date
09162017
Assessment Count for the PSA 2
Risk Level H
M
L
Count of Assessments 138
23
21
Total Count of Assessments 182
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APS Repeat Referrals in a Time Range
PSA ALL Owner All Owners
Start Date 01012017 End Date 12312017
Current DOEA CIRTS Cirts SSN if Risk Date Created PSA Owner Abuse No different than DCF DCF SSN Name County Level Date of Birth Date Sent by DCF
Count 0
Unduplicated Client Count by PSA
PSA Count SSN
Total
Report run on 08312018 0157 PM Page 1 of 1 aps_date_rangerdf
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Assessed Prioritized Consumer List PSA ALL Provider ALL PROVIDERS Program AC County ALL COUNTIES
County Program Consumer Name Client ID
Total Count 0
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Assessment Due Report PSA 01 Start Date 01012017 End Date 08312018 Owner ALL PROVIDERS Worker ALL WORKERS Program Status ACTV and APCL Assessment Type Needed ALL
Overdue and missing assessments are always listed
Owner ID 1065
Client ID Client Name
Owner Assessor ID
Date of Birth
06281928
CIRTS28099
County of Service
GULF
Worker Name HARPER KENNY
Zip Assessment PSA Date
32534 01 01022014
Type
701A
Active Y
Nutr PriorityScore Score
11 58
Rank
5
Due Date
01022015
Status
701S OVERDUE
LTCC APPL Start Date
03252014 4062235673 Test name
Total Clients for Worker 1
Total Clients for Owner 1
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Assessment Due Report PSA 01 Start Date 01012017 End Date 08312018 Owner ALL PROVIDERS Worker ALL WORKERS Program Status ACTV and APCL Assessment Type Needed ALL
Overdue and missing assessments are always listed
Summary by PSA
PSA 01 701A Overdue 1
701B Overdue 213
701C Overdue 0
701S Overdue 157
No 701A 0
No 701B 2
No 701C 0
No 701S 0
701A Not Overdue 0
701B Not Overdue 0
701C Not Overdue 0
701S Not Overdue 0
701S Optional 0
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CIC Service Units and Costs Projections County SummaryPSA 99 Program CCE
Start Date 01012017 End Date 12312017
County LEON
Total Total Total Avg Max Projected
StateFederal Projected Reimbursement Provider Unduplicated Provider Service Share Service Units Unit Rate Cost Per Unit Client Count
Report Total
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CIC Service Units and Costs Projections Provider SummaryPSA ALL Provider ALL PROVIDERS Program FEDERALLY FUNDED (0101 TO 1231) Year 2017 From 01012017 To 12312017
PSA County Program Service Total State
Federal Share
Total Projected
Service Units
Avg Reimbursement
Unit Rate
Max Provider
Cost Per Unit
Total Projected Unduplicated Client Count
02 FRANKLIN O3C1 CONGREGATE MEALS $810300 1710 15
Program Total
County Total
$810300
$810300
GULF O3C1 CONGREGATE MEALS $25205 3 5
Program Total $25205
O3C2 HOME DELIVERED MEALS $25205 3 6
Program Total
County Total
$25205
$50411
LEON O3C1 CONGREGATE MEALS $621300 1311 15
CONGREGATE MEALS GUEST
CONGREGATE MEALS VOLUNTEERS
$252055
$277260
25
30
2
5
Program Total $1150615
O3C2 HOME DELIVERED MEAL GUEST $252055 25 3
Program Total $252055
OA3D PEARLS (SESSION 5)
PEARLS (SESSION 6)
PEARLS (SESSION 7)
PEARLS (SESSION 8)
$10247
$10247
$10247
$10247
10
10
10
10
3
3
3
3
Program Total $40988
OA3E RESPITE IN-HOME $200 2 2
Program Total
County Total
$200
$1443858
WAKULLA O3C2 EMERGENCY HOME DELIVERED SHELF MEALS
$8065604 14899 90
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CIC Service Units and Costs Projections - PSA Summary
PSA ALL Program CCE
Strat Date 01012017 End Date 12312017
Total
PSA County Provider Service
Total State Federal
Share
Total Projected
Service Units
Avg Reimbursement
Unit Rate
Max Projected Provider Unduplicated
Cost Per Unit Client Count
02 LEON SOUTHERN SERVICE CASE MANAGEMENT PROVIDER EMERGENCY HOME DELIVERED SHELF MEALS
$2175533
$602000
483
689
32
20
HOME DELIVERED MEALS $530262 993 5
MATERIAL AID $1994536 199
Provider Total $5302331
CountyTotal $5302331
WAKULLA SOUTHERN SERVICE CASE MANAGEMENT PROVIDER EMERGENCY HOME DELIVERED SHELF MEALS
$2175533
$1240200
483
689
32
5
MATERIAL AID $1994536 199
Provider Total $5410269
CountyTotal $5410269
PSA Total $10712599
05 PINELLAS BURSTEIN-APPLEBEE ADULT DAY CARE $000 0 $900 $1000 0
COUNSELING (MENTAL HEALTH COUNSELINGSCREENING) - INDIVIDUAL
Provider Total
$000
$000
0 $6600 $7700 0
CountyTotal $000
PSA Total $000
Report Total $10712599
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CID Service Units and Costs Projections - PSA SummaryPSA ALL Program CCE
Start Date 01012017 End Date 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
PSA County Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
02 LEON CASE MANAGEMENT $2175533 483
EMERGENCY HOME $602000 689DELIVERED SHELF MEALS HOME DELIVERED MEALS $530262 993
MATERIAL AID $1994536 199
County Total $5302331 2364
WAKULLA CASE MANAGEMENT $2175533 483
EMERGENCY HOME $1240200 689DELIVERED SHELF MEALS MATERIAL AID $1994536 199
County Total $5410269 1371
PSA Total $10712599 3735
05 PINELLAS ADULT DAY CARE $000 0
COUNSELING (MENTAL $000 0 HEALTH COUNSELINGSCREENING) - INDIVIDUAL
County Total $000 0
PSA Total $000 0
Report Total $10712599 3735
$900 $900 $900 $1000 $1000 $1000
$6600 $6600 $6600 $7700 $7700 $7700
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CID Service Units and Costs Projections County SummaryPSA 99
Program CCE County LEON
Start Date 01012017 End Date 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
Report Total
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CIE Service Units and Costs Projections - PSA Summary - All Programs
PSA 99 Program FEDERALLY FUNDED (0101 TO 1231) Year 2017 From 01012017 To 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
Program Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
Report Total
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CIE Service Units and Costs Projections - PSA Summary
PSA ALL Program CCE
Start Date 01012017 End Date 12312017
Avg High Low Total Total Avg High Low Provider Provider Provider
StateFederal Projected Reimbursement Reimbursement Reimbursement Cost Cost CostPSA
02
Service
CASE MANAGEMENT
Share
$4351066
Service Units
966
Unit Rate Unit Rate Unit Rate Per Unit Per Unit Per Unit
EMERGENCY HOME DELIVERED SHELF MEALS $1842200 1378
HOME DELIVERED MEALS $530262 993
MATERIAL AID $3989071 398
PSA Total $10712599 3735
05 ADULT DAY CARE $000 0 $900 $900 $900 $1000 $1000 $1000
COUNSELING (MENTAL HEALTH $000 0 $6600 $6600 $6600 $7700 $7700 $7700 COUNSELINGSCREENING) - INDIVIDUAL
PSA Total $000 0
Report Total $10712599 3735
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CAREGIVER SEARCH REPORT
SEARCH RESULTS FOR CONSUMERS
Criteria First Name Last Name SSN PSA ALL
Client Name Client SSN Caregiver Name Caregiver SSN
000000000 000000000 Test Name Test Name
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CARES Referrals in a Time Range PSA ALL
Start Date 01012017 End Date 12312017
Referred to ALL REFERRALS
Referring PSA Employee Name Client Name Client ID
Referral Imminent NH Admit Aging Date Risk Date Referred To Cares Provider Name Received Date
03A 4061561263 Test Name Test Name 09242017 Y 05292017 ARC or ADRC 09252017
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CARES Referrals in a Time Range PSA ALL
Start Date 01012017 End Date 12312017
Referred to ALL REFERRALS
Referring PSA Employee Name Client Name Client ID
Referral Date
Imminent Risk
NH Admit Date Referred To Cares Provider Name
Aging Received Date
04B Test Name Test Name 4061738075 04082017 N ARC or ADRC Test Name 04082017
Total Clients 110
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CARES Referrals not acknowledged by the Aging Network PSA ALL For Referrals after 01012017 Owner ID ALL Owners
Unduplicated Client count Cares Office Total Clients Count
Report Total
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
CIRTS Issue PSA Client ID Client Name Program
Program Status Start Provider Enrollment ID Provider Name
APCL CLIENT WITH DATE OF DEATH 08 4061759417 Test Name OA3B APCL 07232013 1141 WESTERN WORLD RADIO
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
Program Start Provider CIRTS Issue PSA Client ID Client Name Program Status Enrollment ID Provider Name
06 LTCC APCL 01242014 1514 4061713685 Test Name APCL CLIENT WITH DATE OF DEATH CENTRAL THE ORIGINAL HOUSE OF PIES
Count 503
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Civil Rights PSA ALL Provider ALL PROVIDERS Program AC Start Date 01012017 End Date 12312017 The Poverty Level for Single is The Poverty Level for Couple is Sort by County
County Unduplicated Count
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Client Information Report Start Date 01012017 End Date 12312017
Client ID 1001141246
Emergency
Client Name Test Name
Telephone () - Address 78 TEST STREET TALLAHASSEE FL 32399
Most Recent Caregiver Information Date Updated
Doctor
Comments
Client Demographic Information
Birth Date 06041940 Race W
Owner ID Ethnicity O
Most Recent Income Information
Ind Mon Inc Cpl Mon Inc
Ind Assets Couple Assets
Most Recent Assessment Information
Asmt Date Ref Risk Lvl
Asmt Site Spec Shel
AsmtType Spec Reg
Ref Date Primary CG
Ref Source Living Sit
Enrollment Information
Sex
Marital Status
F
S
Medicaid Number
ADL Score
ADL Count
IADL Score
IADL Count
Memory Score
Priority Score
Env Score
Nutr Score
Risk Score
Social Score
Rank
Provider Location Program Program Status Worker Start Date End Date
Care Plan Service Needed
Date Service Units Type Frq End Date
Care Plan Service Planned
Program Service Units Type Frq Start Date End Date
Services Received between 01012017 and 12312017
Service Billed Provider Location Worker Program Service Date Units Unit Type Amount
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Provider N
Client Service Units Report PSA ALL Provider ALL PROVIDERS Location 0000
Program ALL PROGRAMS Service ALL SERVICES Worker ALL WORKERS
City ALL CITIES Include Zero Unit N Include Aggregate N Calculated Amount equals the number of Units Provided times Fixed Cost if it existsService Start Date 01012017 Service End Date 12312017 If Fixed Cost does not exist Calculated
Group by PSA Provider Location Client Name County Worker Amount equals Billed Amount
Unduplicated Client Count 0 Grand Total 000 $000
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Clients In Common PSA All Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 County All Counties Worker All Workers
County JEFFERSON
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
MIAMI-DADE
0 0 0 0 0 0 0 0 0
4061539538 Test NameCounty Count
County
0 01
X
0 1
X
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
4061650856 Test Name X 4061486560 Test Name X 4062452921 Test Name X
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Clients Served Not Enrolled PSA ALL Start Date 01012017 End Date 12312017 Locations 0000 Provider All Providers
Service Service Min Serv Max Serv Program Start End Enrollment PSA Provider Location Program Consumer Name Client ID Service Date Date Status Enrollment Enrollment Provider
Count 0
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
4061472791 04
09
1092
1291
0072
0042
LTCC
LTCC
APCL
APCL
4062714543 06
06
1514
1762
0072
5006
LTCC
LTCC
APCL
APPL
4061802246 11
06
1177
1514
0179
0072
LTCC
LTCC
APCL
APCL
4061563719 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062644312 06
08
1514
1771
0072
0896
LTCC
LTCC
APCL
APCL
1001141670 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
1001141671 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
4062375003 07
05
05
07
1263
1755
1638
1263
0368
0072
0072
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062155124 06
06
1762
1514
0072
0072
LTCC
LTCC
APPL
APCL
4061743886 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0369
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4061499927 06
06
1514
1762
0072
5005
LTCC
LTCC
APCL
APPL
4061583524 08
06
1144
1514
0896
0072
LTCC
LTCC
APCL
APCL
4062694843 06
03
1514
1922
0072
0179
LTCC
LTCC
APCL
APCL
4062744517 07
06
1263
1514
0369
0072
LTCC
LTCC
APCL
APCL
4062005488 10
11
10
11
1929
1177
1164
1177
0072
0073
0179
0179
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
Total Count 15
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CODE DESCRIPTIONS Category ALL STATE TABLES
Code Description Active Available To Code Category
0 UNKNOWN Y CARES SUBJECTIVE_HEALTH_EVALUATION
01 ALACHUA Y COMMON COUNTIES
02 BAKER Y COMMON COUNTIES
03 BAY Y COMMON COUNTIES
04 BRADFORD Y COMMON COUNTIES
05 BREVARD Y COMMON COUNTIES
06 BROWARD Y COMMON COUNTIES
07 CALHOUN Y COMMON COUNTIES
08 CHARLOTTE Y COMMON COUNTIES
09 CITRUS Y COMMON COUNTIES
1 EXCELLENT Y CARES SUBJECTIVE_HEALTH_EVALUATION
10 CLAY Y COMMON COUNTIES
11 COLLIER Y COMMON COUNTIES
12 COLUMBIA Y COMMON COUNTIES
13 MIAMI-DADE Y COMMON COUNTIES
14 DESOTO Y COMMON COUNTIES
15 DIXIE Y COMMON COUNTIES
16 DUVAL Y COMMON COUNTIES
17 ESCAMBIA Y COMMON COUNTIES
18 FLAGLER Y COMMON COUNTIES
19 FRANKLIN Y COMMON COUNTIES
2 GOOD Y CARES SUBJECTIVE_HEALTH_EVALUATION
20 GADSDEN Y COMMON COUNTIES
21 GILCHRIST Y COMMON COUNTIES
22 GLADES Y COMMON COUNTIES
23 GULF Y COMMON COUNTIES
24 HAMILTON Y COMMON COUNTIES
25 HARDEE Y COMMON COUNTIES
26 HENDRY Y COMMON COUNTIES
27 HERNANDO Y COMMON COUNTIES
28 HIGHLANDS Y COMMON COUNTIES
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CONSUMER AGE VERIFICATION REPORT PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Program AC
Age at Start
Enroll or Start Enroll Provider Program Description Consumer Name Client ID DOB Svc date or Svc Date
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Contract Budget Information PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Program Service Provider Location County Served Provider Contract
Projected Service
Units Unit Measure
Projected Unduplicated
State Federal Share Client Count Begin Date End Date
Row Count 0 Amount Total
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Start Enroll Latest Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Date Asmt Date Worker
O3C1 1036 000 4061653427 Test CENTRAL 34982 W M 07091930 09102013 09102013 CIRTS20804 0 Name
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Start Enroll Date
Latest Asmt Date Worker
4061593624 Test Name CENTRAL 34946 B F 11261940 12012011 12312013 CIRTS23407
Count 164
Unduplicated Client Count 163
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Assessments After DOD Report
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Owner 1025
The shaded records indicate clients who have different DOBs andor different names
Assemt Current PSA Owner Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Owner Assessor
Provider Assessor
Assemt Date
Assemt Type
Unduplicated Count Total 0
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Open Enrollments
The Vital Statistics Data for 07192002 - 09112014PSA ALL Provider ALL Program Status ACTV Include MLTC ACTVS N
The shaded records indicate clients who have different DOBs andor different names
Enroll PSA
Enrollment Provider Loc Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Enroll Program Status
Enroll Program
Current Owner ID
02 1065 0072 4062244026 Test Name Test Name 10222004 03231917 03231917 ACTV CCE 1065
Count of enrollments for the Provider 1
Count of enrollments for the PSA 1
Count of enrollments for the Report 1
Unduplicated Count of Individuals with open enrollments and DOD PSA Total Clients Count
02 1
Total 1
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Unduplicated count of individuals with Services after DOD
PSA Total Clients Count
Report Total
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
List of Clients with PSA table entry for SERVICES_AFTER_DOD
Unduplicated Count Total 0
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Age
Provider
Total
Age lt 60 Age 60 - 64 Age 65 - 74 Age 75 - 84 Age 85+ Total Clients Avg Age
Total
Avg Age
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Ethnicity
Provider Hispanic Other Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Race
American Indian Native Hawaiian Other Provider Asian Alaska Native Black Pacific Islander Minority White Multiple Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Gender
Provider Male Female Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Monthly Income
Provider 0 - - Higher than Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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None
Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Total Persons Served 0
Age lt 60 Years 0 0
Age 60 - 64 0 0
Age 65 - 74 0 0
Age 75 - 84 0 0
Age 85+ 0 0
Total Age 0 0
Average 000
Ethnicity Hispanic 0 0
Other Ethnicity 0 0
Unknown Ethnicity 0 0
Total 0 0
Race Asian 0 0
American Indian Alaska Native 0 0
Black 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority 0 0
White 0 0
Multiple 0 0
Unknown 0 0
Total 0 0
Sex Male 0 0
Female 0 0
Unknown Sex 0 0
Total 0 0
Monthly Income 0 - 0 0
- 0 0
Higher than 0 0
Unknown 0 0
Total 0 0
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Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Client ID Date Of Birth Ethnicity Race Sex Individual Monthly Income
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Demographics of Clients OAA Registered Served Only PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 City All Cities Program All Programs Service All Services County ALL COUNTIES Table OAA Registered Services Only Low Income Medium Income
Total Persons Served 0
Agelt 60 Years
Age 60 - 64
Age 65 - 74
Age 75 - 84
Age 85+
0
0
0
0
0
0
0
0
0
0
Monthly Income
0 -
-Higher than
Unknown
0
0
0
0
0
0
0
0
Total
Average
0
000
0 Total 0 0
Ethnicity Hispanic
Other
Unknown
0
0
0
0
0
0
Living Situation
Alone
Null
Policy Change
0
0
0
0
0
0
Total 0 0 Unknown
With Caregiver
0
0
0
0
Race Asian 0 0
With Other
With Other Caregiver
0
0
0
0
American Indian Alaska Native
Black
0
0
0
0Total Living Situation 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority
White
0
0
0
0 Limited English Proficiency
Multiple
Unknown
Total Race
0
0
0
0
0
0
Yes
No
Unknown
0
0
0
0
0
0
Total 0 0
Sex Male
Female
Unknown
0
0
0
0
0
0
Total 0 0
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Disaster Assistance Clients for a Provider PSA ALL Provider All Providers Location 0000 Worker All Workers City All Cities Zip Code All Zip Codes Sort By ZIP
Provider 1036 Provider Name Location 0000 Worker CIRTS18634
Need Care Client Name Address City Zip County Phone Asst Reg Situation Relat Care phone Care Name
34946 N WO DA 000 SAINT JAMES DRIVE CENTRAL (025) 101-0620 Test NameTest Name SAINT LUCIE (005) 100-0369 Y
Client is active and no assessment information is available Special Shelter and Special Registry are unknown
Report run on 08312018 1102 AM Page 1 of 8 disaster_by_provrdf
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
Total by PSA 0
Report run on 08312018 1111 AM Page 1 of 5 eheap_exceptionsrdf
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
ALACH BAKER BAY BRADF BREVA BROWA CALHO CHARL CITRUS CLAY COLLIE COLUM DESOT DIXIE DUVAL ESCAM FLAGL FRANK GADSDAssisted Household Report UA ORD RD RD UN OTTE R BIA O BIA ER LIN EN
1 of Household Assisted 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Households AssistedWith Gross Income
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C 100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D 125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
3 Households with at leastOne member
A 60 Years or older 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B Disabled 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C Age 5 years or under 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D Under 60 Years Old 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Undup Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Assisted
Applicant Household Report
of Applicant Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Energy Assisted Household Report
County of Assisted
Households
Households Assisted By Poverty Level
Under 75 75 - 100 101 - 125 126 - 150 Over 150 60 Years or older
At least one member who is
Age 5 years Age 2 years Age 3 years Disabled or younger and younger through 5
Under 60 Years Old
Undup Households
Assisted
Energy Assistance Total
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Unduplicated Total 0 0
County of Assisted
Households Under 75 75 - 100
Households Assisted By Poverty Level
101 - 125 126 - 150 Over 150 60 Years or older Disabled
Age 5 years or younger
Age 2 years and younger
Age 3 years through 5
Under 60 Years Old
At least one member who is
Undup Households
Assisted
Other Assisted Household Report
Other Assistance Total
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Applicant Household Report
County of Applicant
Households Under 75 75 - 100 101 - 125 126 - 150 Over 150 Income data
unavailable
Total 0
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01
Enrollment Active Consumer Count by Program PSA ALL Provider ALL PROVIDERS
County Description Program Count of Clients
BREVARD
ADI
CCE
HCE
LSP
NDP
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
MLTC
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
31
57
44
5
62
123
141
26
9
7
5
40
5
50
67
129
2
19
42
29
1
233
79
63
8
2
14
3
37
14
47
3
3
33
127
10
02
03
04
ALACHUA
BAKER
BAY
BRADFORD
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05
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Enrollment Terminations with Reasons PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 Program All Programs Program Status ALL Program Status Worker ALL WORKERS
Last First Program Medicaid Provider Start End Name Name Client ID Status Description Worker Number Program Location Enrollment Enrollment
Count 0
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Enrollments with Care Plan Report
PSA ALL Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTIVE STATUS Care Plan Service ALL SERVICES Care Plan Start 01012017 Care Plan End 12312017
Care Plan Care Plan Care Plan Client Name
Unduplicated Client Count 0
Client ID Program Status Worker Start Date End Date Service
Report run on 08312018 1054 AM Page 1 of 1 enroll_careplrdf Report run by RSHQALL Dispose of this report so that it cannot be read or reconstructed
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PSA CLIENT_ID CLIENT_NAME OWNER PROVIDER_ID ASSESSMENT_DATE ASSESSOR_NAME MEDICAID_NUMBER CAREGIVER_CHANGE ENVIRONMENT_CHANGE HEALTH_CHANGE INCOME_CHANGE SITUATION_CHANGE INITIAL_ASSM ANNUAL_ASSM SSN REFERRAL_SOURCE 1114 N N N N Y N 771771777 SELFFAMILY 812017 JANE CASEWORKER 2 1001141633 TEST TEST N
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Fixed Service Costs List PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Provider Location County Program Service Reimbursement Unit Rate Provider Cost Per Unit Begin Valid End Valid
Count 0
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APS Repeat Referrals in a Time Range
PSA ALL Owner All Owners
Start Date 01012017 End Date 12312017
Current DOEA CIRTS Cirts SSN if Risk Date Created PSA Owner Abuse No different than DCF DCF SSN Name County Level Date of Birth Date Sent by DCF
Count 0
Unduplicated Client Count by PSA
PSA Count SSN
Total
Report run on 08312018 0157 PM Page 1 of 1 aps_date_rangerdf
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Assessed Prioritized Consumer List PSA ALL Provider ALL PROVIDERS Program AC County ALL COUNTIES
County Program Consumer Name Client ID
Total Count 0
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Assessment Due Report PSA 01 Start Date 01012017 End Date 08312018 Owner ALL PROVIDERS Worker ALL WORKERS Program Status ACTV and APCL Assessment Type Needed ALL
Overdue and missing assessments are always listed
Owner ID 1065
Client ID Client Name
Owner Assessor ID
Date of Birth
06281928
CIRTS28099
County of Service
GULF
Worker Name HARPER KENNY
Zip Assessment PSA Date
32534 01 01022014
Type
701A
Active Y
Nutr PriorityScore Score
11 58
Rank
5
Due Date
01022015
Status
701S OVERDUE
LTCC APPL Start Date
03252014 4062235673 Test name
Total Clients for Worker 1
Total Clients for Owner 1
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Assessment Due Report PSA 01 Start Date 01012017 End Date 08312018 Owner ALL PROVIDERS Worker ALL WORKERS Program Status ACTV and APCL Assessment Type Needed ALL
Overdue and missing assessments are always listed
Summary by PSA
PSA 01 701A Overdue 1
701B Overdue 213
701C Overdue 0
701S Overdue 157
No 701A 0
No 701B 2
No 701C 0
No 701S 0
701A Not Overdue 0
701B Not Overdue 0
701C Not Overdue 0
701S Not Overdue 0
701S Optional 0
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CIC Service Units and Costs Projections County SummaryPSA 99 Program CCE
Start Date 01012017 End Date 12312017
County LEON
Total Total Total Avg Max Projected
StateFederal Projected Reimbursement Provider Unduplicated Provider Service Share Service Units Unit Rate Cost Per Unit Client Count
Report Total
Report run on 08312018 0242 PM Page 1 of 1 cic_serv_cntyrdf
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CIC Service Units and Costs Projections Provider SummaryPSA ALL Provider ALL PROVIDERS Program FEDERALLY FUNDED (0101 TO 1231) Year 2017 From 01012017 To 12312017
PSA County Program Service Total State
Federal Share
Total Projected
Service Units
Avg Reimbursement
Unit Rate
Max Provider
Cost Per Unit
Total Projected Unduplicated Client Count
02 FRANKLIN O3C1 CONGREGATE MEALS $810300 1710 15
Program Total
County Total
$810300
$810300
GULF O3C1 CONGREGATE MEALS $25205 3 5
Program Total $25205
O3C2 HOME DELIVERED MEALS $25205 3 6
Program Total
County Total
$25205
$50411
LEON O3C1 CONGREGATE MEALS $621300 1311 15
CONGREGATE MEALS GUEST
CONGREGATE MEALS VOLUNTEERS
$252055
$277260
25
30
2
5
Program Total $1150615
O3C2 HOME DELIVERED MEAL GUEST $252055 25 3
Program Total $252055
OA3D PEARLS (SESSION 5)
PEARLS (SESSION 6)
PEARLS (SESSION 7)
PEARLS (SESSION 8)
$10247
$10247
$10247
$10247
10
10
10
10
3
3
3
3
Program Total $40988
OA3E RESPITE IN-HOME $200 2 2
Program Total
County Total
$200
$1443858
WAKULLA O3C2 EMERGENCY HOME DELIVERED SHELF MEALS
$8065604 14899 90
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CIC Service Units and Costs Projections - PSA Summary
PSA ALL Program CCE
Strat Date 01012017 End Date 12312017
Total
PSA County Provider Service
Total State Federal
Share
Total Projected
Service Units
Avg Reimbursement
Unit Rate
Max Projected Provider Unduplicated
Cost Per Unit Client Count
02 LEON SOUTHERN SERVICE CASE MANAGEMENT PROVIDER EMERGENCY HOME DELIVERED SHELF MEALS
$2175533
$602000
483
689
32
20
HOME DELIVERED MEALS $530262 993 5
MATERIAL AID $1994536 199
Provider Total $5302331
CountyTotal $5302331
WAKULLA SOUTHERN SERVICE CASE MANAGEMENT PROVIDER EMERGENCY HOME DELIVERED SHELF MEALS
$2175533
$1240200
483
689
32
5
MATERIAL AID $1994536 199
Provider Total $5410269
CountyTotal $5410269
PSA Total $10712599
05 PINELLAS BURSTEIN-APPLEBEE ADULT DAY CARE $000 0 $900 $1000 0
COUNSELING (MENTAL HEALTH COUNSELINGSCREENING) - INDIVIDUAL
Provider Total
$000
$000
0 $6600 $7700 0
CountyTotal $000
PSA Total $000
Report Total $10712599
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CID Service Units and Costs Projections - PSA SummaryPSA ALL Program CCE
Start Date 01012017 End Date 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
PSA County Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
02 LEON CASE MANAGEMENT $2175533 483
EMERGENCY HOME $602000 689DELIVERED SHELF MEALS HOME DELIVERED MEALS $530262 993
MATERIAL AID $1994536 199
County Total $5302331 2364
WAKULLA CASE MANAGEMENT $2175533 483
EMERGENCY HOME $1240200 689DELIVERED SHELF MEALS MATERIAL AID $1994536 199
County Total $5410269 1371
PSA Total $10712599 3735
05 PINELLAS ADULT DAY CARE $000 0
COUNSELING (MENTAL $000 0 HEALTH COUNSELINGSCREENING) - INDIVIDUAL
County Total $000 0
PSA Total $000 0
Report Total $10712599 3735
$900 $900 $900 $1000 $1000 $1000
$6600 $6600 $6600 $7700 $7700 $7700
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CID Service Units and Costs Projections County SummaryPSA 99
Program CCE County LEON
Start Date 01012017 End Date 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
Report Total
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CIE Service Units and Costs Projections - PSA Summary - All Programs
PSA 99 Program FEDERALLY FUNDED (0101 TO 1231) Year 2017 From 01012017 To 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
Program Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
Report Total
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CIE Service Units and Costs Projections - PSA Summary
PSA ALL Program CCE
Start Date 01012017 End Date 12312017
Avg High Low Total Total Avg High Low Provider Provider Provider
StateFederal Projected Reimbursement Reimbursement Reimbursement Cost Cost CostPSA
02
Service
CASE MANAGEMENT
Share
$4351066
Service Units
966
Unit Rate Unit Rate Unit Rate Per Unit Per Unit Per Unit
EMERGENCY HOME DELIVERED SHELF MEALS $1842200 1378
HOME DELIVERED MEALS $530262 993
MATERIAL AID $3989071 398
PSA Total $10712599 3735
05 ADULT DAY CARE $000 0 $900 $900 $900 $1000 $1000 $1000
COUNSELING (MENTAL HEALTH $000 0 $6600 $6600 $6600 $7700 $7700 $7700 COUNSELINGSCREENING) - INDIVIDUAL
PSA Total $000 0
Report Total $10712599 3735
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CAREGIVER SEARCH REPORT
SEARCH RESULTS FOR CONSUMERS
Criteria First Name Last Name SSN PSA ALL
Client Name Client SSN Caregiver Name Caregiver SSN
000000000 000000000 Test Name Test Name
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CARES Referrals in a Time Range PSA ALL
Start Date 01012017 End Date 12312017
Referred to ALL REFERRALS
Referring PSA Employee Name Client Name Client ID
Referral Imminent NH Admit Aging Date Risk Date Referred To Cares Provider Name Received Date
03A 4061561263 Test Name Test Name 09242017 Y 05292017 ARC or ADRC 09252017
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CARES Referrals in a Time Range PSA ALL
Start Date 01012017 End Date 12312017
Referred to ALL REFERRALS
Referring PSA Employee Name Client Name Client ID
Referral Date
Imminent Risk
NH Admit Date Referred To Cares Provider Name
Aging Received Date
04B Test Name Test Name 4061738075 04082017 N ARC or ADRC Test Name 04082017
Total Clients 110
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CARES Referrals not acknowledged by the Aging Network PSA ALL For Referrals after 01012017 Owner ID ALL Owners
Unduplicated Client count Cares Office Total Clients Count
Report Total
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
CIRTS Issue PSA Client ID Client Name Program
Program Status Start Provider Enrollment ID Provider Name
APCL CLIENT WITH DATE OF DEATH 08 4061759417 Test Name OA3B APCL 07232013 1141 WESTERN WORLD RADIO
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
Program Start Provider CIRTS Issue PSA Client ID Client Name Program Status Enrollment ID Provider Name
06 LTCC APCL 01242014 1514 4061713685 Test Name APCL CLIENT WITH DATE OF DEATH CENTRAL THE ORIGINAL HOUSE OF PIES
Count 503
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Civil Rights PSA ALL Provider ALL PROVIDERS Program AC Start Date 01012017 End Date 12312017 The Poverty Level for Single is The Poverty Level for Couple is Sort by County
County Unduplicated Count
Report run on 08312018 1055 AM Page 1 of 1 civil_rightsrdf
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Client Information Report Start Date 01012017 End Date 12312017
Client ID 1001141246
Emergency
Client Name Test Name
Telephone () - Address 78 TEST STREET TALLAHASSEE FL 32399
Most Recent Caregiver Information Date Updated
Doctor
Comments
Client Demographic Information
Birth Date 06041940 Race W
Owner ID Ethnicity O
Most Recent Income Information
Ind Mon Inc Cpl Mon Inc
Ind Assets Couple Assets
Most Recent Assessment Information
Asmt Date Ref Risk Lvl
Asmt Site Spec Shel
AsmtType Spec Reg
Ref Date Primary CG
Ref Source Living Sit
Enrollment Information
Sex
Marital Status
F
S
Medicaid Number
ADL Score
ADL Count
IADL Score
IADL Count
Memory Score
Priority Score
Env Score
Nutr Score
Risk Score
Social Score
Rank
Provider Location Program Program Status Worker Start Date End Date
Care Plan Service Needed
Date Service Units Type Frq End Date
Care Plan Service Planned
Program Service Units Type Frq Start Date End Date
Services Received between 01012017 and 12312017
Service Billed Provider Location Worker Program Service Date Units Unit Type Amount
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Provider N
Client Service Units Report PSA ALL Provider ALL PROVIDERS Location 0000
Program ALL PROGRAMS Service ALL SERVICES Worker ALL WORKERS
City ALL CITIES Include Zero Unit N Include Aggregate N Calculated Amount equals the number of Units Provided times Fixed Cost if it existsService Start Date 01012017 Service End Date 12312017 If Fixed Cost does not exist Calculated
Group by PSA Provider Location Client Name County Worker Amount equals Billed Amount
Unduplicated Client Count 0 Grand Total 000 $000
Report run on 08312018 0234 PM Page 1 of 1 clnt_serv_unitsrdf
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Clients In Common PSA All Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 County All Counties Worker All Workers
County JEFFERSON
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
MIAMI-DADE
0 0 0 0 0 0 0 0 0
4061539538 Test NameCounty Count
County
0 01
X
0 1
X
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
4061650856 Test Name X 4061486560 Test Name X 4062452921 Test Name X
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Clients Served Not Enrolled PSA ALL Start Date 01012017 End Date 12312017 Locations 0000 Provider All Providers
Service Service Min Serv Max Serv Program Start End Enrollment PSA Provider Location Program Consumer Name Client ID Service Date Date Status Enrollment Enrollment Provider
Count 0
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
4061472791 04
09
1092
1291
0072
0042
LTCC
LTCC
APCL
APCL
4062714543 06
06
1514
1762
0072
5006
LTCC
LTCC
APCL
APPL
4061802246 11
06
1177
1514
0179
0072
LTCC
LTCC
APCL
APCL
4061563719 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062644312 06
08
1514
1771
0072
0896
LTCC
LTCC
APCL
APCL
1001141670 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
1001141671 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
4062375003 07
05
05
07
1263
1755
1638
1263
0368
0072
0072
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062155124 06
06
1762
1514
0072
0072
LTCC
LTCC
APPL
APCL
4061743886 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0369
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4061499927 06
06
1514
1762
0072
5005
LTCC
LTCC
APCL
APPL
4061583524 08
06
1144
1514
0896
0072
LTCC
LTCC
APCL
APCL
4062694843 06
03
1514
1922
0072
0179
LTCC
LTCC
APCL
APCL
4062744517 07
06
1263
1514
0369
0072
LTCC
LTCC
APCL
APCL
4062005488 10
11
10
11
1929
1177
1164
1177
0072
0073
0179
0179
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
Total Count 15
Report run on 08312018 0200 PM Page 2 of 2 clnts_mult_enrollrdf
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CODE DESCRIPTIONS Category ALL STATE TABLES
Code Description Active Available To Code Category
0 UNKNOWN Y CARES SUBJECTIVE_HEALTH_EVALUATION
01 ALACHUA Y COMMON COUNTIES
02 BAKER Y COMMON COUNTIES
03 BAY Y COMMON COUNTIES
04 BRADFORD Y COMMON COUNTIES
05 BREVARD Y COMMON COUNTIES
06 BROWARD Y COMMON COUNTIES
07 CALHOUN Y COMMON COUNTIES
08 CHARLOTTE Y COMMON COUNTIES
09 CITRUS Y COMMON COUNTIES
1 EXCELLENT Y CARES SUBJECTIVE_HEALTH_EVALUATION
10 CLAY Y COMMON COUNTIES
11 COLLIER Y COMMON COUNTIES
12 COLUMBIA Y COMMON COUNTIES
13 MIAMI-DADE Y COMMON COUNTIES
14 DESOTO Y COMMON COUNTIES
15 DIXIE Y COMMON COUNTIES
16 DUVAL Y COMMON COUNTIES
17 ESCAMBIA Y COMMON COUNTIES
18 FLAGLER Y COMMON COUNTIES
19 FRANKLIN Y COMMON COUNTIES
2 GOOD Y CARES SUBJECTIVE_HEALTH_EVALUATION
20 GADSDEN Y COMMON COUNTIES
21 GILCHRIST Y COMMON COUNTIES
22 GLADES Y COMMON COUNTIES
23 GULF Y COMMON COUNTIES
24 HAMILTON Y COMMON COUNTIES
25 HARDEE Y COMMON COUNTIES
26 HENDRY Y COMMON COUNTIES
27 HERNANDO Y COMMON COUNTIES
28 HIGHLANDS Y COMMON COUNTIES
Report run on 08312018 0140 PM Page 1 of 45 state_codesrdf Report run by RSHQALL Dispose of this report so that it cannot be read or reconstructed
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CONSUMER AGE VERIFICATION REPORT PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Program AC
Age at Start
Enroll or Start Enroll Provider Program Description Consumer Name Client ID DOB Svc date or Svc Date
Report run on 08312018 0203 PM Page 1 of 1 age_verifyrdf
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Contract Budget Information PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Program Service Provider Location County Served Provider Contract
Projected Service
Units Unit Measure
Projected Unduplicated
State Federal Share Client Count Begin Date End Date
Row Count 0 Amount Total
Report run on 08312018 0233 PM Page 1 of 1 contract_budgetrdf
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Start Enroll Latest Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Date Asmt Date Worker
O3C1 1036 000 4061653427 Test CENTRAL 34982 W M 07091930 09102013 09102013 CIRTS20804 0 Name
Report run on 08312018 1133 AM Page 1 of 6 actv_by_progrdf
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Start Enroll Date
Latest Asmt Date Worker
4061593624 Test Name CENTRAL 34946 B F 11261940 12012011 12312013 CIRTS23407
Count 164
Unduplicated Client Count 163
Report run on 08312018 1133 AM Page 6 of 6 actv_by_progrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Assessments After DOD Report
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Owner 1025
The shaded records indicate clients who have different DOBs andor different names
Assemt Current PSA Owner Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Owner Assessor
Provider Assessor
Assemt Date
Assemt Type
Unduplicated Count Total 0
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Open Enrollments
The Vital Statistics Data for 07192002 - 09112014PSA ALL Provider ALL Program Status ACTV Include MLTC ACTVS N
The shaded records indicate clients who have different DOBs andor different names
Enroll PSA
Enrollment Provider Loc Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Enroll Program Status
Enroll Program
Current Owner ID
02 1065 0072 4062244026 Test Name Test Name 10222004 03231917 03231917 ACTV CCE 1065
Count of enrollments for the Provider 1
Count of enrollments for the PSA 1
Count of enrollments for the Report 1
Unduplicated Count of Individuals with open enrollments and DOD PSA Total Clients Count
02 1
Total 1
Report run on 08312018 0205 PM Page 1 of 1 vs_open_enrollrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Report run on 08312018 0207 PM Page 1 of 3 vs_servicesrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Unduplicated count of individuals with Services after DOD
PSA Total Clients Count
Report Total
Report run on 08312018 0207 PM Page 2 of 3 vs_servicesrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
List of Clients with PSA table entry for SERVICES_AFTER_DOD
Unduplicated Count Total 0
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Age
Provider
Total
Age lt 60 Age 60 - 64 Age 65 - 74 Age 75 - 84 Age 85+ Total Clients Avg Age
Total
Avg Age
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Ethnicity
Provider Hispanic Other Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Race
American Indian Native Hawaiian Other Provider Asian Alaska Native Black Pacific Islander Minority White Multiple Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Gender
Provider Male Female Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Monthly Income
Provider 0 - - Higher than Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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None
Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Total Persons Served 0
Age lt 60 Years 0 0
Age 60 - 64 0 0
Age 65 - 74 0 0
Age 75 - 84 0 0
Age 85+ 0 0
Total Age 0 0
Average 000
Ethnicity Hispanic 0 0
Other Ethnicity 0 0
Unknown Ethnicity 0 0
Total 0 0
Race Asian 0 0
American Indian Alaska Native 0 0
Black 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority 0 0
White 0 0
Multiple 0 0
Unknown 0 0
Total 0 0
Sex Male 0 0
Female 0 0
Unknown Sex 0 0
Total 0 0
Monthly Income 0 - 0 0
- 0 0
Higher than 0 0
Unknown 0 0
Total 0 0
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Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Client ID Date Of Birth Ethnicity Race Sex Individual Monthly Income
Report run on 08312018 1058 AM Page 2 of 2 demo_by_prov_detrdf Report run byRSHQALL Dispose of this report so that it can not be read or reconstructed
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Demographics of Clients OAA Registered Served Only PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 City All Cities Program All Programs Service All Services County ALL COUNTIES Table OAA Registered Services Only Low Income Medium Income
Total Persons Served 0
Agelt 60 Years
Age 60 - 64
Age 65 - 74
Age 75 - 84
Age 85+
0
0
0
0
0
0
0
0
0
0
Monthly Income
0 -
-Higher than
Unknown
0
0
0
0
0
0
0
0
Total
Average
0
000
0 Total 0 0
Ethnicity Hispanic
Other
Unknown
0
0
0
0
0
0
Living Situation
Alone
Null
Policy Change
0
0
0
0
0
0
Total 0 0 Unknown
With Caregiver
0
0
0
0
Race Asian 0 0
With Other
With Other Caregiver
0
0
0
0
American Indian Alaska Native
Black
0
0
0
0Total Living Situation 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority
White
0
0
0
0 Limited English Proficiency
Multiple
Unknown
Total Race
0
0
0
0
0
0
Yes
No
Unknown
0
0
0
0
0
0
Total 0 0
Sex Male
Female
Unknown
0
0
0
0
0
0
Total 0 0
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Disaster Assistance Clients for a Provider PSA ALL Provider All Providers Location 0000 Worker All Workers City All Cities Zip Code All Zip Codes Sort By ZIP
Provider 1036 Provider Name Location 0000 Worker CIRTS18634
Need Care Client Name Address City Zip County Phone Asst Reg Situation Relat Care phone Care Name
34946 N WO DA 000 SAINT JAMES DRIVE CENTRAL (025) 101-0620 Test NameTest Name SAINT LUCIE (005) 100-0369 Y
Client is active and no assessment information is available Special Shelter and Special Registry are unknown
Report run on 08312018 1102 AM Page 1 of 8 disaster_by_provrdf
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
Total by PSA 0
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
ALACH BAKER BAY BRADF BREVA BROWA CALHO CHARL CITRUS CLAY COLLIE COLUM DESOT DIXIE DUVAL ESCAM FLAGL FRANK GADSDAssisted Household Report UA ORD RD RD UN OTTE R BIA O BIA ER LIN EN
1 of Household Assisted 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Households AssistedWith Gross Income
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C 100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D 125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
3 Households with at leastOne member
A 60 Years or older 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B Disabled 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C Age 5 years or under 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D Under 60 Years Old 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Undup Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Assisted
Applicant Household Report
of Applicant Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Energy Assisted Household Report
County of Assisted
Households
Households Assisted By Poverty Level
Under 75 75 - 100 101 - 125 126 - 150 Over 150 60 Years or older
At least one member who is
Age 5 years Age 2 years Age 3 years Disabled or younger and younger through 5
Under 60 Years Old
Undup Households
Assisted
Energy Assistance Total
Report run on 08312018 1107 AM Page 1 of 3 eheap_summaryrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Unduplicated Total 0 0
County of Assisted
Households Under 75 75 - 100
Households Assisted By Poverty Level
101 - 125 126 - 150 Over 150 60 Years or older Disabled
Age 5 years or younger
Age 2 years and younger
Age 3 years through 5
Under 60 Years Old
At least one member who is
Undup Households
Assisted
Other Assisted Household Report
Other Assistance Total
Report run on 08312018 1107 AM Page 2 of 3 eheap_summaryrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Applicant Household Report
County of Applicant
Households Under 75 75 - 100 101 - 125 126 - 150 Over 150 Income data
unavailable
Total 0
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01
Enrollment Active Consumer Count by Program PSA ALL Provider ALL PROVIDERS
County Description Program Count of Clients
BREVARD
ADI
CCE
HCE
LSP
NDP
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
MLTC
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
31
57
44
5
62
123
141
26
9
7
5
40
5
50
67
129
2
19
42
29
1
233
79
63
8
2
14
3
37
14
47
3
3
33
127
10
02
03
04
ALACHUA
BAKER
BAY
BRADFORD
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Enrollment Terminations with Reasons PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 Program All Programs Program Status ALL Program Status Worker ALL WORKERS
Last First Program Medicaid Provider Start End Name Name Client ID Status Description Worker Number Program Location Enrollment Enrollment
Count 0
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Enrollments with Care Plan Report
PSA ALL Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTIVE STATUS Care Plan Service ALL SERVICES Care Plan Start 01012017 Care Plan End 12312017
Care Plan Care Plan Care Plan Client Name
Unduplicated Client Count 0
Client ID Program Status Worker Start Date End Date Service
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PSA CLIENT_ID CLIENT_NAME OWNER PROVIDER_ID ASSESSMENT_DATE ASSESSOR_NAME MEDICAID_NUMBER CAREGIVER_CHANGE ENVIRONMENT_CHANGE HEALTH_CHANGE INCOME_CHANGE SITUATION_CHANGE INITIAL_ASSM ANNUAL_ASSM SSN REFERRAL_SOURCE 1114 N N N N Y N 771771777 SELFFAMILY 812017 JANE CASEWORKER 2 1001141633 TEST TEST N
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Fixed Service Costs List PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Provider Location County Program Service Reimbursement Unit Rate Provider Cost Per Unit Begin Valid End Valid
Count 0
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Assessed Prioritized Consumer List PSA ALL Provider ALL PROVIDERS Program AC County ALL COUNTIES
County Program Consumer Name Client ID
Total Count 0
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Assessment Due Report PSA 01 Start Date 01012017 End Date 08312018 Owner ALL PROVIDERS Worker ALL WORKERS Program Status ACTV and APCL Assessment Type Needed ALL
Overdue and missing assessments are always listed
Owner ID 1065
Client ID Client Name
Owner Assessor ID
Date of Birth
06281928
CIRTS28099
County of Service
GULF
Worker Name HARPER KENNY
Zip Assessment PSA Date
32534 01 01022014
Type
701A
Active Y
Nutr PriorityScore Score
11 58
Rank
5
Due Date
01022015
Status
701S OVERDUE
LTCC APPL Start Date
03252014 4062235673 Test name
Total Clients for Worker 1
Total Clients for Owner 1
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Assessment Due Report PSA 01 Start Date 01012017 End Date 08312018 Owner ALL PROVIDERS Worker ALL WORKERS Program Status ACTV and APCL Assessment Type Needed ALL
Overdue and missing assessments are always listed
Summary by PSA
PSA 01 701A Overdue 1
701B Overdue 213
701C Overdue 0
701S Overdue 157
No 701A 0
No 701B 2
No 701C 0
No 701S 0
701A Not Overdue 0
701B Not Overdue 0
701C Not Overdue 0
701S Not Overdue 0
701S Optional 0
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CIC Service Units and Costs Projections County SummaryPSA 99 Program CCE
Start Date 01012017 End Date 12312017
County LEON
Total Total Total Avg Max Projected
StateFederal Projected Reimbursement Provider Unduplicated Provider Service Share Service Units Unit Rate Cost Per Unit Client Count
Report Total
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CIC Service Units and Costs Projections Provider SummaryPSA ALL Provider ALL PROVIDERS Program FEDERALLY FUNDED (0101 TO 1231) Year 2017 From 01012017 To 12312017
PSA County Program Service Total State
Federal Share
Total Projected
Service Units
Avg Reimbursement
Unit Rate
Max Provider
Cost Per Unit
Total Projected Unduplicated Client Count
02 FRANKLIN O3C1 CONGREGATE MEALS $810300 1710 15
Program Total
County Total
$810300
$810300
GULF O3C1 CONGREGATE MEALS $25205 3 5
Program Total $25205
O3C2 HOME DELIVERED MEALS $25205 3 6
Program Total
County Total
$25205
$50411
LEON O3C1 CONGREGATE MEALS $621300 1311 15
CONGREGATE MEALS GUEST
CONGREGATE MEALS VOLUNTEERS
$252055
$277260
25
30
2
5
Program Total $1150615
O3C2 HOME DELIVERED MEAL GUEST $252055 25 3
Program Total $252055
OA3D PEARLS (SESSION 5)
PEARLS (SESSION 6)
PEARLS (SESSION 7)
PEARLS (SESSION 8)
$10247
$10247
$10247
$10247
10
10
10
10
3
3
3
3
Program Total $40988
OA3E RESPITE IN-HOME $200 2 2
Program Total
County Total
$200
$1443858
WAKULLA O3C2 EMERGENCY HOME DELIVERED SHELF MEALS
$8065604 14899 90
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CIC Service Units and Costs Projections - PSA Summary
PSA ALL Program CCE
Strat Date 01012017 End Date 12312017
Total
PSA County Provider Service
Total State Federal
Share
Total Projected
Service Units
Avg Reimbursement
Unit Rate
Max Projected Provider Unduplicated
Cost Per Unit Client Count
02 LEON SOUTHERN SERVICE CASE MANAGEMENT PROVIDER EMERGENCY HOME DELIVERED SHELF MEALS
$2175533
$602000
483
689
32
20
HOME DELIVERED MEALS $530262 993 5
MATERIAL AID $1994536 199
Provider Total $5302331
CountyTotal $5302331
WAKULLA SOUTHERN SERVICE CASE MANAGEMENT PROVIDER EMERGENCY HOME DELIVERED SHELF MEALS
$2175533
$1240200
483
689
32
5
MATERIAL AID $1994536 199
Provider Total $5410269
CountyTotal $5410269
PSA Total $10712599
05 PINELLAS BURSTEIN-APPLEBEE ADULT DAY CARE $000 0 $900 $1000 0
COUNSELING (MENTAL HEALTH COUNSELINGSCREENING) - INDIVIDUAL
Provider Total
$000
$000
0 $6600 $7700 0
CountyTotal $000
PSA Total $000
Report Total $10712599
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CID Service Units and Costs Projections - PSA SummaryPSA ALL Program CCE
Start Date 01012017 End Date 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
PSA County Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
02 LEON CASE MANAGEMENT $2175533 483
EMERGENCY HOME $602000 689DELIVERED SHELF MEALS HOME DELIVERED MEALS $530262 993
MATERIAL AID $1994536 199
County Total $5302331 2364
WAKULLA CASE MANAGEMENT $2175533 483
EMERGENCY HOME $1240200 689DELIVERED SHELF MEALS MATERIAL AID $1994536 199
County Total $5410269 1371
PSA Total $10712599 3735
05 PINELLAS ADULT DAY CARE $000 0
COUNSELING (MENTAL $000 0 HEALTH COUNSELINGSCREENING) - INDIVIDUAL
County Total $000 0
PSA Total $000 0
Report Total $10712599 3735
$900 $900 $900 $1000 $1000 $1000
$6600 $6600 $6600 $7700 $7700 $7700
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CID Service Units and Costs Projections County SummaryPSA 99
Program CCE County LEON
Start Date 01012017 End Date 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
Report Total
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CIE Service Units and Costs Projections - PSA Summary - All Programs
PSA 99 Program FEDERALLY FUNDED (0101 TO 1231) Year 2017 From 01012017 To 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
Program Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
Report Total
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CIE Service Units and Costs Projections - PSA Summary
PSA ALL Program CCE
Start Date 01012017 End Date 12312017
Avg High Low Total Total Avg High Low Provider Provider Provider
StateFederal Projected Reimbursement Reimbursement Reimbursement Cost Cost CostPSA
02
Service
CASE MANAGEMENT
Share
$4351066
Service Units
966
Unit Rate Unit Rate Unit Rate Per Unit Per Unit Per Unit
EMERGENCY HOME DELIVERED SHELF MEALS $1842200 1378
HOME DELIVERED MEALS $530262 993
MATERIAL AID $3989071 398
PSA Total $10712599 3735
05 ADULT DAY CARE $000 0 $900 $900 $900 $1000 $1000 $1000
COUNSELING (MENTAL HEALTH $000 0 $6600 $6600 $6600 $7700 $7700 $7700 COUNSELINGSCREENING) - INDIVIDUAL
PSA Total $000 0
Report Total $10712599 3735
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CAREGIVER SEARCH REPORT
SEARCH RESULTS FOR CONSUMERS
Criteria First Name Last Name SSN PSA ALL
Client Name Client SSN Caregiver Name Caregiver SSN
000000000 000000000 Test Name Test Name
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CARES Referrals in a Time Range PSA ALL
Start Date 01012017 End Date 12312017
Referred to ALL REFERRALS
Referring PSA Employee Name Client Name Client ID
Referral Imminent NH Admit Aging Date Risk Date Referred To Cares Provider Name Received Date
03A 4061561263 Test Name Test Name 09242017 Y 05292017 ARC or ADRC 09252017
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CARES Referrals in a Time Range PSA ALL
Start Date 01012017 End Date 12312017
Referred to ALL REFERRALS
Referring PSA Employee Name Client Name Client ID
Referral Date
Imminent Risk
NH Admit Date Referred To Cares Provider Name
Aging Received Date
04B Test Name Test Name 4061738075 04082017 N ARC or ADRC Test Name 04082017
Total Clients 110
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CARES Referrals not acknowledged by the Aging Network PSA ALL For Referrals after 01012017 Owner ID ALL Owners
Unduplicated Client count Cares Office Total Clients Count
Report Total
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
CIRTS Issue PSA Client ID Client Name Program
Program Status Start Provider Enrollment ID Provider Name
APCL CLIENT WITH DATE OF DEATH 08 4061759417 Test Name OA3B APCL 07232013 1141 WESTERN WORLD RADIO
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
Program Start Provider CIRTS Issue PSA Client ID Client Name Program Status Enrollment ID Provider Name
06 LTCC APCL 01242014 1514 4061713685 Test Name APCL CLIENT WITH DATE OF DEATH CENTRAL THE ORIGINAL HOUSE OF PIES
Count 503
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Civil Rights PSA ALL Provider ALL PROVIDERS Program AC Start Date 01012017 End Date 12312017 The Poverty Level for Single is The Poverty Level for Couple is Sort by County
County Unduplicated Count
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Client Information Report Start Date 01012017 End Date 12312017
Client ID 1001141246
Emergency
Client Name Test Name
Telephone () - Address 78 TEST STREET TALLAHASSEE FL 32399
Most Recent Caregiver Information Date Updated
Doctor
Comments
Client Demographic Information
Birth Date 06041940 Race W
Owner ID Ethnicity O
Most Recent Income Information
Ind Mon Inc Cpl Mon Inc
Ind Assets Couple Assets
Most Recent Assessment Information
Asmt Date Ref Risk Lvl
Asmt Site Spec Shel
AsmtType Spec Reg
Ref Date Primary CG
Ref Source Living Sit
Enrollment Information
Sex
Marital Status
F
S
Medicaid Number
ADL Score
ADL Count
IADL Score
IADL Count
Memory Score
Priority Score
Env Score
Nutr Score
Risk Score
Social Score
Rank
Provider Location Program Program Status Worker Start Date End Date
Care Plan Service Needed
Date Service Units Type Frq End Date
Care Plan Service Planned
Program Service Units Type Frq Start Date End Date
Services Received between 01012017 and 12312017
Service Billed Provider Location Worker Program Service Date Units Unit Type Amount
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Provider N
Client Service Units Report PSA ALL Provider ALL PROVIDERS Location 0000
Program ALL PROGRAMS Service ALL SERVICES Worker ALL WORKERS
City ALL CITIES Include Zero Unit N Include Aggregate N Calculated Amount equals the number of Units Provided times Fixed Cost if it existsService Start Date 01012017 Service End Date 12312017 If Fixed Cost does not exist Calculated
Group by PSA Provider Location Client Name County Worker Amount equals Billed Amount
Unduplicated Client Count 0 Grand Total 000 $000
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Clients In Common PSA All Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 County All Counties Worker All Workers
County JEFFERSON
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
MIAMI-DADE
0 0 0 0 0 0 0 0 0
4061539538 Test NameCounty Count
County
0 01
X
0 1
X
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
4061650856 Test Name X 4061486560 Test Name X 4062452921 Test Name X
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Clients Served Not Enrolled PSA ALL Start Date 01012017 End Date 12312017 Locations 0000 Provider All Providers
Service Service Min Serv Max Serv Program Start End Enrollment PSA Provider Location Program Consumer Name Client ID Service Date Date Status Enrollment Enrollment Provider
Count 0
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
4061472791 04
09
1092
1291
0072
0042
LTCC
LTCC
APCL
APCL
4062714543 06
06
1514
1762
0072
5006
LTCC
LTCC
APCL
APPL
4061802246 11
06
1177
1514
0179
0072
LTCC
LTCC
APCL
APCL
4061563719 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062644312 06
08
1514
1771
0072
0896
LTCC
LTCC
APCL
APCL
1001141670 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
1001141671 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
4062375003 07
05
05
07
1263
1755
1638
1263
0368
0072
0072
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062155124 06
06
1762
1514
0072
0072
LTCC
LTCC
APPL
APCL
4061743886 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0369
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4061499927 06
06
1514
1762
0072
5005
LTCC
LTCC
APCL
APPL
4061583524 08
06
1144
1514
0896
0072
LTCC
LTCC
APCL
APCL
4062694843 06
03
1514
1922
0072
0179
LTCC
LTCC
APCL
APCL
4062744517 07
06
1263
1514
0369
0072
LTCC
LTCC
APCL
APCL
4062005488 10
11
10
11
1929
1177
1164
1177
0072
0073
0179
0179
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
Total Count 15
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CODE DESCRIPTIONS Category ALL STATE TABLES
Code Description Active Available To Code Category
0 UNKNOWN Y CARES SUBJECTIVE_HEALTH_EVALUATION
01 ALACHUA Y COMMON COUNTIES
02 BAKER Y COMMON COUNTIES
03 BAY Y COMMON COUNTIES
04 BRADFORD Y COMMON COUNTIES
05 BREVARD Y COMMON COUNTIES
06 BROWARD Y COMMON COUNTIES
07 CALHOUN Y COMMON COUNTIES
08 CHARLOTTE Y COMMON COUNTIES
09 CITRUS Y COMMON COUNTIES
1 EXCELLENT Y CARES SUBJECTIVE_HEALTH_EVALUATION
10 CLAY Y COMMON COUNTIES
11 COLLIER Y COMMON COUNTIES
12 COLUMBIA Y COMMON COUNTIES
13 MIAMI-DADE Y COMMON COUNTIES
14 DESOTO Y COMMON COUNTIES
15 DIXIE Y COMMON COUNTIES
16 DUVAL Y COMMON COUNTIES
17 ESCAMBIA Y COMMON COUNTIES
18 FLAGLER Y COMMON COUNTIES
19 FRANKLIN Y COMMON COUNTIES
2 GOOD Y CARES SUBJECTIVE_HEALTH_EVALUATION
20 GADSDEN Y COMMON COUNTIES
21 GILCHRIST Y COMMON COUNTIES
22 GLADES Y COMMON COUNTIES
23 GULF Y COMMON COUNTIES
24 HAMILTON Y COMMON COUNTIES
25 HARDEE Y COMMON COUNTIES
26 HENDRY Y COMMON COUNTIES
27 HERNANDO Y COMMON COUNTIES
28 HIGHLANDS Y COMMON COUNTIES
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CONSUMER AGE VERIFICATION REPORT PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Program AC
Age at Start
Enroll or Start Enroll Provider Program Description Consumer Name Client ID DOB Svc date or Svc Date
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Contract Budget Information PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Program Service Provider Location County Served Provider Contract
Projected Service
Units Unit Measure
Projected Unduplicated
State Federal Share Client Count Begin Date End Date
Row Count 0 Amount Total
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Start Enroll Latest Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Date Asmt Date Worker
O3C1 1036 000 4061653427 Test CENTRAL 34982 W M 07091930 09102013 09102013 CIRTS20804 0 Name
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Start Enroll Date
Latest Asmt Date Worker
4061593624 Test Name CENTRAL 34946 B F 11261940 12012011 12312013 CIRTS23407
Count 164
Unduplicated Client Count 163
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Assessments After DOD Report
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Owner 1025
The shaded records indicate clients who have different DOBs andor different names
Assemt Current PSA Owner Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Owner Assessor
Provider Assessor
Assemt Date
Assemt Type
Unduplicated Count Total 0
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Open Enrollments
The Vital Statistics Data for 07192002 - 09112014PSA ALL Provider ALL Program Status ACTV Include MLTC ACTVS N
The shaded records indicate clients who have different DOBs andor different names
Enroll PSA
Enrollment Provider Loc Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Enroll Program Status
Enroll Program
Current Owner ID
02 1065 0072 4062244026 Test Name Test Name 10222004 03231917 03231917 ACTV CCE 1065
Count of enrollments for the Provider 1
Count of enrollments for the PSA 1
Count of enrollments for the Report 1
Unduplicated Count of Individuals with open enrollments and DOD PSA Total Clients Count
02 1
Total 1
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Unduplicated count of individuals with Services after DOD
PSA Total Clients Count
Report Total
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
List of Clients with PSA table entry for SERVICES_AFTER_DOD
Unduplicated Count Total 0
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Age
Provider
Total
Age lt 60 Age 60 - 64 Age 65 - 74 Age 75 - 84 Age 85+ Total Clients Avg Age
Total
Avg Age
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Ethnicity
Provider Hispanic Other Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Race
American Indian Native Hawaiian Other Provider Asian Alaska Native Black Pacific Islander Minority White Multiple Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Gender
Provider Male Female Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Monthly Income
Provider 0 - - Higher than Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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None
Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Total Persons Served 0
Age lt 60 Years 0 0
Age 60 - 64 0 0
Age 65 - 74 0 0
Age 75 - 84 0 0
Age 85+ 0 0
Total Age 0 0
Average 000
Ethnicity Hispanic 0 0
Other Ethnicity 0 0
Unknown Ethnicity 0 0
Total 0 0
Race Asian 0 0
American Indian Alaska Native 0 0
Black 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority 0 0
White 0 0
Multiple 0 0
Unknown 0 0
Total 0 0
Sex Male 0 0
Female 0 0
Unknown Sex 0 0
Total 0 0
Monthly Income 0 - 0 0
- 0 0
Higher than 0 0
Unknown 0 0
Total 0 0
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Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Client ID Date Of Birth Ethnicity Race Sex Individual Monthly Income
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Demographics of Clients OAA Registered Served Only PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 City All Cities Program All Programs Service All Services County ALL COUNTIES Table OAA Registered Services Only Low Income Medium Income
Total Persons Served 0
Agelt 60 Years
Age 60 - 64
Age 65 - 74
Age 75 - 84
Age 85+
0
0
0
0
0
0
0
0
0
0
Monthly Income
0 -
-Higher than
Unknown
0
0
0
0
0
0
0
0
Total
Average
0
000
0 Total 0 0
Ethnicity Hispanic
Other
Unknown
0
0
0
0
0
0
Living Situation
Alone
Null
Policy Change
0
0
0
0
0
0
Total 0 0 Unknown
With Caregiver
0
0
0
0
Race Asian 0 0
With Other
With Other Caregiver
0
0
0
0
American Indian Alaska Native
Black
0
0
0
0Total Living Situation 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority
White
0
0
0
0 Limited English Proficiency
Multiple
Unknown
Total Race
0
0
0
0
0
0
Yes
No
Unknown
0
0
0
0
0
0
Total 0 0
Sex Male
Female
Unknown
0
0
0
0
0
0
Total 0 0
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Disaster Assistance Clients for a Provider PSA ALL Provider All Providers Location 0000 Worker All Workers City All Cities Zip Code All Zip Codes Sort By ZIP
Provider 1036 Provider Name Location 0000 Worker CIRTS18634
Need Care Client Name Address City Zip County Phone Asst Reg Situation Relat Care phone Care Name
34946 N WO DA 000 SAINT JAMES DRIVE CENTRAL (025) 101-0620 Test NameTest Name SAINT LUCIE (005) 100-0369 Y
Client is active and no assessment information is available Special Shelter and Special Registry are unknown
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
Total by PSA 0
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
ALACH BAKER BAY BRADF BREVA BROWA CALHO CHARL CITRUS CLAY COLLIE COLUM DESOT DIXIE DUVAL ESCAM FLAGL FRANK GADSDAssisted Household Report UA ORD RD RD UN OTTE R BIA O BIA ER LIN EN
1 of Household Assisted 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Households AssistedWith Gross Income
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C 100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D 125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
3 Households with at leastOne member
A 60 Years or older 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B Disabled 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C Age 5 years or under 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D Under 60 Years Old 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Undup Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Assisted
Applicant Household Report
of Applicant Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Energy Assisted Household Report
County of Assisted
Households
Households Assisted By Poverty Level
Under 75 75 - 100 101 - 125 126 - 150 Over 150 60 Years or older
At least one member who is
Age 5 years Age 2 years Age 3 years Disabled or younger and younger through 5
Under 60 Years Old
Undup Households
Assisted
Energy Assistance Total
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Unduplicated Total 0 0
County of Assisted
Households Under 75 75 - 100
Households Assisted By Poverty Level
101 - 125 126 - 150 Over 150 60 Years or older Disabled
Age 5 years or younger
Age 2 years and younger
Age 3 years through 5
Under 60 Years Old
At least one member who is
Undup Households
Assisted
Other Assisted Household Report
Other Assistance Total
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Applicant Household Report
County of Applicant
Households Under 75 75 - 100 101 - 125 126 - 150 Over 150 Income data
unavailable
Total 0
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01
Enrollment Active Consumer Count by Program PSA ALL Provider ALL PROVIDERS
County Description Program Count of Clients
BREVARD
ADI
CCE
HCE
LSP
NDP
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
MLTC
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
31
57
44
5
62
123
141
26
9
7
5
40
5
50
67
129
2
19
42
29
1
233
79
63
8
2
14
3
37
14
47
3
3
33
127
10
02
03
04
ALACHUA
BAKER
BAY
BRADFORD
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Enrollment Terminations with Reasons PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 Program All Programs Program Status ALL Program Status Worker ALL WORKERS
Last First Program Medicaid Provider Start End Name Name Client ID Status Description Worker Number Program Location Enrollment Enrollment
Count 0
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Enrollments with Care Plan Report
PSA ALL Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTIVE STATUS Care Plan Service ALL SERVICES Care Plan Start 01012017 Care Plan End 12312017
Care Plan Care Plan Care Plan Client Name
Unduplicated Client Count 0
Client ID Program Status Worker Start Date End Date Service
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PSA CLIENT_ID CLIENT_NAME OWNER PROVIDER_ID ASSESSMENT_DATE ASSESSOR_NAME MEDICAID_NUMBER CAREGIVER_CHANGE ENVIRONMENT_CHANGE HEALTH_CHANGE INCOME_CHANGE SITUATION_CHANGE INITIAL_ASSM ANNUAL_ASSM SSN REFERRAL_SOURCE 1114 N N N N Y N 771771777 SELFFAMILY 812017 JANE CASEWORKER 2 1001141633 TEST TEST N
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Fixed Service Costs List PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Provider Location County Program Service Reimbursement Unit Rate Provider Cost Per Unit Begin Valid End Valid
Count 0
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Assessment Due Report PSA 01 Start Date 01012017 End Date 08312018 Owner ALL PROVIDERS Worker ALL WORKERS Program Status ACTV and APCL Assessment Type Needed ALL
Overdue and missing assessments are always listed
Owner ID 1065
Client ID Client Name
Owner Assessor ID
Date of Birth
06281928
CIRTS28099
County of Service
GULF
Worker Name HARPER KENNY
Zip Assessment PSA Date
32534 01 01022014
Type
701A
Active Y
Nutr PriorityScore Score
11 58
Rank
5
Due Date
01022015
Status
701S OVERDUE
LTCC APPL Start Date
03252014 4062235673 Test name
Total Clients for Worker 1
Total Clients for Owner 1
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Assessment Due Report PSA 01 Start Date 01012017 End Date 08312018 Owner ALL PROVIDERS Worker ALL WORKERS Program Status ACTV and APCL Assessment Type Needed ALL
Overdue and missing assessments are always listed
Summary by PSA
PSA 01 701A Overdue 1
701B Overdue 213
701C Overdue 0
701S Overdue 157
No 701A 0
No 701B 2
No 701C 0
No 701S 0
701A Not Overdue 0
701B Not Overdue 0
701C Not Overdue 0
701S Not Overdue 0
701S Optional 0
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CIC Service Units and Costs Projections County SummaryPSA 99 Program CCE
Start Date 01012017 End Date 12312017
County LEON
Total Total Total Avg Max Projected
StateFederal Projected Reimbursement Provider Unduplicated Provider Service Share Service Units Unit Rate Cost Per Unit Client Count
Report Total
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CIC Service Units and Costs Projections Provider SummaryPSA ALL Provider ALL PROVIDERS Program FEDERALLY FUNDED (0101 TO 1231) Year 2017 From 01012017 To 12312017
PSA County Program Service Total State
Federal Share
Total Projected
Service Units
Avg Reimbursement
Unit Rate
Max Provider
Cost Per Unit
Total Projected Unduplicated Client Count
02 FRANKLIN O3C1 CONGREGATE MEALS $810300 1710 15
Program Total
County Total
$810300
$810300
GULF O3C1 CONGREGATE MEALS $25205 3 5
Program Total $25205
O3C2 HOME DELIVERED MEALS $25205 3 6
Program Total
County Total
$25205
$50411
LEON O3C1 CONGREGATE MEALS $621300 1311 15
CONGREGATE MEALS GUEST
CONGREGATE MEALS VOLUNTEERS
$252055
$277260
25
30
2
5
Program Total $1150615
O3C2 HOME DELIVERED MEAL GUEST $252055 25 3
Program Total $252055
OA3D PEARLS (SESSION 5)
PEARLS (SESSION 6)
PEARLS (SESSION 7)
PEARLS (SESSION 8)
$10247
$10247
$10247
$10247
10
10
10
10
3
3
3
3
Program Total $40988
OA3E RESPITE IN-HOME $200 2 2
Program Total
County Total
$200
$1443858
WAKULLA O3C2 EMERGENCY HOME DELIVERED SHELF MEALS
$8065604 14899 90
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CIC Service Units and Costs Projections - PSA Summary
PSA ALL Program CCE
Strat Date 01012017 End Date 12312017
Total
PSA County Provider Service
Total State Federal
Share
Total Projected
Service Units
Avg Reimbursement
Unit Rate
Max Projected Provider Unduplicated
Cost Per Unit Client Count
02 LEON SOUTHERN SERVICE CASE MANAGEMENT PROVIDER EMERGENCY HOME DELIVERED SHELF MEALS
$2175533
$602000
483
689
32
20
HOME DELIVERED MEALS $530262 993 5
MATERIAL AID $1994536 199
Provider Total $5302331
CountyTotal $5302331
WAKULLA SOUTHERN SERVICE CASE MANAGEMENT PROVIDER EMERGENCY HOME DELIVERED SHELF MEALS
$2175533
$1240200
483
689
32
5
MATERIAL AID $1994536 199
Provider Total $5410269
CountyTotal $5410269
PSA Total $10712599
05 PINELLAS BURSTEIN-APPLEBEE ADULT DAY CARE $000 0 $900 $1000 0
COUNSELING (MENTAL HEALTH COUNSELINGSCREENING) - INDIVIDUAL
Provider Total
$000
$000
0 $6600 $7700 0
CountyTotal $000
PSA Total $000
Report Total $10712599
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CID Service Units and Costs Projections - PSA SummaryPSA ALL Program CCE
Start Date 01012017 End Date 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
PSA County Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
02 LEON CASE MANAGEMENT $2175533 483
EMERGENCY HOME $602000 689DELIVERED SHELF MEALS HOME DELIVERED MEALS $530262 993
MATERIAL AID $1994536 199
County Total $5302331 2364
WAKULLA CASE MANAGEMENT $2175533 483
EMERGENCY HOME $1240200 689DELIVERED SHELF MEALS MATERIAL AID $1994536 199
County Total $5410269 1371
PSA Total $10712599 3735
05 PINELLAS ADULT DAY CARE $000 0
COUNSELING (MENTAL $000 0 HEALTH COUNSELINGSCREENING) - INDIVIDUAL
County Total $000 0
PSA Total $000 0
Report Total $10712599 3735
$900 $900 $900 $1000 $1000 $1000
$6600 $6600 $6600 $7700 $7700 $7700
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CID Service Units and Costs Projections County SummaryPSA 99
Program CCE County LEON
Start Date 01012017 End Date 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
Report Total
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CIE Service Units and Costs Projections - PSA Summary - All Programs
PSA 99 Program FEDERALLY FUNDED (0101 TO 1231) Year 2017 From 01012017 To 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
Program Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
Report Total
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CIE Service Units and Costs Projections - PSA Summary
PSA ALL Program CCE
Start Date 01012017 End Date 12312017
Avg High Low Total Total Avg High Low Provider Provider Provider
StateFederal Projected Reimbursement Reimbursement Reimbursement Cost Cost CostPSA
02
Service
CASE MANAGEMENT
Share
$4351066
Service Units
966
Unit Rate Unit Rate Unit Rate Per Unit Per Unit Per Unit
EMERGENCY HOME DELIVERED SHELF MEALS $1842200 1378
HOME DELIVERED MEALS $530262 993
MATERIAL AID $3989071 398
PSA Total $10712599 3735
05 ADULT DAY CARE $000 0 $900 $900 $900 $1000 $1000 $1000
COUNSELING (MENTAL HEALTH $000 0 $6600 $6600 $6600 $7700 $7700 $7700 COUNSELINGSCREENING) - INDIVIDUAL
PSA Total $000 0
Report Total $10712599 3735
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CAREGIVER SEARCH REPORT
SEARCH RESULTS FOR CONSUMERS
Criteria First Name Last Name SSN PSA ALL
Client Name Client SSN Caregiver Name Caregiver SSN
000000000 000000000 Test Name Test Name
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CARES Referrals in a Time Range PSA ALL
Start Date 01012017 End Date 12312017
Referred to ALL REFERRALS
Referring PSA Employee Name Client Name Client ID
Referral Imminent NH Admit Aging Date Risk Date Referred To Cares Provider Name Received Date
03A 4061561263 Test Name Test Name 09242017 Y 05292017 ARC or ADRC 09252017
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CARES Referrals in a Time Range PSA ALL
Start Date 01012017 End Date 12312017
Referred to ALL REFERRALS
Referring PSA Employee Name Client Name Client ID
Referral Date
Imminent Risk
NH Admit Date Referred To Cares Provider Name
Aging Received Date
04B Test Name Test Name 4061738075 04082017 N ARC or ADRC Test Name 04082017
Total Clients 110
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CARES Referrals not acknowledged by the Aging Network PSA ALL For Referrals after 01012017 Owner ID ALL Owners
Unduplicated Client count Cares Office Total Clients Count
Report Total
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
CIRTS Issue PSA Client ID Client Name Program
Program Status Start Provider Enrollment ID Provider Name
APCL CLIENT WITH DATE OF DEATH 08 4061759417 Test Name OA3B APCL 07232013 1141 WESTERN WORLD RADIO
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
Program Start Provider CIRTS Issue PSA Client ID Client Name Program Status Enrollment ID Provider Name
06 LTCC APCL 01242014 1514 4061713685 Test Name APCL CLIENT WITH DATE OF DEATH CENTRAL THE ORIGINAL HOUSE OF PIES
Count 503
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Civil Rights PSA ALL Provider ALL PROVIDERS Program AC Start Date 01012017 End Date 12312017 The Poverty Level for Single is The Poverty Level for Couple is Sort by County
County Unduplicated Count
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Client Information Report Start Date 01012017 End Date 12312017
Client ID 1001141246
Emergency
Client Name Test Name
Telephone () - Address 78 TEST STREET TALLAHASSEE FL 32399
Most Recent Caregiver Information Date Updated
Doctor
Comments
Client Demographic Information
Birth Date 06041940 Race W
Owner ID Ethnicity O
Most Recent Income Information
Ind Mon Inc Cpl Mon Inc
Ind Assets Couple Assets
Most Recent Assessment Information
Asmt Date Ref Risk Lvl
Asmt Site Spec Shel
AsmtType Spec Reg
Ref Date Primary CG
Ref Source Living Sit
Enrollment Information
Sex
Marital Status
F
S
Medicaid Number
ADL Score
ADL Count
IADL Score
IADL Count
Memory Score
Priority Score
Env Score
Nutr Score
Risk Score
Social Score
Rank
Provider Location Program Program Status Worker Start Date End Date
Care Plan Service Needed
Date Service Units Type Frq End Date
Care Plan Service Planned
Program Service Units Type Frq Start Date End Date
Services Received between 01012017 and 12312017
Service Billed Provider Location Worker Program Service Date Units Unit Type Amount
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Provider N
Client Service Units Report PSA ALL Provider ALL PROVIDERS Location 0000
Program ALL PROGRAMS Service ALL SERVICES Worker ALL WORKERS
City ALL CITIES Include Zero Unit N Include Aggregate N Calculated Amount equals the number of Units Provided times Fixed Cost if it existsService Start Date 01012017 Service End Date 12312017 If Fixed Cost does not exist Calculated
Group by PSA Provider Location Client Name County Worker Amount equals Billed Amount
Unduplicated Client Count 0 Grand Total 000 $000
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Clients In Common PSA All Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 County All Counties Worker All Workers
County JEFFERSON
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
MIAMI-DADE
0 0 0 0 0 0 0 0 0
4061539538 Test NameCounty Count
County
0 01
X
0 1
X
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
4061650856 Test Name X 4061486560 Test Name X 4062452921 Test Name X
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Clients Served Not Enrolled PSA ALL Start Date 01012017 End Date 12312017 Locations 0000 Provider All Providers
Service Service Min Serv Max Serv Program Start End Enrollment PSA Provider Location Program Consumer Name Client ID Service Date Date Status Enrollment Enrollment Provider
Count 0
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
4061472791 04
09
1092
1291
0072
0042
LTCC
LTCC
APCL
APCL
4062714543 06
06
1514
1762
0072
5006
LTCC
LTCC
APCL
APPL
4061802246 11
06
1177
1514
0179
0072
LTCC
LTCC
APCL
APCL
4061563719 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062644312 06
08
1514
1771
0072
0896
LTCC
LTCC
APCL
APCL
1001141670 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
1001141671 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
4062375003 07
05
05
07
1263
1755
1638
1263
0368
0072
0072
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062155124 06
06
1762
1514
0072
0072
LTCC
LTCC
APPL
APCL
4061743886 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0369
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4061499927 06
06
1514
1762
0072
5005
LTCC
LTCC
APCL
APPL
4061583524 08
06
1144
1514
0896
0072
LTCC
LTCC
APCL
APCL
4062694843 06
03
1514
1922
0072
0179
LTCC
LTCC
APCL
APCL
4062744517 07
06
1263
1514
0369
0072
LTCC
LTCC
APCL
APCL
4062005488 10
11
10
11
1929
1177
1164
1177
0072
0073
0179
0179
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
Total Count 15
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CODE DESCRIPTIONS Category ALL STATE TABLES
Code Description Active Available To Code Category
0 UNKNOWN Y CARES SUBJECTIVE_HEALTH_EVALUATION
01 ALACHUA Y COMMON COUNTIES
02 BAKER Y COMMON COUNTIES
03 BAY Y COMMON COUNTIES
04 BRADFORD Y COMMON COUNTIES
05 BREVARD Y COMMON COUNTIES
06 BROWARD Y COMMON COUNTIES
07 CALHOUN Y COMMON COUNTIES
08 CHARLOTTE Y COMMON COUNTIES
09 CITRUS Y COMMON COUNTIES
1 EXCELLENT Y CARES SUBJECTIVE_HEALTH_EVALUATION
10 CLAY Y COMMON COUNTIES
11 COLLIER Y COMMON COUNTIES
12 COLUMBIA Y COMMON COUNTIES
13 MIAMI-DADE Y COMMON COUNTIES
14 DESOTO Y COMMON COUNTIES
15 DIXIE Y COMMON COUNTIES
16 DUVAL Y COMMON COUNTIES
17 ESCAMBIA Y COMMON COUNTIES
18 FLAGLER Y COMMON COUNTIES
19 FRANKLIN Y COMMON COUNTIES
2 GOOD Y CARES SUBJECTIVE_HEALTH_EVALUATION
20 GADSDEN Y COMMON COUNTIES
21 GILCHRIST Y COMMON COUNTIES
22 GLADES Y COMMON COUNTIES
23 GULF Y COMMON COUNTIES
24 HAMILTON Y COMMON COUNTIES
25 HARDEE Y COMMON COUNTIES
26 HENDRY Y COMMON COUNTIES
27 HERNANDO Y COMMON COUNTIES
28 HIGHLANDS Y COMMON COUNTIES
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CONSUMER AGE VERIFICATION REPORT PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Program AC
Age at Start
Enroll or Start Enroll Provider Program Description Consumer Name Client ID DOB Svc date or Svc Date
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Contract Budget Information PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Program Service Provider Location County Served Provider Contract
Projected Service
Units Unit Measure
Projected Unduplicated
State Federal Share Client Count Begin Date End Date
Row Count 0 Amount Total
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Start Enroll Latest Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Date Asmt Date Worker
O3C1 1036 000 4061653427 Test CENTRAL 34982 W M 07091930 09102013 09102013 CIRTS20804 0 Name
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Start Enroll Date
Latest Asmt Date Worker
4061593624 Test Name CENTRAL 34946 B F 11261940 12012011 12312013 CIRTS23407
Count 164
Unduplicated Client Count 163
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Assessments After DOD Report
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Owner 1025
The shaded records indicate clients who have different DOBs andor different names
Assemt Current PSA Owner Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Owner Assessor
Provider Assessor
Assemt Date
Assemt Type
Unduplicated Count Total 0
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Open Enrollments
The Vital Statistics Data for 07192002 - 09112014PSA ALL Provider ALL Program Status ACTV Include MLTC ACTVS N
The shaded records indicate clients who have different DOBs andor different names
Enroll PSA
Enrollment Provider Loc Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Enroll Program Status
Enroll Program
Current Owner ID
02 1065 0072 4062244026 Test Name Test Name 10222004 03231917 03231917 ACTV CCE 1065
Count of enrollments for the Provider 1
Count of enrollments for the PSA 1
Count of enrollments for the Report 1
Unduplicated Count of Individuals with open enrollments and DOD PSA Total Clients Count
02 1
Total 1
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Unduplicated count of individuals with Services after DOD
PSA Total Clients Count
Report Total
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
List of Clients with PSA table entry for SERVICES_AFTER_DOD
Unduplicated Count Total 0
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Age
Provider
Total
Age lt 60 Age 60 - 64 Age 65 - 74 Age 75 - 84 Age 85+ Total Clients Avg Age
Total
Avg Age
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Ethnicity
Provider Hispanic Other Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Race
American Indian Native Hawaiian Other Provider Asian Alaska Native Black Pacific Islander Minority White Multiple Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Gender
Provider Male Female Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Monthly Income
Provider 0 - - Higher than Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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None
Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Total Persons Served 0
Age lt 60 Years 0 0
Age 60 - 64 0 0
Age 65 - 74 0 0
Age 75 - 84 0 0
Age 85+ 0 0
Total Age 0 0
Average 000
Ethnicity Hispanic 0 0
Other Ethnicity 0 0
Unknown Ethnicity 0 0
Total 0 0
Race Asian 0 0
American Indian Alaska Native 0 0
Black 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority 0 0
White 0 0
Multiple 0 0
Unknown 0 0
Total 0 0
Sex Male 0 0
Female 0 0
Unknown Sex 0 0
Total 0 0
Monthly Income 0 - 0 0
- 0 0
Higher than 0 0
Unknown 0 0
Total 0 0
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Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Client ID Date Of Birth Ethnicity Race Sex Individual Monthly Income
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Demographics of Clients OAA Registered Served Only PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 City All Cities Program All Programs Service All Services County ALL COUNTIES Table OAA Registered Services Only Low Income Medium Income
Total Persons Served 0
Agelt 60 Years
Age 60 - 64
Age 65 - 74
Age 75 - 84
Age 85+
0
0
0
0
0
0
0
0
0
0
Monthly Income
0 -
-Higher than
Unknown
0
0
0
0
0
0
0
0
Total
Average
0
000
0 Total 0 0
Ethnicity Hispanic
Other
Unknown
0
0
0
0
0
0
Living Situation
Alone
Null
Policy Change
0
0
0
0
0
0
Total 0 0 Unknown
With Caregiver
0
0
0
0
Race Asian 0 0
With Other
With Other Caregiver
0
0
0
0
American Indian Alaska Native
Black
0
0
0
0Total Living Situation 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority
White
0
0
0
0 Limited English Proficiency
Multiple
Unknown
Total Race
0
0
0
0
0
0
Yes
No
Unknown
0
0
0
0
0
0
Total 0 0
Sex Male
Female
Unknown
0
0
0
0
0
0
Total 0 0
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Disaster Assistance Clients for a Provider PSA ALL Provider All Providers Location 0000 Worker All Workers City All Cities Zip Code All Zip Codes Sort By ZIP
Provider 1036 Provider Name Location 0000 Worker CIRTS18634
Need Care Client Name Address City Zip County Phone Asst Reg Situation Relat Care phone Care Name
34946 N WO DA 000 SAINT JAMES DRIVE CENTRAL (025) 101-0620 Test NameTest Name SAINT LUCIE (005) 100-0369 Y
Client is active and no assessment information is available Special Shelter and Special Registry are unknown
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
Total by PSA 0
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
ALACH BAKER BAY BRADF BREVA BROWA CALHO CHARL CITRUS CLAY COLLIE COLUM DESOT DIXIE DUVAL ESCAM FLAGL FRANK GADSDAssisted Household Report UA ORD RD RD UN OTTE R BIA O BIA ER LIN EN
1 of Household Assisted 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Households AssistedWith Gross Income
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C 100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D 125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
3 Households with at leastOne member
A 60 Years or older 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B Disabled 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C Age 5 years or under 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D Under 60 Years Old 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Undup Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Assisted
Applicant Household Report
of Applicant Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Energy Assisted Household Report
County of Assisted
Households
Households Assisted By Poverty Level
Under 75 75 - 100 101 - 125 126 - 150 Over 150 60 Years or older
At least one member who is
Age 5 years Age 2 years Age 3 years Disabled or younger and younger through 5
Under 60 Years Old
Undup Households
Assisted
Energy Assistance Total
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Unduplicated Total 0 0
County of Assisted
Households Under 75 75 - 100
Households Assisted By Poverty Level
101 - 125 126 - 150 Over 150 60 Years or older Disabled
Age 5 years or younger
Age 2 years and younger
Age 3 years through 5
Under 60 Years Old
At least one member who is
Undup Households
Assisted
Other Assisted Household Report
Other Assistance Total
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Applicant Household Report
County of Applicant
Households Under 75 75 - 100 101 - 125 126 - 150 Over 150 Income data
unavailable
Total 0
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01
Enrollment Active Consumer Count by Program PSA ALL Provider ALL PROVIDERS
County Description Program Count of Clients
BREVARD
ADI
CCE
HCE
LSP
NDP
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
MLTC
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
31
57
44
5
62
123
141
26
9
7
5
40
5
50
67
129
2
19
42
29
1
233
79
63
8
2
14
3
37
14
47
3
3
33
127
10
02
03
04
ALACHUA
BAKER
BAY
BRADFORD
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Enrollment Terminations with Reasons PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 Program All Programs Program Status ALL Program Status Worker ALL WORKERS
Last First Program Medicaid Provider Start End Name Name Client ID Status Description Worker Number Program Location Enrollment Enrollment
Count 0
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Enrollments with Care Plan Report
PSA ALL Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTIVE STATUS Care Plan Service ALL SERVICES Care Plan Start 01012017 Care Plan End 12312017
Care Plan Care Plan Care Plan Client Name
Unduplicated Client Count 0
Client ID Program Status Worker Start Date End Date Service
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PSA CLIENT_ID CLIENT_NAME OWNER PROVIDER_ID ASSESSMENT_DATE ASSESSOR_NAME MEDICAID_NUMBER CAREGIVER_CHANGE ENVIRONMENT_CHANGE HEALTH_CHANGE INCOME_CHANGE SITUATION_CHANGE INITIAL_ASSM ANNUAL_ASSM SSN REFERRAL_SOURCE 1114 N N N N Y N 771771777 SELFFAMILY 812017 JANE CASEWORKER 2 1001141633 TEST TEST N
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Fixed Service Costs List PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Provider Location County Program Service Reimbursement Unit Rate Provider Cost Per Unit Begin Valid End Valid
Count 0
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Assessment Due Report PSA 01 Start Date 01012017 End Date 08312018 Owner ALL PROVIDERS Worker ALL WORKERS Program Status ACTV and APCL Assessment Type Needed ALL
Overdue and missing assessments are always listed
Summary by PSA
PSA 01 701A Overdue 1
701B Overdue 213
701C Overdue 0
701S Overdue 157
No 701A 0
No 701B 2
No 701C 0
No 701S 0
701A Not Overdue 0
701B Not Overdue 0
701C Not Overdue 0
701S Not Overdue 0
701S Optional 0
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CIC Service Units and Costs Projections County SummaryPSA 99 Program CCE
Start Date 01012017 End Date 12312017
County LEON
Total Total Total Avg Max Projected
StateFederal Projected Reimbursement Provider Unduplicated Provider Service Share Service Units Unit Rate Cost Per Unit Client Count
Report Total
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CIC Service Units and Costs Projections Provider SummaryPSA ALL Provider ALL PROVIDERS Program FEDERALLY FUNDED (0101 TO 1231) Year 2017 From 01012017 To 12312017
PSA County Program Service Total State
Federal Share
Total Projected
Service Units
Avg Reimbursement
Unit Rate
Max Provider
Cost Per Unit
Total Projected Unduplicated Client Count
02 FRANKLIN O3C1 CONGREGATE MEALS $810300 1710 15
Program Total
County Total
$810300
$810300
GULF O3C1 CONGREGATE MEALS $25205 3 5
Program Total $25205
O3C2 HOME DELIVERED MEALS $25205 3 6
Program Total
County Total
$25205
$50411
LEON O3C1 CONGREGATE MEALS $621300 1311 15
CONGREGATE MEALS GUEST
CONGREGATE MEALS VOLUNTEERS
$252055
$277260
25
30
2
5
Program Total $1150615
O3C2 HOME DELIVERED MEAL GUEST $252055 25 3
Program Total $252055
OA3D PEARLS (SESSION 5)
PEARLS (SESSION 6)
PEARLS (SESSION 7)
PEARLS (SESSION 8)
$10247
$10247
$10247
$10247
10
10
10
10
3
3
3
3
Program Total $40988
OA3E RESPITE IN-HOME $200 2 2
Program Total
County Total
$200
$1443858
WAKULLA O3C2 EMERGENCY HOME DELIVERED SHELF MEALS
$8065604 14899 90
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CIC Service Units and Costs Projections - PSA Summary
PSA ALL Program CCE
Strat Date 01012017 End Date 12312017
Total
PSA County Provider Service
Total State Federal
Share
Total Projected
Service Units
Avg Reimbursement
Unit Rate
Max Projected Provider Unduplicated
Cost Per Unit Client Count
02 LEON SOUTHERN SERVICE CASE MANAGEMENT PROVIDER EMERGENCY HOME DELIVERED SHELF MEALS
$2175533
$602000
483
689
32
20
HOME DELIVERED MEALS $530262 993 5
MATERIAL AID $1994536 199
Provider Total $5302331
CountyTotal $5302331
WAKULLA SOUTHERN SERVICE CASE MANAGEMENT PROVIDER EMERGENCY HOME DELIVERED SHELF MEALS
$2175533
$1240200
483
689
32
5
MATERIAL AID $1994536 199
Provider Total $5410269
CountyTotal $5410269
PSA Total $10712599
05 PINELLAS BURSTEIN-APPLEBEE ADULT DAY CARE $000 0 $900 $1000 0
COUNSELING (MENTAL HEALTH COUNSELINGSCREENING) - INDIVIDUAL
Provider Total
$000
$000
0 $6600 $7700 0
CountyTotal $000
PSA Total $000
Report Total $10712599
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CID Service Units and Costs Projections - PSA SummaryPSA ALL Program CCE
Start Date 01012017 End Date 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
PSA County Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
02 LEON CASE MANAGEMENT $2175533 483
EMERGENCY HOME $602000 689DELIVERED SHELF MEALS HOME DELIVERED MEALS $530262 993
MATERIAL AID $1994536 199
County Total $5302331 2364
WAKULLA CASE MANAGEMENT $2175533 483
EMERGENCY HOME $1240200 689DELIVERED SHELF MEALS MATERIAL AID $1994536 199
County Total $5410269 1371
PSA Total $10712599 3735
05 PINELLAS ADULT DAY CARE $000 0
COUNSELING (MENTAL $000 0 HEALTH COUNSELINGSCREENING) - INDIVIDUAL
County Total $000 0
PSA Total $000 0
Report Total $10712599 3735
$900 $900 $900 $1000 $1000 $1000
$6600 $6600 $6600 $7700 $7700 $7700
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CID Service Units and Costs Projections County SummaryPSA 99
Program CCE County LEON
Start Date 01012017 End Date 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
Report Total
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CIE Service Units and Costs Projections - PSA Summary - All Programs
PSA 99 Program FEDERALLY FUNDED (0101 TO 1231) Year 2017 From 01012017 To 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
Program Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
Report Total
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CIE Service Units and Costs Projections - PSA Summary
PSA ALL Program CCE
Start Date 01012017 End Date 12312017
Avg High Low Total Total Avg High Low Provider Provider Provider
StateFederal Projected Reimbursement Reimbursement Reimbursement Cost Cost CostPSA
02
Service
CASE MANAGEMENT
Share
$4351066
Service Units
966
Unit Rate Unit Rate Unit Rate Per Unit Per Unit Per Unit
EMERGENCY HOME DELIVERED SHELF MEALS $1842200 1378
HOME DELIVERED MEALS $530262 993
MATERIAL AID $3989071 398
PSA Total $10712599 3735
05 ADULT DAY CARE $000 0 $900 $900 $900 $1000 $1000 $1000
COUNSELING (MENTAL HEALTH $000 0 $6600 $6600 $6600 $7700 $7700 $7700 COUNSELINGSCREENING) - INDIVIDUAL
PSA Total $000 0
Report Total $10712599 3735
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CAREGIVER SEARCH REPORT
SEARCH RESULTS FOR CONSUMERS
Criteria First Name Last Name SSN PSA ALL
Client Name Client SSN Caregiver Name Caregiver SSN
000000000 000000000 Test Name Test Name
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CARES Referrals in a Time Range PSA ALL
Start Date 01012017 End Date 12312017
Referred to ALL REFERRALS
Referring PSA Employee Name Client Name Client ID
Referral Imminent NH Admit Aging Date Risk Date Referred To Cares Provider Name Received Date
03A 4061561263 Test Name Test Name 09242017 Y 05292017 ARC or ADRC 09252017
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CARES Referrals in a Time Range PSA ALL
Start Date 01012017 End Date 12312017
Referred to ALL REFERRALS
Referring PSA Employee Name Client Name Client ID
Referral Date
Imminent Risk
NH Admit Date Referred To Cares Provider Name
Aging Received Date
04B Test Name Test Name 4061738075 04082017 N ARC or ADRC Test Name 04082017
Total Clients 110
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CARES Referrals not acknowledged by the Aging Network PSA ALL For Referrals after 01012017 Owner ID ALL Owners
Unduplicated Client count Cares Office Total Clients Count
Report Total
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
CIRTS Issue PSA Client ID Client Name Program
Program Status Start Provider Enrollment ID Provider Name
APCL CLIENT WITH DATE OF DEATH 08 4061759417 Test Name OA3B APCL 07232013 1141 WESTERN WORLD RADIO
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
Program Start Provider CIRTS Issue PSA Client ID Client Name Program Status Enrollment ID Provider Name
06 LTCC APCL 01242014 1514 4061713685 Test Name APCL CLIENT WITH DATE OF DEATH CENTRAL THE ORIGINAL HOUSE OF PIES
Count 503
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Civil Rights PSA ALL Provider ALL PROVIDERS Program AC Start Date 01012017 End Date 12312017 The Poverty Level for Single is The Poverty Level for Couple is Sort by County
County Unduplicated Count
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Client Information Report Start Date 01012017 End Date 12312017
Client ID 1001141246
Emergency
Client Name Test Name
Telephone () - Address 78 TEST STREET TALLAHASSEE FL 32399
Most Recent Caregiver Information Date Updated
Doctor
Comments
Client Demographic Information
Birth Date 06041940 Race W
Owner ID Ethnicity O
Most Recent Income Information
Ind Mon Inc Cpl Mon Inc
Ind Assets Couple Assets
Most Recent Assessment Information
Asmt Date Ref Risk Lvl
Asmt Site Spec Shel
AsmtType Spec Reg
Ref Date Primary CG
Ref Source Living Sit
Enrollment Information
Sex
Marital Status
F
S
Medicaid Number
ADL Score
ADL Count
IADL Score
IADL Count
Memory Score
Priority Score
Env Score
Nutr Score
Risk Score
Social Score
Rank
Provider Location Program Program Status Worker Start Date End Date
Care Plan Service Needed
Date Service Units Type Frq End Date
Care Plan Service Planned
Program Service Units Type Frq Start Date End Date
Services Received between 01012017 and 12312017
Service Billed Provider Location Worker Program Service Date Units Unit Type Amount
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Provider N
Client Service Units Report PSA ALL Provider ALL PROVIDERS Location 0000
Program ALL PROGRAMS Service ALL SERVICES Worker ALL WORKERS
City ALL CITIES Include Zero Unit N Include Aggregate N Calculated Amount equals the number of Units Provided times Fixed Cost if it existsService Start Date 01012017 Service End Date 12312017 If Fixed Cost does not exist Calculated
Group by PSA Provider Location Client Name County Worker Amount equals Billed Amount
Unduplicated Client Count 0 Grand Total 000 $000
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Clients In Common PSA All Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 County All Counties Worker All Workers
County JEFFERSON
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
MIAMI-DADE
0 0 0 0 0 0 0 0 0
4061539538 Test NameCounty Count
County
0 01
X
0 1
X
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
4061650856 Test Name X 4061486560 Test Name X 4062452921 Test Name X
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Clients Served Not Enrolled PSA ALL Start Date 01012017 End Date 12312017 Locations 0000 Provider All Providers
Service Service Min Serv Max Serv Program Start End Enrollment PSA Provider Location Program Consumer Name Client ID Service Date Date Status Enrollment Enrollment Provider
Count 0
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
4061472791 04
09
1092
1291
0072
0042
LTCC
LTCC
APCL
APCL
4062714543 06
06
1514
1762
0072
5006
LTCC
LTCC
APCL
APPL
4061802246 11
06
1177
1514
0179
0072
LTCC
LTCC
APCL
APCL
4061563719 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062644312 06
08
1514
1771
0072
0896
LTCC
LTCC
APCL
APCL
1001141670 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
1001141671 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
4062375003 07
05
05
07
1263
1755
1638
1263
0368
0072
0072
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062155124 06
06
1762
1514
0072
0072
LTCC
LTCC
APPL
APCL
4061743886 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0369
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4061499927 06
06
1514
1762
0072
5005
LTCC
LTCC
APCL
APPL
4061583524 08
06
1144
1514
0896
0072
LTCC
LTCC
APCL
APCL
4062694843 06
03
1514
1922
0072
0179
LTCC
LTCC
APCL
APCL
4062744517 07
06
1263
1514
0369
0072
LTCC
LTCC
APCL
APCL
4062005488 10
11
10
11
1929
1177
1164
1177
0072
0073
0179
0179
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
Report run on 08312018 0200 PM Page 1 of 2 clnts_mult_enrollrdf
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
Total Count 15
Report run on 08312018 0200 PM Page 2 of 2 clnts_mult_enrollrdf
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CODE DESCRIPTIONS Category ALL STATE TABLES
Code Description Active Available To Code Category
0 UNKNOWN Y CARES SUBJECTIVE_HEALTH_EVALUATION
01 ALACHUA Y COMMON COUNTIES
02 BAKER Y COMMON COUNTIES
03 BAY Y COMMON COUNTIES
04 BRADFORD Y COMMON COUNTIES
05 BREVARD Y COMMON COUNTIES
06 BROWARD Y COMMON COUNTIES
07 CALHOUN Y COMMON COUNTIES
08 CHARLOTTE Y COMMON COUNTIES
09 CITRUS Y COMMON COUNTIES
1 EXCELLENT Y CARES SUBJECTIVE_HEALTH_EVALUATION
10 CLAY Y COMMON COUNTIES
11 COLLIER Y COMMON COUNTIES
12 COLUMBIA Y COMMON COUNTIES
13 MIAMI-DADE Y COMMON COUNTIES
14 DESOTO Y COMMON COUNTIES
15 DIXIE Y COMMON COUNTIES
16 DUVAL Y COMMON COUNTIES
17 ESCAMBIA Y COMMON COUNTIES
18 FLAGLER Y COMMON COUNTIES
19 FRANKLIN Y COMMON COUNTIES
2 GOOD Y CARES SUBJECTIVE_HEALTH_EVALUATION
20 GADSDEN Y COMMON COUNTIES
21 GILCHRIST Y COMMON COUNTIES
22 GLADES Y COMMON COUNTIES
23 GULF Y COMMON COUNTIES
24 HAMILTON Y COMMON COUNTIES
25 HARDEE Y COMMON COUNTIES
26 HENDRY Y COMMON COUNTIES
27 HERNANDO Y COMMON COUNTIES
28 HIGHLANDS Y COMMON COUNTIES
Report run on 08312018 0140 PM Page 1 of 45 state_codesrdf Report run by RSHQALL Dispose of this report so that it cannot be read or reconstructed
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CONSUMER AGE VERIFICATION REPORT PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Program AC
Age at Start
Enroll or Start Enroll Provider Program Description Consumer Name Client ID DOB Svc date or Svc Date
Report run on 08312018 0203 PM Page 1 of 1 age_verifyrdf
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Contract Budget Information PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Program Service Provider Location County Served Provider Contract
Projected Service
Units Unit Measure
Projected Unduplicated
State Federal Share Client Count Begin Date End Date
Row Count 0 Amount Total
Report run on 08312018 0233 PM Page 1 of 1 contract_budgetrdf
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Start Enroll Latest Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Date Asmt Date Worker
O3C1 1036 000 4061653427 Test CENTRAL 34982 W M 07091930 09102013 09102013 CIRTS20804 0 Name
Report run on 08312018 1133 AM Page 1 of 6 actv_by_progrdf
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Start Enroll Date
Latest Asmt Date Worker
4061593624 Test Name CENTRAL 34946 B F 11261940 12012011 12312013 CIRTS23407
Count 164
Unduplicated Client Count 163
Report run on 08312018 1133 AM Page 6 of 6 actv_by_progrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Assessments After DOD Report
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Owner 1025
The shaded records indicate clients who have different DOBs andor different names
Assemt Current PSA Owner Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Owner Assessor
Provider Assessor
Assemt Date
Assemt Type
Unduplicated Count Total 0
Report run on 08312018 0206 PM Page 1 of 1 vs_assmrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Open Enrollments
The Vital Statistics Data for 07192002 - 09112014PSA ALL Provider ALL Program Status ACTV Include MLTC ACTVS N
The shaded records indicate clients who have different DOBs andor different names
Enroll PSA
Enrollment Provider Loc Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Enroll Program Status
Enroll Program
Current Owner ID
02 1065 0072 4062244026 Test Name Test Name 10222004 03231917 03231917 ACTV CCE 1065
Count of enrollments for the Provider 1
Count of enrollments for the PSA 1
Count of enrollments for the Report 1
Unduplicated Count of Individuals with open enrollments and DOD PSA Total Clients Count
02 1
Total 1
Report run on 08312018 0205 PM Page 1 of 1 vs_open_enrollrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Report run on 08312018 0207 PM Page 1 of 3 vs_servicesrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Unduplicated count of individuals with Services after DOD
PSA Total Clients Count
Report Total
Report run on 08312018 0207 PM Page 2 of 3 vs_servicesrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
List of Clients with PSA table entry for SERVICES_AFTER_DOD
Unduplicated Count Total 0
Report run on 08312018 0207 PM Page 3 of 3 vs_servicesrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Age
Provider
Total
Age lt 60 Age 60 - 64 Age 65 - 74 Age 75 - 84 Age 85+ Total Clients Avg Age
Total
Avg Age
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 1 of 5 demo_all_prvrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Ethnicity
Provider Hispanic Other Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 2 of 5 demo_all_prvrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Race
American Indian Native Hawaiian Other Provider Asian Alaska Native Black Pacific Islander Minority White Multiple Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 3 of 5 demo_all_prvrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Gender
Provider Male Female Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 4 of 5 demo_all_prvrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Monthly Income
Provider 0 - - Higher than Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 5 of 5 demo_all_prvrdf
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None
Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Total Persons Served 0
Age lt 60 Years 0 0
Age 60 - 64 0 0
Age 65 - 74 0 0
Age 75 - 84 0 0
Age 85+ 0 0
Total Age 0 0
Average 000
Ethnicity Hispanic 0 0
Other Ethnicity 0 0
Unknown Ethnicity 0 0
Total 0 0
Race Asian 0 0
American Indian Alaska Native 0 0
Black 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority 0 0
White 0 0
Multiple 0 0
Unknown 0 0
Total 0 0
Sex Male 0 0
Female 0 0
Unknown Sex 0 0
Total 0 0
Monthly Income 0 - 0 0
- 0 0
Higher than 0 0
Unknown 0 0
Total 0 0
Report run on 08312018 1058 AM Page 1 of 2 demo_by_prov_detrdf Report run byRSHQALL Dispose of this report so that it can not be read or reconstructed
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Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Client ID Date Of Birth Ethnicity Race Sex Individual Monthly Income
Report run on 08312018 1058 AM Page 2 of 2 demo_by_prov_detrdf Report run byRSHQALL Dispose of this report so that it can not be read or reconstructed
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Demographics of Clients OAA Registered Served Only PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 City All Cities Program All Programs Service All Services County ALL COUNTIES Table OAA Registered Services Only Low Income Medium Income
Total Persons Served 0
Agelt 60 Years
Age 60 - 64
Age 65 - 74
Age 75 - 84
Age 85+
0
0
0
0
0
0
0
0
0
0
Monthly Income
0 -
-Higher than
Unknown
0
0
0
0
0
0
0
0
Total
Average
0
000
0 Total 0 0
Ethnicity Hispanic
Other
Unknown
0
0
0
0
0
0
Living Situation
Alone
Null
Policy Change
0
0
0
0
0
0
Total 0 0 Unknown
With Caregiver
0
0
0
0
Race Asian 0 0
With Other
With Other Caregiver
0
0
0
0
American Indian Alaska Native
Black
0
0
0
0Total Living Situation 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority
White
0
0
0
0 Limited English Proficiency
Multiple
Unknown
Total Race
0
0
0
0
0
0
Yes
No
Unknown
0
0
0
0
0
0
Total 0 0
Sex Male
Female
Unknown
0
0
0
0
0
0
Total 0 0
Report run on 08312018 1056 AM Page 1 of 1 demo_by_provrdf
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Disaster Assistance Clients for a Provider PSA ALL Provider All Providers Location 0000 Worker All Workers City All Cities Zip Code All Zip Codes Sort By ZIP
Provider 1036 Provider Name Location 0000 Worker CIRTS18634
Need Care Client Name Address City Zip County Phone Asst Reg Situation Relat Care phone Care Name
34946 N WO DA 000 SAINT JAMES DRIVE CENTRAL (025) 101-0620 Test NameTest Name SAINT LUCIE (005) 100-0369 Y
Client is active and no assessment information is available Special Shelter and Special Registry are unknown
Report run on 08312018 1102 AM Page 1 of 8 disaster_by_provrdf
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
Total by PSA 0
Report run on 08312018 1111 AM Page 1 of 5 eheap_exceptionsrdf
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
ALACH BAKER BAY BRADF BREVA BROWA CALHO CHARL CITRUS CLAY COLLIE COLUM DESOT DIXIE DUVAL ESCAM FLAGL FRANK GADSDAssisted Household Report UA ORD RD RD UN OTTE R BIA O BIA ER LIN EN
1 of Household Assisted 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Households AssistedWith Gross Income
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C 100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D 125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
3 Households with at leastOne member
A 60 Years or older 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B Disabled 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C Age 5 years or under 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D Under 60 Years Old 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Undup Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Assisted
Applicant Household Report
of Applicant Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
Report run on 08312018 1111 AM Page 2 of 5 eheap_exceptionsrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Energy Assisted Household Report
County of Assisted
Households
Households Assisted By Poverty Level
Under 75 75 - 100 101 - 125 126 - 150 Over 150 60 Years or older
At least one member who is
Age 5 years Age 2 years Age 3 years Disabled or younger and younger through 5
Under 60 Years Old
Undup Households
Assisted
Energy Assistance Total
Report run on 08312018 1107 AM Page 1 of 3 eheap_summaryrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Unduplicated Total 0 0
County of Assisted
Households Under 75 75 - 100
Households Assisted By Poverty Level
101 - 125 126 - 150 Over 150 60 Years or older Disabled
Age 5 years or younger
Age 2 years and younger
Age 3 years through 5
Under 60 Years Old
At least one member who is
Undup Households
Assisted
Other Assisted Household Report
Other Assistance Total
Report run on 08312018 1107 AM Page 2 of 3 eheap_summaryrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Applicant Household Report
County of Applicant
Households Under 75 75 - 100 101 - 125 126 - 150 Over 150 Income data
unavailable
Total 0
Report run on 08312018 1107 AM Page 3 of 3 eheap_summaryrdf
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01
Enrollment Active Consumer Count by Program PSA ALL Provider ALL PROVIDERS
County Description Program Count of Clients
BREVARD
ADI
CCE
HCE
LSP
NDP
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
MLTC
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
31
57
44
5
62
123
141
26
9
7
5
40
5
50
67
129
2
19
42
29
1
233
79
63
8
2
14
3
37
14
47
3
3
33
127
10
02
03
04
ALACHUA
BAKER
BAY
BRADFORD
Report run on 08312018 1148 AM Page 1 of 18 actv_countrdf
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Enrollment Terminations with Reasons PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 Program All Programs Program Status ALL Program Status Worker ALL WORKERS
Last First Program Medicaid Provider Start End Name Name Client ID Status Description Worker Number Program Location Enrollment Enrollment
Count 0
Report run on 08312018 1150 AM Page 1 of 1 enroll_term_reasonrdf
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Enrollments with Care Plan Report
PSA ALL Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTIVE STATUS Care Plan Service ALL SERVICES Care Plan Start 01012017 Care Plan End 12312017
Care Plan Care Plan Care Plan Client Name
Unduplicated Client Count 0
Client ID Program Status Worker Start Date End Date Service
Report run on 08312018 1054 AM Page 1 of 1 enroll_careplrdf Report run by RSHQALL Dispose of this report so that it cannot be read or reconstructed
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PSA CLIENT_ID CLIENT_NAME OWNER PROVIDER_ID ASSESSMENT_DATE ASSESSOR_NAME MEDICAID_NUMBER CAREGIVER_CHANGE ENVIRONMENT_CHANGE HEALTH_CHANGE INCOME_CHANGE SITUATION_CHANGE INITIAL_ASSM ANNUAL_ASSM SSN REFERRAL_SOURCE 1114 N N N N Y N 771771777 SELFFAMILY 812017 JANE CASEWORKER 2 1001141633 TEST TEST N
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Fixed Service Costs List PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Provider Location County Program Service Reimbursement Unit Rate Provider Cost Per Unit Begin Valid End Valid
Count 0
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CIC Service Units and Costs Projections County SummaryPSA 99 Program CCE
Start Date 01012017 End Date 12312017
County LEON
Total Total Total Avg Max Projected
StateFederal Projected Reimbursement Provider Unduplicated Provider Service Share Service Units Unit Rate Cost Per Unit Client Count
Report Total
Report run on 08312018 0242 PM Page 1 of 1 cic_serv_cntyrdf
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CIC Service Units and Costs Projections Provider SummaryPSA ALL Provider ALL PROVIDERS Program FEDERALLY FUNDED (0101 TO 1231) Year 2017 From 01012017 To 12312017
PSA County Program Service Total State
Federal Share
Total Projected
Service Units
Avg Reimbursement
Unit Rate
Max Provider
Cost Per Unit
Total Projected Unduplicated Client Count
02 FRANKLIN O3C1 CONGREGATE MEALS $810300 1710 15
Program Total
County Total
$810300
$810300
GULF O3C1 CONGREGATE MEALS $25205 3 5
Program Total $25205
O3C2 HOME DELIVERED MEALS $25205 3 6
Program Total
County Total
$25205
$50411
LEON O3C1 CONGREGATE MEALS $621300 1311 15
CONGREGATE MEALS GUEST
CONGREGATE MEALS VOLUNTEERS
$252055
$277260
25
30
2
5
Program Total $1150615
O3C2 HOME DELIVERED MEAL GUEST $252055 25 3
Program Total $252055
OA3D PEARLS (SESSION 5)
PEARLS (SESSION 6)
PEARLS (SESSION 7)
PEARLS (SESSION 8)
$10247
$10247
$10247
$10247
10
10
10
10
3
3
3
3
Program Total $40988
OA3E RESPITE IN-HOME $200 2 2
Program Total
County Total
$200
$1443858
WAKULLA O3C2 EMERGENCY HOME DELIVERED SHELF MEALS
$8065604 14899 90
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CIC Service Units and Costs Projections - PSA Summary
PSA ALL Program CCE
Strat Date 01012017 End Date 12312017
Total
PSA County Provider Service
Total State Federal
Share
Total Projected
Service Units
Avg Reimbursement
Unit Rate
Max Projected Provider Unduplicated
Cost Per Unit Client Count
02 LEON SOUTHERN SERVICE CASE MANAGEMENT PROVIDER EMERGENCY HOME DELIVERED SHELF MEALS
$2175533
$602000
483
689
32
20
HOME DELIVERED MEALS $530262 993 5
MATERIAL AID $1994536 199
Provider Total $5302331
CountyTotal $5302331
WAKULLA SOUTHERN SERVICE CASE MANAGEMENT PROVIDER EMERGENCY HOME DELIVERED SHELF MEALS
$2175533
$1240200
483
689
32
5
MATERIAL AID $1994536 199
Provider Total $5410269
CountyTotal $5410269
PSA Total $10712599
05 PINELLAS BURSTEIN-APPLEBEE ADULT DAY CARE $000 0 $900 $1000 0
COUNSELING (MENTAL HEALTH COUNSELINGSCREENING) - INDIVIDUAL
Provider Total
$000
$000
0 $6600 $7700 0
CountyTotal $000
PSA Total $000
Report Total $10712599
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CID Service Units and Costs Projections - PSA SummaryPSA ALL Program CCE
Start Date 01012017 End Date 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
PSA County Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
02 LEON CASE MANAGEMENT $2175533 483
EMERGENCY HOME $602000 689DELIVERED SHELF MEALS HOME DELIVERED MEALS $530262 993
MATERIAL AID $1994536 199
County Total $5302331 2364
WAKULLA CASE MANAGEMENT $2175533 483
EMERGENCY HOME $1240200 689DELIVERED SHELF MEALS MATERIAL AID $1994536 199
County Total $5410269 1371
PSA Total $10712599 3735
05 PINELLAS ADULT DAY CARE $000 0
COUNSELING (MENTAL $000 0 HEALTH COUNSELINGSCREENING) - INDIVIDUAL
County Total $000 0
PSA Total $000 0
Report Total $10712599 3735
$900 $900 $900 $1000 $1000 $1000
$6600 $6600 $6600 $7700 $7700 $7700
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CID Service Units and Costs Projections County SummaryPSA 99
Program CCE County LEON
Start Date 01012017 End Date 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
Report Total
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CIE Service Units and Costs Projections - PSA Summary - All Programs
PSA 99 Program FEDERALLY FUNDED (0101 TO 1231) Year 2017 From 01012017 To 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
Program Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
Report Total
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CIE Service Units and Costs Projections - PSA Summary
PSA ALL Program CCE
Start Date 01012017 End Date 12312017
Avg High Low Total Total Avg High Low Provider Provider Provider
StateFederal Projected Reimbursement Reimbursement Reimbursement Cost Cost CostPSA
02
Service
CASE MANAGEMENT
Share
$4351066
Service Units
966
Unit Rate Unit Rate Unit Rate Per Unit Per Unit Per Unit
EMERGENCY HOME DELIVERED SHELF MEALS $1842200 1378
HOME DELIVERED MEALS $530262 993
MATERIAL AID $3989071 398
PSA Total $10712599 3735
05 ADULT DAY CARE $000 0 $900 $900 $900 $1000 $1000 $1000
COUNSELING (MENTAL HEALTH $000 0 $6600 $6600 $6600 $7700 $7700 $7700 COUNSELINGSCREENING) - INDIVIDUAL
PSA Total $000 0
Report Total $10712599 3735
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CAREGIVER SEARCH REPORT
SEARCH RESULTS FOR CONSUMERS
Criteria First Name Last Name SSN PSA ALL
Client Name Client SSN Caregiver Name Caregiver SSN
000000000 000000000 Test Name Test Name
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CARES Referrals in a Time Range PSA ALL
Start Date 01012017 End Date 12312017
Referred to ALL REFERRALS
Referring PSA Employee Name Client Name Client ID
Referral Imminent NH Admit Aging Date Risk Date Referred To Cares Provider Name Received Date
03A 4061561263 Test Name Test Name 09242017 Y 05292017 ARC or ADRC 09252017
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CARES Referrals in a Time Range PSA ALL
Start Date 01012017 End Date 12312017
Referred to ALL REFERRALS
Referring PSA Employee Name Client Name Client ID
Referral Date
Imminent Risk
NH Admit Date Referred To Cares Provider Name
Aging Received Date
04B Test Name Test Name 4061738075 04082017 N ARC or ADRC Test Name 04082017
Total Clients 110
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CARES Referrals not acknowledged by the Aging Network PSA ALL For Referrals after 01012017 Owner ID ALL Owners
Unduplicated Client count Cares Office Total Clients Count
Report Total
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
CIRTS Issue PSA Client ID Client Name Program
Program Status Start Provider Enrollment ID Provider Name
APCL CLIENT WITH DATE OF DEATH 08 4061759417 Test Name OA3B APCL 07232013 1141 WESTERN WORLD RADIO
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
Program Start Provider CIRTS Issue PSA Client ID Client Name Program Status Enrollment ID Provider Name
06 LTCC APCL 01242014 1514 4061713685 Test Name APCL CLIENT WITH DATE OF DEATH CENTRAL THE ORIGINAL HOUSE OF PIES
Count 503
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Civil Rights PSA ALL Provider ALL PROVIDERS Program AC Start Date 01012017 End Date 12312017 The Poverty Level for Single is The Poverty Level for Couple is Sort by County
County Unduplicated Count
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Client Information Report Start Date 01012017 End Date 12312017
Client ID 1001141246
Emergency
Client Name Test Name
Telephone () - Address 78 TEST STREET TALLAHASSEE FL 32399
Most Recent Caregiver Information Date Updated
Doctor
Comments
Client Demographic Information
Birth Date 06041940 Race W
Owner ID Ethnicity O
Most Recent Income Information
Ind Mon Inc Cpl Mon Inc
Ind Assets Couple Assets
Most Recent Assessment Information
Asmt Date Ref Risk Lvl
Asmt Site Spec Shel
AsmtType Spec Reg
Ref Date Primary CG
Ref Source Living Sit
Enrollment Information
Sex
Marital Status
F
S
Medicaid Number
ADL Score
ADL Count
IADL Score
IADL Count
Memory Score
Priority Score
Env Score
Nutr Score
Risk Score
Social Score
Rank
Provider Location Program Program Status Worker Start Date End Date
Care Plan Service Needed
Date Service Units Type Frq End Date
Care Plan Service Planned
Program Service Units Type Frq Start Date End Date
Services Received between 01012017 and 12312017
Service Billed Provider Location Worker Program Service Date Units Unit Type Amount
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Provider N
Client Service Units Report PSA ALL Provider ALL PROVIDERS Location 0000
Program ALL PROGRAMS Service ALL SERVICES Worker ALL WORKERS
City ALL CITIES Include Zero Unit N Include Aggregate N Calculated Amount equals the number of Units Provided times Fixed Cost if it existsService Start Date 01012017 Service End Date 12312017 If Fixed Cost does not exist Calculated
Group by PSA Provider Location Client Name County Worker Amount equals Billed Amount
Unduplicated Client Count 0 Grand Total 000 $000
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Clients In Common PSA All Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 County All Counties Worker All Workers
County JEFFERSON
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
MIAMI-DADE
0 0 0 0 0 0 0 0 0
4061539538 Test NameCounty Count
County
0 01
X
0 1
X
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
4061650856 Test Name X 4061486560 Test Name X 4062452921 Test Name X
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Clients Served Not Enrolled PSA ALL Start Date 01012017 End Date 12312017 Locations 0000 Provider All Providers
Service Service Min Serv Max Serv Program Start End Enrollment PSA Provider Location Program Consumer Name Client ID Service Date Date Status Enrollment Enrollment Provider
Count 0
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
4061472791 04
09
1092
1291
0072
0042
LTCC
LTCC
APCL
APCL
4062714543 06
06
1514
1762
0072
5006
LTCC
LTCC
APCL
APPL
4061802246 11
06
1177
1514
0179
0072
LTCC
LTCC
APCL
APCL
4061563719 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062644312 06
08
1514
1771
0072
0896
LTCC
LTCC
APCL
APCL
1001141670 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
1001141671 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
4062375003 07
05
05
07
1263
1755
1638
1263
0368
0072
0072
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062155124 06
06
1762
1514
0072
0072
LTCC
LTCC
APPL
APCL
4061743886 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0369
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4061499927 06
06
1514
1762
0072
5005
LTCC
LTCC
APCL
APPL
4061583524 08
06
1144
1514
0896
0072
LTCC
LTCC
APCL
APCL
4062694843 06
03
1514
1922
0072
0179
LTCC
LTCC
APCL
APCL
4062744517 07
06
1263
1514
0369
0072
LTCC
LTCC
APCL
APCL
4062005488 10
11
10
11
1929
1177
1164
1177
0072
0073
0179
0179
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
Total Count 15
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CODE DESCRIPTIONS Category ALL STATE TABLES
Code Description Active Available To Code Category
0 UNKNOWN Y CARES SUBJECTIVE_HEALTH_EVALUATION
01 ALACHUA Y COMMON COUNTIES
02 BAKER Y COMMON COUNTIES
03 BAY Y COMMON COUNTIES
04 BRADFORD Y COMMON COUNTIES
05 BREVARD Y COMMON COUNTIES
06 BROWARD Y COMMON COUNTIES
07 CALHOUN Y COMMON COUNTIES
08 CHARLOTTE Y COMMON COUNTIES
09 CITRUS Y COMMON COUNTIES
1 EXCELLENT Y CARES SUBJECTIVE_HEALTH_EVALUATION
10 CLAY Y COMMON COUNTIES
11 COLLIER Y COMMON COUNTIES
12 COLUMBIA Y COMMON COUNTIES
13 MIAMI-DADE Y COMMON COUNTIES
14 DESOTO Y COMMON COUNTIES
15 DIXIE Y COMMON COUNTIES
16 DUVAL Y COMMON COUNTIES
17 ESCAMBIA Y COMMON COUNTIES
18 FLAGLER Y COMMON COUNTIES
19 FRANKLIN Y COMMON COUNTIES
2 GOOD Y CARES SUBJECTIVE_HEALTH_EVALUATION
20 GADSDEN Y COMMON COUNTIES
21 GILCHRIST Y COMMON COUNTIES
22 GLADES Y COMMON COUNTIES
23 GULF Y COMMON COUNTIES
24 HAMILTON Y COMMON COUNTIES
25 HARDEE Y COMMON COUNTIES
26 HENDRY Y COMMON COUNTIES
27 HERNANDO Y COMMON COUNTIES
28 HIGHLANDS Y COMMON COUNTIES
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CONSUMER AGE VERIFICATION REPORT PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Program AC
Age at Start
Enroll or Start Enroll Provider Program Description Consumer Name Client ID DOB Svc date or Svc Date
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Contract Budget Information PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Program Service Provider Location County Served Provider Contract
Projected Service
Units Unit Measure
Projected Unduplicated
State Federal Share Client Count Begin Date End Date
Row Count 0 Amount Total
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Start Enroll Latest Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Date Asmt Date Worker
O3C1 1036 000 4061653427 Test CENTRAL 34982 W M 07091930 09102013 09102013 CIRTS20804 0 Name
Report run on 08312018 1133 AM Page 1 of 6 actv_by_progrdf
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Start Enroll Date
Latest Asmt Date Worker
4061593624 Test Name CENTRAL 34946 B F 11261940 12012011 12312013 CIRTS23407
Count 164
Unduplicated Client Count 163
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Assessments After DOD Report
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Owner 1025
The shaded records indicate clients who have different DOBs andor different names
Assemt Current PSA Owner Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Owner Assessor
Provider Assessor
Assemt Date
Assemt Type
Unduplicated Count Total 0
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Open Enrollments
The Vital Statistics Data for 07192002 - 09112014PSA ALL Provider ALL Program Status ACTV Include MLTC ACTVS N
The shaded records indicate clients who have different DOBs andor different names
Enroll PSA
Enrollment Provider Loc Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Enroll Program Status
Enroll Program
Current Owner ID
02 1065 0072 4062244026 Test Name Test Name 10222004 03231917 03231917 ACTV CCE 1065
Count of enrollments for the Provider 1
Count of enrollments for the PSA 1
Count of enrollments for the Report 1
Unduplicated Count of Individuals with open enrollments and DOD PSA Total Clients Count
02 1
Total 1
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Report run on 08312018 0207 PM Page 1 of 3 vs_servicesrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Unduplicated count of individuals with Services after DOD
PSA Total Clients Count
Report Total
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
List of Clients with PSA table entry for SERVICES_AFTER_DOD
Unduplicated Count Total 0
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Age
Provider
Total
Age lt 60 Age 60 - 64 Age 65 - 74 Age 75 - 84 Age 85+ Total Clients Avg Age
Total
Avg Age
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Ethnicity
Provider Hispanic Other Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Race
American Indian Native Hawaiian Other Provider Asian Alaska Native Black Pacific Islander Minority White Multiple Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Gender
Provider Male Female Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Monthly Income
Provider 0 - - Higher than Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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None
Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Total Persons Served 0
Age lt 60 Years 0 0
Age 60 - 64 0 0
Age 65 - 74 0 0
Age 75 - 84 0 0
Age 85+ 0 0
Total Age 0 0
Average 000
Ethnicity Hispanic 0 0
Other Ethnicity 0 0
Unknown Ethnicity 0 0
Total 0 0
Race Asian 0 0
American Indian Alaska Native 0 0
Black 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority 0 0
White 0 0
Multiple 0 0
Unknown 0 0
Total 0 0
Sex Male 0 0
Female 0 0
Unknown Sex 0 0
Total 0 0
Monthly Income 0 - 0 0
- 0 0
Higher than 0 0
Unknown 0 0
Total 0 0
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Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Client ID Date Of Birth Ethnicity Race Sex Individual Monthly Income
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Demographics of Clients OAA Registered Served Only PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 City All Cities Program All Programs Service All Services County ALL COUNTIES Table OAA Registered Services Only Low Income Medium Income
Total Persons Served 0
Agelt 60 Years
Age 60 - 64
Age 65 - 74
Age 75 - 84
Age 85+
0
0
0
0
0
0
0
0
0
0
Monthly Income
0 -
-Higher than
Unknown
0
0
0
0
0
0
0
0
Total
Average
0
000
0 Total 0 0
Ethnicity Hispanic
Other
Unknown
0
0
0
0
0
0
Living Situation
Alone
Null
Policy Change
0
0
0
0
0
0
Total 0 0 Unknown
With Caregiver
0
0
0
0
Race Asian 0 0
With Other
With Other Caregiver
0
0
0
0
American Indian Alaska Native
Black
0
0
0
0Total Living Situation 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority
White
0
0
0
0 Limited English Proficiency
Multiple
Unknown
Total Race
0
0
0
0
0
0
Yes
No
Unknown
0
0
0
0
0
0
Total 0 0
Sex Male
Female
Unknown
0
0
0
0
0
0
Total 0 0
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Disaster Assistance Clients for a Provider PSA ALL Provider All Providers Location 0000 Worker All Workers City All Cities Zip Code All Zip Codes Sort By ZIP
Provider 1036 Provider Name Location 0000 Worker CIRTS18634
Need Care Client Name Address City Zip County Phone Asst Reg Situation Relat Care phone Care Name
34946 N WO DA 000 SAINT JAMES DRIVE CENTRAL (025) 101-0620 Test NameTest Name SAINT LUCIE (005) 100-0369 Y
Client is active and no assessment information is available Special Shelter and Special Registry are unknown
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
Total by PSA 0
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
ALACH BAKER BAY BRADF BREVA BROWA CALHO CHARL CITRUS CLAY COLLIE COLUM DESOT DIXIE DUVAL ESCAM FLAGL FRANK GADSDAssisted Household Report UA ORD RD RD UN OTTE R BIA O BIA ER LIN EN
1 of Household Assisted 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Households AssistedWith Gross Income
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C 100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D 125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
3 Households with at leastOne member
A 60 Years or older 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B Disabled 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C Age 5 years or under 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D Under 60 Years Old 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Undup Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Assisted
Applicant Household Report
of Applicant Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Energy Assisted Household Report
County of Assisted
Households
Households Assisted By Poverty Level
Under 75 75 - 100 101 - 125 126 - 150 Over 150 60 Years or older
At least one member who is
Age 5 years Age 2 years Age 3 years Disabled or younger and younger through 5
Under 60 Years Old
Undup Households
Assisted
Energy Assistance Total
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Unduplicated Total 0 0
County of Assisted
Households Under 75 75 - 100
Households Assisted By Poverty Level
101 - 125 126 - 150 Over 150 60 Years or older Disabled
Age 5 years or younger
Age 2 years and younger
Age 3 years through 5
Under 60 Years Old
At least one member who is
Undup Households
Assisted
Other Assisted Household Report
Other Assistance Total
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Applicant Household Report
County of Applicant
Households Under 75 75 - 100 101 - 125 126 - 150 Over 150 Income data
unavailable
Total 0
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01
Enrollment Active Consumer Count by Program PSA ALL Provider ALL PROVIDERS
County Description Program Count of Clients
BREVARD
ADI
CCE
HCE
LSP
NDP
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
MLTC
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
31
57
44
5
62
123
141
26
9
7
5
40
5
50
67
129
2
19
42
29
1
233
79
63
8
2
14
3
37
14
47
3
3
33
127
10
02
03
04
ALACHUA
BAKER
BAY
BRADFORD
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Enrollment Terminations with Reasons PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 Program All Programs Program Status ALL Program Status Worker ALL WORKERS
Last First Program Medicaid Provider Start End Name Name Client ID Status Description Worker Number Program Location Enrollment Enrollment
Count 0
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Enrollments with Care Plan Report
PSA ALL Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTIVE STATUS Care Plan Service ALL SERVICES Care Plan Start 01012017 Care Plan End 12312017
Care Plan Care Plan Care Plan Client Name
Unduplicated Client Count 0
Client ID Program Status Worker Start Date End Date Service
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PSA CLIENT_ID CLIENT_NAME OWNER PROVIDER_ID ASSESSMENT_DATE ASSESSOR_NAME MEDICAID_NUMBER CAREGIVER_CHANGE ENVIRONMENT_CHANGE HEALTH_CHANGE INCOME_CHANGE SITUATION_CHANGE INITIAL_ASSM ANNUAL_ASSM SSN REFERRAL_SOURCE 1114 N N N N Y N 771771777 SELFFAMILY 812017 JANE CASEWORKER 2 1001141633 TEST TEST N
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Fixed Service Costs List PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Provider Location County Program Service Reimbursement Unit Rate Provider Cost Per Unit Begin Valid End Valid
Count 0
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CIC Service Units and Costs Projections Provider SummaryPSA ALL Provider ALL PROVIDERS Program FEDERALLY FUNDED (0101 TO 1231) Year 2017 From 01012017 To 12312017
PSA County Program Service Total State
Federal Share
Total Projected
Service Units
Avg Reimbursement
Unit Rate
Max Provider
Cost Per Unit
Total Projected Unduplicated Client Count
02 FRANKLIN O3C1 CONGREGATE MEALS $810300 1710 15
Program Total
County Total
$810300
$810300
GULF O3C1 CONGREGATE MEALS $25205 3 5
Program Total $25205
O3C2 HOME DELIVERED MEALS $25205 3 6
Program Total
County Total
$25205
$50411
LEON O3C1 CONGREGATE MEALS $621300 1311 15
CONGREGATE MEALS GUEST
CONGREGATE MEALS VOLUNTEERS
$252055
$277260
25
30
2
5
Program Total $1150615
O3C2 HOME DELIVERED MEAL GUEST $252055 25 3
Program Total $252055
OA3D PEARLS (SESSION 5)
PEARLS (SESSION 6)
PEARLS (SESSION 7)
PEARLS (SESSION 8)
$10247
$10247
$10247
$10247
10
10
10
10
3
3
3
3
Program Total $40988
OA3E RESPITE IN-HOME $200 2 2
Program Total
County Total
$200
$1443858
WAKULLA O3C2 EMERGENCY HOME DELIVERED SHELF MEALS
$8065604 14899 90
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CIC Service Units and Costs Projections - PSA Summary
PSA ALL Program CCE
Strat Date 01012017 End Date 12312017
Total
PSA County Provider Service
Total State Federal
Share
Total Projected
Service Units
Avg Reimbursement
Unit Rate
Max Projected Provider Unduplicated
Cost Per Unit Client Count
02 LEON SOUTHERN SERVICE CASE MANAGEMENT PROVIDER EMERGENCY HOME DELIVERED SHELF MEALS
$2175533
$602000
483
689
32
20
HOME DELIVERED MEALS $530262 993 5
MATERIAL AID $1994536 199
Provider Total $5302331
CountyTotal $5302331
WAKULLA SOUTHERN SERVICE CASE MANAGEMENT PROVIDER EMERGENCY HOME DELIVERED SHELF MEALS
$2175533
$1240200
483
689
32
5
MATERIAL AID $1994536 199
Provider Total $5410269
CountyTotal $5410269
PSA Total $10712599
05 PINELLAS BURSTEIN-APPLEBEE ADULT DAY CARE $000 0 $900 $1000 0
COUNSELING (MENTAL HEALTH COUNSELINGSCREENING) - INDIVIDUAL
Provider Total
$000
$000
0 $6600 $7700 0
CountyTotal $000
PSA Total $000
Report Total $10712599
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CID Service Units and Costs Projections - PSA SummaryPSA ALL Program CCE
Start Date 01012017 End Date 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
PSA County Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
02 LEON CASE MANAGEMENT $2175533 483
EMERGENCY HOME $602000 689DELIVERED SHELF MEALS HOME DELIVERED MEALS $530262 993
MATERIAL AID $1994536 199
County Total $5302331 2364
WAKULLA CASE MANAGEMENT $2175533 483
EMERGENCY HOME $1240200 689DELIVERED SHELF MEALS MATERIAL AID $1994536 199
County Total $5410269 1371
PSA Total $10712599 3735
05 PINELLAS ADULT DAY CARE $000 0
COUNSELING (MENTAL $000 0 HEALTH COUNSELINGSCREENING) - INDIVIDUAL
County Total $000 0
PSA Total $000 0
Report Total $10712599 3735
$900 $900 $900 $1000 $1000 $1000
$6600 $6600 $6600 $7700 $7700 $7700
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CID Service Units and Costs Projections County SummaryPSA 99
Program CCE County LEON
Start Date 01012017 End Date 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
Report Total
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CIE Service Units and Costs Projections - PSA Summary - All Programs
PSA 99 Program FEDERALLY FUNDED (0101 TO 1231) Year 2017 From 01012017 To 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
Program Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
Report Total
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CIE Service Units and Costs Projections - PSA Summary
PSA ALL Program CCE
Start Date 01012017 End Date 12312017
Avg High Low Total Total Avg High Low Provider Provider Provider
StateFederal Projected Reimbursement Reimbursement Reimbursement Cost Cost CostPSA
02
Service
CASE MANAGEMENT
Share
$4351066
Service Units
966
Unit Rate Unit Rate Unit Rate Per Unit Per Unit Per Unit
EMERGENCY HOME DELIVERED SHELF MEALS $1842200 1378
HOME DELIVERED MEALS $530262 993
MATERIAL AID $3989071 398
PSA Total $10712599 3735
05 ADULT DAY CARE $000 0 $900 $900 $900 $1000 $1000 $1000
COUNSELING (MENTAL HEALTH $000 0 $6600 $6600 $6600 $7700 $7700 $7700 COUNSELINGSCREENING) - INDIVIDUAL
PSA Total $000 0
Report Total $10712599 3735
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CAREGIVER SEARCH REPORT
SEARCH RESULTS FOR CONSUMERS
Criteria First Name Last Name SSN PSA ALL
Client Name Client SSN Caregiver Name Caregiver SSN
000000000 000000000 Test Name Test Name
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CARES Referrals in a Time Range PSA ALL
Start Date 01012017 End Date 12312017
Referred to ALL REFERRALS
Referring PSA Employee Name Client Name Client ID
Referral Imminent NH Admit Aging Date Risk Date Referred To Cares Provider Name Received Date
03A 4061561263 Test Name Test Name 09242017 Y 05292017 ARC or ADRC 09252017
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CARES Referrals in a Time Range PSA ALL
Start Date 01012017 End Date 12312017
Referred to ALL REFERRALS
Referring PSA Employee Name Client Name Client ID
Referral Date
Imminent Risk
NH Admit Date Referred To Cares Provider Name
Aging Received Date
04B Test Name Test Name 4061738075 04082017 N ARC or ADRC Test Name 04082017
Total Clients 110
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CARES Referrals not acknowledged by the Aging Network PSA ALL For Referrals after 01012017 Owner ID ALL Owners
Unduplicated Client count Cares Office Total Clients Count
Report Total
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
CIRTS Issue PSA Client ID Client Name Program
Program Status Start Provider Enrollment ID Provider Name
APCL CLIENT WITH DATE OF DEATH 08 4061759417 Test Name OA3B APCL 07232013 1141 WESTERN WORLD RADIO
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
Program Start Provider CIRTS Issue PSA Client ID Client Name Program Status Enrollment ID Provider Name
06 LTCC APCL 01242014 1514 4061713685 Test Name APCL CLIENT WITH DATE OF DEATH CENTRAL THE ORIGINAL HOUSE OF PIES
Count 503
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Civil Rights PSA ALL Provider ALL PROVIDERS Program AC Start Date 01012017 End Date 12312017 The Poverty Level for Single is The Poverty Level for Couple is Sort by County
County Unduplicated Count
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Client Information Report Start Date 01012017 End Date 12312017
Client ID 1001141246
Emergency
Client Name Test Name
Telephone () - Address 78 TEST STREET TALLAHASSEE FL 32399
Most Recent Caregiver Information Date Updated
Doctor
Comments
Client Demographic Information
Birth Date 06041940 Race W
Owner ID Ethnicity O
Most Recent Income Information
Ind Mon Inc Cpl Mon Inc
Ind Assets Couple Assets
Most Recent Assessment Information
Asmt Date Ref Risk Lvl
Asmt Site Spec Shel
AsmtType Spec Reg
Ref Date Primary CG
Ref Source Living Sit
Enrollment Information
Sex
Marital Status
F
S
Medicaid Number
ADL Score
ADL Count
IADL Score
IADL Count
Memory Score
Priority Score
Env Score
Nutr Score
Risk Score
Social Score
Rank
Provider Location Program Program Status Worker Start Date End Date
Care Plan Service Needed
Date Service Units Type Frq End Date
Care Plan Service Planned
Program Service Units Type Frq Start Date End Date
Services Received between 01012017 and 12312017
Service Billed Provider Location Worker Program Service Date Units Unit Type Amount
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Provider N
Client Service Units Report PSA ALL Provider ALL PROVIDERS Location 0000
Program ALL PROGRAMS Service ALL SERVICES Worker ALL WORKERS
City ALL CITIES Include Zero Unit N Include Aggregate N Calculated Amount equals the number of Units Provided times Fixed Cost if it existsService Start Date 01012017 Service End Date 12312017 If Fixed Cost does not exist Calculated
Group by PSA Provider Location Client Name County Worker Amount equals Billed Amount
Unduplicated Client Count 0 Grand Total 000 $000
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Clients In Common PSA All Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 County All Counties Worker All Workers
County JEFFERSON
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
MIAMI-DADE
0 0 0 0 0 0 0 0 0
4061539538 Test NameCounty Count
County
0 01
X
0 1
X
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
4061650856 Test Name X 4061486560 Test Name X 4062452921 Test Name X
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Clients Served Not Enrolled PSA ALL Start Date 01012017 End Date 12312017 Locations 0000 Provider All Providers
Service Service Min Serv Max Serv Program Start End Enrollment PSA Provider Location Program Consumer Name Client ID Service Date Date Status Enrollment Enrollment Provider
Count 0
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
4061472791 04
09
1092
1291
0072
0042
LTCC
LTCC
APCL
APCL
4062714543 06
06
1514
1762
0072
5006
LTCC
LTCC
APCL
APPL
4061802246 11
06
1177
1514
0179
0072
LTCC
LTCC
APCL
APCL
4061563719 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062644312 06
08
1514
1771
0072
0896
LTCC
LTCC
APCL
APCL
1001141670 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
1001141671 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
4062375003 07
05
05
07
1263
1755
1638
1263
0368
0072
0072
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062155124 06
06
1762
1514
0072
0072
LTCC
LTCC
APPL
APCL
4061743886 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0369
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4061499927 06
06
1514
1762
0072
5005
LTCC
LTCC
APCL
APPL
4061583524 08
06
1144
1514
0896
0072
LTCC
LTCC
APCL
APCL
4062694843 06
03
1514
1922
0072
0179
LTCC
LTCC
APCL
APCL
4062744517 07
06
1263
1514
0369
0072
LTCC
LTCC
APCL
APCL
4062005488 10
11
10
11
1929
1177
1164
1177
0072
0073
0179
0179
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
Total Count 15
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CODE DESCRIPTIONS Category ALL STATE TABLES
Code Description Active Available To Code Category
0 UNKNOWN Y CARES SUBJECTIVE_HEALTH_EVALUATION
01 ALACHUA Y COMMON COUNTIES
02 BAKER Y COMMON COUNTIES
03 BAY Y COMMON COUNTIES
04 BRADFORD Y COMMON COUNTIES
05 BREVARD Y COMMON COUNTIES
06 BROWARD Y COMMON COUNTIES
07 CALHOUN Y COMMON COUNTIES
08 CHARLOTTE Y COMMON COUNTIES
09 CITRUS Y COMMON COUNTIES
1 EXCELLENT Y CARES SUBJECTIVE_HEALTH_EVALUATION
10 CLAY Y COMMON COUNTIES
11 COLLIER Y COMMON COUNTIES
12 COLUMBIA Y COMMON COUNTIES
13 MIAMI-DADE Y COMMON COUNTIES
14 DESOTO Y COMMON COUNTIES
15 DIXIE Y COMMON COUNTIES
16 DUVAL Y COMMON COUNTIES
17 ESCAMBIA Y COMMON COUNTIES
18 FLAGLER Y COMMON COUNTIES
19 FRANKLIN Y COMMON COUNTIES
2 GOOD Y CARES SUBJECTIVE_HEALTH_EVALUATION
20 GADSDEN Y COMMON COUNTIES
21 GILCHRIST Y COMMON COUNTIES
22 GLADES Y COMMON COUNTIES
23 GULF Y COMMON COUNTIES
24 HAMILTON Y COMMON COUNTIES
25 HARDEE Y COMMON COUNTIES
26 HENDRY Y COMMON COUNTIES
27 HERNANDO Y COMMON COUNTIES
28 HIGHLANDS Y COMMON COUNTIES
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CONSUMER AGE VERIFICATION REPORT PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Program AC
Age at Start
Enroll or Start Enroll Provider Program Description Consumer Name Client ID DOB Svc date or Svc Date
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Contract Budget Information PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Program Service Provider Location County Served Provider Contract
Projected Service
Units Unit Measure
Projected Unduplicated
State Federal Share Client Count Begin Date End Date
Row Count 0 Amount Total
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Start Enroll Latest Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Date Asmt Date Worker
O3C1 1036 000 4061653427 Test CENTRAL 34982 W M 07091930 09102013 09102013 CIRTS20804 0 Name
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Start Enroll Date
Latest Asmt Date Worker
4061593624 Test Name CENTRAL 34946 B F 11261940 12012011 12312013 CIRTS23407
Count 164
Unduplicated Client Count 163
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Assessments After DOD Report
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Owner 1025
The shaded records indicate clients who have different DOBs andor different names
Assemt Current PSA Owner Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Owner Assessor
Provider Assessor
Assemt Date
Assemt Type
Unduplicated Count Total 0
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Open Enrollments
The Vital Statistics Data for 07192002 - 09112014PSA ALL Provider ALL Program Status ACTV Include MLTC ACTVS N
The shaded records indicate clients who have different DOBs andor different names
Enroll PSA
Enrollment Provider Loc Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Enroll Program Status
Enroll Program
Current Owner ID
02 1065 0072 4062244026 Test Name Test Name 10222004 03231917 03231917 ACTV CCE 1065
Count of enrollments for the Provider 1
Count of enrollments for the PSA 1
Count of enrollments for the Report 1
Unduplicated Count of Individuals with open enrollments and DOD PSA Total Clients Count
02 1
Total 1
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Unduplicated count of individuals with Services after DOD
PSA Total Clients Count
Report Total
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
List of Clients with PSA table entry for SERVICES_AFTER_DOD
Unduplicated Count Total 0
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Age
Provider
Total
Age lt 60 Age 60 - 64 Age 65 - 74 Age 75 - 84 Age 85+ Total Clients Avg Age
Total
Avg Age
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Ethnicity
Provider Hispanic Other Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Race
American Indian Native Hawaiian Other Provider Asian Alaska Native Black Pacific Islander Minority White Multiple Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Gender
Provider Male Female Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Monthly Income
Provider 0 - - Higher than Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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None
Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Total Persons Served 0
Age lt 60 Years 0 0
Age 60 - 64 0 0
Age 65 - 74 0 0
Age 75 - 84 0 0
Age 85+ 0 0
Total Age 0 0
Average 000
Ethnicity Hispanic 0 0
Other Ethnicity 0 0
Unknown Ethnicity 0 0
Total 0 0
Race Asian 0 0
American Indian Alaska Native 0 0
Black 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority 0 0
White 0 0
Multiple 0 0
Unknown 0 0
Total 0 0
Sex Male 0 0
Female 0 0
Unknown Sex 0 0
Total 0 0
Monthly Income 0 - 0 0
- 0 0
Higher than 0 0
Unknown 0 0
Total 0 0
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Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Client ID Date Of Birth Ethnicity Race Sex Individual Monthly Income
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Demographics of Clients OAA Registered Served Only PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 City All Cities Program All Programs Service All Services County ALL COUNTIES Table OAA Registered Services Only Low Income Medium Income
Total Persons Served 0
Agelt 60 Years
Age 60 - 64
Age 65 - 74
Age 75 - 84
Age 85+
0
0
0
0
0
0
0
0
0
0
Monthly Income
0 -
-Higher than
Unknown
0
0
0
0
0
0
0
0
Total
Average
0
000
0 Total 0 0
Ethnicity Hispanic
Other
Unknown
0
0
0
0
0
0
Living Situation
Alone
Null
Policy Change
0
0
0
0
0
0
Total 0 0 Unknown
With Caregiver
0
0
0
0
Race Asian 0 0
With Other
With Other Caregiver
0
0
0
0
American Indian Alaska Native
Black
0
0
0
0Total Living Situation 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority
White
0
0
0
0 Limited English Proficiency
Multiple
Unknown
Total Race
0
0
0
0
0
0
Yes
No
Unknown
0
0
0
0
0
0
Total 0 0
Sex Male
Female
Unknown
0
0
0
0
0
0
Total 0 0
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Disaster Assistance Clients for a Provider PSA ALL Provider All Providers Location 0000 Worker All Workers City All Cities Zip Code All Zip Codes Sort By ZIP
Provider 1036 Provider Name Location 0000 Worker CIRTS18634
Need Care Client Name Address City Zip County Phone Asst Reg Situation Relat Care phone Care Name
34946 N WO DA 000 SAINT JAMES DRIVE CENTRAL (025) 101-0620 Test NameTest Name SAINT LUCIE (005) 100-0369 Y
Client is active and no assessment information is available Special Shelter and Special Registry are unknown
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
Total by PSA 0
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
ALACH BAKER BAY BRADF BREVA BROWA CALHO CHARL CITRUS CLAY COLLIE COLUM DESOT DIXIE DUVAL ESCAM FLAGL FRANK GADSDAssisted Household Report UA ORD RD RD UN OTTE R BIA O BIA ER LIN EN
1 of Household Assisted 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Households AssistedWith Gross Income
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C 100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D 125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
3 Households with at leastOne member
A 60 Years or older 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B Disabled 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C Age 5 years or under 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D Under 60 Years Old 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Undup Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Assisted
Applicant Household Report
of Applicant Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Energy Assisted Household Report
County of Assisted
Households
Households Assisted By Poverty Level
Under 75 75 - 100 101 - 125 126 - 150 Over 150 60 Years or older
At least one member who is
Age 5 years Age 2 years Age 3 years Disabled or younger and younger through 5
Under 60 Years Old
Undup Households
Assisted
Energy Assistance Total
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Unduplicated Total 0 0
County of Assisted
Households Under 75 75 - 100
Households Assisted By Poverty Level
101 - 125 126 - 150 Over 150 60 Years or older Disabled
Age 5 years or younger
Age 2 years and younger
Age 3 years through 5
Under 60 Years Old
At least one member who is
Undup Households
Assisted
Other Assisted Household Report
Other Assistance Total
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Applicant Household Report
County of Applicant
Households Under 75 75 - 100 101 - 125 126 - 150 Over 150 Income data
unavailable
Total 0
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01
Enrollment Active Consumer Count by Program PSA ALL Provider ALL PROVIDERS
County Description Program Count of Clients
BREVARD
ADI
CCE
HCE
LSP
NDP
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
MLTC
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
31
57
44
5
62
123
141
26
9
7
5
40
5
50
67
129
2
19
42
29
1
233
79
63
8
2
14
3
37
14
47
3
3
33
127
10
02
03
04
ALACHUA
BAKER
BAY
BRADFORD
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Enrollment Terminations with Reasons PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 Program All Programs Program Status ALL Program Status Worker ALL WORKERS
Last First Program Medicaid Provider Start End Name Name Client ID Status Description Worker Number Program Location Enrollment Enrollment
Count 0
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Enrollments with Care Plan Report
PSA ALL Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTIVE STATUS Care Plan Service ALL SERVICES Care Plan Start 01012017 Care Plan End 12312017
Care Plan Care Plan Care Plan Client Name
Unduplicated Client Count 0
Client ID Program Status Worker Start Date End Date Service
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PSA CLIENT_ID CLIENT_NAME OWNER PROVIDER_ID ASSESSMENT_DATE ASSESSOR_NAME MEDICAID_NUMBER CAREGIVER_CHANGE ENVIRONMENT_CHANGE HEALTH_CHANGE INCOME_CHANGE SITUATION_CHANGE INITIAL_ASSM ANNUAL_ASSM SSN REFERRAL_SOURCE 1114 N N N N Y N 771771777 SELFFAMILY 812017 JANE CASEWORKER 2 1001141633 TEST TEST N
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Fixed Service Costs List PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Provider Location County Program Service Reimbursement Unit Rate Provider Cost Per Unit Begin Valid End Valid
Count 0
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CIC Service Units and Costs Projections - PSA Summary
PSA ALL Program CCE
Strat Date 01012017 End Date 12312017
Total
PSA County Provider Service
Total State Federal
Share
Total Projected
Service Units
Avg Reimbursement
Unit Rate
Max Projected Provider Unduplicated
Cost Per Unit Client Count
02 LEON SOUTHERN SERVICE CASE MANAGEMENT PROVIDER EMERGENCY HOME DELIVERED SHELF MEALS
$2175533
$602000
483
689
32
20
HOME DELIVERED MEALS $530262 993 5
MATERIAL AID $1994536 199
Provider Total $5302331
CountyTotal $5302331
WAKULLA SOUTHERN SERVICE CASE MANAGEMENT PROVIDER EMERGENCY HOME DELIVERED SHELF MEALS
$2175533
$1240200
483
689
32
5
MATERIAL AID $1994536 199
Provider Total $5410269
CountyTotal $5410269
PSA Total $10712599
05 PINELLAS BURSTEIN-APPLEBEE ADULT DAY CARE $000 0 $900 $1000 0
COUNSELING (MENTAL HEALTH COUNSELINGSCREENING) - INDIVIDUAL
Provider Total
$000
$000
0 $6600 $7700 0
CountyTotal $000
PSA Total $000
Report Total $10712599
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CID Service Units and Costs Projections - PSA SummaryPSA ALL Program CCE
Start Date 01012017 End Date 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
PSA County Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
02 LEON CASE MANAGEMENT $2175533 483
EMERGENCY HOME $602000 689DELIVERED SHELF MEALS HOME DELIVERED MEALS $530262 993
MATERIAL AID $1994536 199
County Total $5302331 2364
WAKULLA CASE MANAGEMENT $2175533 483
EMERGENCY HOME $1240200 689DELIVERED SHELF MEALS MATERIAL AID $1994536 199
County Total $5410269 1371
PSA Total $10712599 3735
05 PINELLAS ADULT DAY CARE $000 0
COUNSELING (MENTAL $000 0 HEALTH COUNSELINGSCREENING) - INDIVIDUAL
County Total $000 0
PSA Total $000 0
Report Total $10712599 3735
$900 $900 $900 $1000 $1000 $1000
$6600 $6600 $6600 $7700 $7700 $7700
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CID Service Units and Costs Projections County SummaryPSA 99
Program CCE County LEON
Start Date 01012017 End Date 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
Report Total
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CIE Service Units and Costs Projections - PSA Summary - All Programs
PSA 99 Program FEDERALLY FUNDED (0101 TO 1231) Year 2017 From 01012017 To 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
Program Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
Report Total
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CIE Service Units and Costs Projections - PSA Summary
PSA ALL Program CCE
Start Date 01012017 End Date 12312017
Avg High Low Total Total Avg High Low Provider Provider Provider
StateFederal Projected Reimbursement Reimbursement Reimbursement Cost Cost CostPSA
02
Service
CASE MANAGEMENT
Share
$4351066
Service Units
966
Unit Rate Unit Rate Unit Rate Per Unit Per Unit Per Unit
EMERGENCY HOME DELIVERED SHELF MEALS $1842200 1378
HOME DELIVERED MEALS $530262 993
MATERIAL AID $3989071 398
PSA Total $10712599 3735
05 ADULT DAY CARE $000 0 $900 $900 $900 $1000 $1000 $1000
COUNSELING (MENTAL HEALTH $000 0 $6600 $6600 $6600 $7700 $7700 $7700 COUNSELINGSCREENING) - INDIVIDUAL
PSA Total $000 0
Report Total $10712599 3735
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CAREGIVER SEARCH REPORT
SEARCH RESULTS FOR CONSUMERS
Criteria First Name Last Name SSN PSA ALL
Client Name Client SSN Caregiver Name Caregiver SSN
000000000 000000000 Test Name Test Name
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CARES Referrals in a Time Range PSA ALL
Start Date 01012017 End Date 12312017
Referred to ALL REFERRALS
Referring PSA Employee Name Client Name Client ID
Referral Imminent NH Admit Aging Date Risk Date Referred To Cares Provider Name Received Date
03A 4061561263 Test Name Test Name 09242017 Y 05292017 ARC or ADRC 09252017
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CARES Referrals in a Time Range PSA ALL
Start Date 01012017 End Date 12312017
Referred to ALL REFERRALS
Referring PSA Employee Name Client Name Client ID
Referral Date
Imminent Risk
NH Admit Date Referred To Cares Provider Name
Aging Received Date
04B Test Name Test Name 4061738075 04082017 N ARC or ADRC Test Name 04082017
Total Clients 110
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CARES Referrals not acknowledged by the Aging Network PSA ALL For Referrals after 01012017 Owner ID ALL Owners
Unduplicated Client count Cares Office Total Clients Count
Report Total
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
CIRTS Issue PSA Client ID Client Name Program
Program Status Start Provider Enrollment ID Provider Name
APCL CLIENT WITH DATE OF DEATH 08 4061759417 Test Name OA3B APCL 07232013 1141 WESTERN WORLD RADIO
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
Program Start Provider CIRTS Issue PSA Client ID Client Name Program Status Enrollment ID Provider Name
06 LTCC APCL 01242014 1514 4061713685 Test Name APCL CLIENT WITH DATE OF DEATH CENTRAL THE ORIGINAL HOUSE OF PIES
Count 503
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Civil Rights PSA ALL Provider ALL PROVIDERS Program AC Start Date 01012017 End Date 12312017 The Poverty Level for Single is The Poverty Level for Couple is Sort by County
County Unduplicated Count
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Client Information Report Start Date 01012017 End Date 12312017
Client ID 1001141246
Emergency
Client Name Test Name
Telephone () - Address 78 TEST STREET TALLAHASSEE FL 32399
Most Recent Caregiver Information Date Updated
Doctor
Comments
Client Demographic Information
Birth Date 06041940 Race W
Owner ID Ethnicity O
Most Recent Income Information
Ind Mon Inc Cpl Mon Inc
Ind Assets Couple Assets
Most Recent Assessment Information
Asmt Date Ref Risk Lvl
Asmt Site Spec Shel
AsmtType Spec Reg
Ref Date Primary CG
Ref Source Living Sit
Enrollment Information
Sex
Marital Status
F
S
Medicaid Number
ADL Score
ADL Count
IADL Score
IADL Count
Memory Score
Priority Score
Env Score
Nutr Score
Risk Score
Social Score
Rank
Provider Location Program Program Status Worker Start Date End Date
Care Plan Service Needed
Date Service Units Type Frq End Date
Care Plan Service Planned
Program Service Units Type Frq Start Date End Date
Services Received between 01012017 and 12312017
Service Billed Provider Location Worker Program Service Date Units Unit Type Amount
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Provider N
Client Service Units Report PSA ALL Provider ALL PROVIDERS Location 0000
Program ALL PROGRAMS Service ALL SERVICES Worker ALL WORKERS
City ALL CITIES Include Zero Unit N Include Aggregate N Calculated Amount equals the number of Units Provided times Fixed Cost if it existsService Start Date 01012017 Service End Date 12312017 If Fixed Cost does not exist Calculated
Group by PSA Provider Location Client Name County Worker Amount equals Billed Amount
Unduplicated Client Count 0 Grand Total 000 $000
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Clients In Common PSA All Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 County All Counties Worker All Workers
County JEFFERSON
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
MIAMI-DADE
0 0 0 0 0 0 0 0 0
4061539538 Test NameCounty Count
County
0 01
X
0 1
X
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
4061650856 Test Name X 4061486560 Test Name X 4062452921 Test Name X
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Clients Served Not Enrolled PSA ALL Start Date 01012017 End Date 12312017 Locations 0000 Provider All Providers
Service Service Min Serv Max Serv Program Start End Enrollment PSA Provider Location Program Consumer Name Client ID Service Date Date Status Enrollment Enrollment Provider
Count 0
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
4061472791 04
09
1092
1291
0072
0042
LTCC
LTCC
APCL
APCL
4062714543 06
06
1514
1762
0072
5006
LTCC
LTCC
APCL
APPL
4061802246 11
06
1177
1514
0179
0072
LTCC
LTCC
APCL
APCL
4061563719 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062644312 06
08
1514
1771
0072
0896
LTCC
LTCC
APCL
APCL
1001141670 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
1001141671 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
4062375003 07
05
05
07
1263
1755
1638
1263
0368
0072
0072
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062155124 06
06
1762
1514
0072
0072
LTCC
LTCC
APPL
APCL
4061743886 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0369
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4061499927 06
06
1514
1762
0072
5005
LTCC
LTCC
APCL
APPL
4061583524 08
06
1144
1514
0896
0072
LTCC
LTCC
APCL
APCL
4062694843 06
03
1514
1922
0072
0179
LTCC
LTCC
APCL
APCL
4062744517 07
06
1263
1514
0369
0072
LTCC
LTCC
APCL
APCL
4062005488 10
11
10
11
1929
1177
1164
1177
0072
0073
0179
0179
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
Total Count 15
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CODE DESCRIPTIONS Category ALL STATE TABLES
Code Description Active Available To Code Category
0 UNKNOWN Y CARES SUBJECTIVE_HEALTH_EVALUATION
01 ALACHUA Y COMMON COUNTIES
02 BAKER Y COMMON COUNTIES
03 BAY Y COMMON COUNTIES
04 BRADFORD Y COMMON COUNTIES
05 BREVARD Y COMMON COUNTIES
06 BROWARD Y COMMON COUNTIES
07 CALHOUN Y COMMON COUNTIES
08 CHARLOTTE Y COMMON COUNTIES
09 CITRUS Y COMMON COUNTIES
1 EXCELLENT Y CARES SUBJECTIVE_HEALTH_EVALUATION
10 CLAY Y COMMON COUNTIES
11 COLLIER Y COMMON COUNTIES
12 COLUMBIA Y COMMON COUNTIES
13 MIAMI-DADE Y COMMON COUNTIES
14 DESOTO Y COMMON COUNTIES
15 DIXIE Y COMMON COUNTIES
16 DUVAL Y COMMON COUNTIES
17 ESCAMBIA Y COMMON COUNTIES
18 FLAGLER Y COMMON COUNTIES
19 FRANKLIN Y COMMON COUNTIES
2 GOOD Y CARES SUBJECTIVE_HEALTH_EVALUATION
20 GADSDEN Y COMMON COUNTIES
21 GILCHRIST Y COMMON COUNTIES
22 GLADES Y COMMON COUNTIES
23 GULF Y COMMON COUNTIES
24 HAMILTON Y COMMON COUNTIES
25 HARDEE Y COMMON COUNTIES
26 HENDRY Y COMMON COUNTIES
27 HERNANDO Y COMMON COUNTIES
28 HIGHLANDS Y COMMON COUNTIES
Report run on 08312018 0140 PM Page 1 of 45 state_codesrdf Report run by RSHQALL Dispose of this report so that it cannot be read or reconstructed
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CONSUMER AGE VERIFICATION REPORT PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Program AC
Age at Start
Enroll or Start Enroll Provider Program Description Consumer Name Client ID DOB Svc date or Svc Date
Report run on 08312018 0203 PM Page 1 of 1 age_verifyrdf
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Contract Budget Information PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Program Service Provider Location County Served Provider Contract
Projected Service
Units Unit Measure
Projected Unduplicated
State Federal Share Client Count Begin Date End Date
Row Count 0 Amount Total
Report run on 08312018 0233 PM Page 1 of 1 contract_budgetrdf
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Start Enroll Latest Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Date Asmt Date Worker
O3C1 1036 000 4061653427 Test CENTRAL 34982 W M 07091930 09102013 09102013 CIRTS20804 0 Name
Report run on 08312018 1133 AM Page 1 of 6 actv_by_progrdf
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Start Enroll Date
Latest Asmt Date Worker
4061593624 Test Name CENTRAL 34946 B F 11261940 12012011 12312013 CIRTS23407
Count 164
Unduplicated Client Count 163
Report run on 08312018 1133 AM Page 6 of 6 actv_by_progrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Assessments After DOD Report
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Owner 1025
The shaded records indicate clients who have different DOBs andor different names
Assemt Current PSA Owner Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Owner Assessor
Provider Assessor
Assemt Date
Assemt Type
Unduplicated Count Total 0
Report run on 08312018 0206 PM Page 1 of 1 vs_assmrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Open Enrollments
The Vital Statistics Data for 07192002 - 09112014PSA ALL Provider ALL Program Status ACTV Include MLTC ACTVS N
The shaded records indicate clients who have different DOBs andor different names
Enroll PSA
Enrollment Provider Loc Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Enroll Program Status
Enroll Program
Current Owner ID
02 1065 0072 4062244026 Test Name Test Name 10222004 03231917 03231917 ACTV CCE 1065
Count of enrollments for the Provider 1
Count of enrollments for the PSA 1
Count of enrollments for the Report 1
Unduplicated Count of Individuals with open enrollments and DOD PSA Total Clients Count
02 1
Total 1
Report run on 08312018 0205 PM Page 1 of 1 vs_open_enrollrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Report run on 08312018 0207 PM Page 1 of 3 vs_servicesrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Unduplicated count of individuals with Services after DOD
PSA Total Clients Count
Report Total
Report run on 08312018 0207 PM Page 2 of 3 vs_servicesrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
List of Clients with PSA table entry for SERVICES_AFTER_DOD
Unduplicated Count Total 0
Report run on 08312018 0207 PM Page 3 of 3 vs_servicesrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Age
Provider
Total
Age lt 60 Age 60 - 64 Age 65 - 74 Age 75 - 84 Age 85+ Total Clients Avg Age
Total
Avg Age
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Ethnicity
Provider Hispanic Other Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Race
American Indian Native Hawaiian Other Provider Asian Alaska Native Black Pacific Islander Minority White Multiple Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Gender
Provider Male Female Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Monthly Income
Provider 0 - - Higher than Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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None
Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Total Persons Served 0
Age lt 60 Years 0 0
Age 60 - 64 0 0
Age 65 - 74 0 0
Age 75 - 84 0 0
Age 85+ 0 0
Total Age 0 0
Average 000
Ethnicity Hispanic 0 0
Other Ethnicity 0 0
Unknown Ethnicity 0 0
Total 0 0
Race Asian 0 0
American Indian Alaska Native 0 0
Black 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority 0 0
White 0 0
Multiple 0 0
Unknown 0 0
Total 0 0
Sex Male 0 0
Female 0 0
Unknown Sex 0 0
Total 0 0
Monthly Income 0 - 0 0
- 0 0
Higher than 0 0
Unknown 0 0
Total 0 0
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Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Client ID Date Of Birth Ethnicity Race Sex Individual Monthly Income
Report run on 08312018 1058 AM Page 2 of 2 demo_by_prov_detrdf Report run byRSHQALL Dispose of this report so that it can not be read or reconstructed
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Demographics of Clients OAA Registered Served Only PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 City All Cities Program All Programs Service All Services County ALL COUNTIES Table OAA Registered Services Only Low Income Medium Income
Total Persons Served 0
Agelt 60 Years
Age 60 - 64
Age 65 - 74
Age 75 - 84
Age 85+
0
0
0
0
0
0
0
0
0
0
Monthly Income
0 -
-Higher than
Unknown
0
0
0
0
0
0
0
0
Total
Average
0
000
0 Total 0 0
Ethnicity Hispanic
Other
Unknown
0
0
0
0
0
0
Living Situation
Alone
Null
Policy Change
0
0
0
0
0
0
Total 0 0 Unknown
With Caregiver
0
0
0
0
Race Asian 0 0
With Other
With Other Caregiver
0
0
0
0
American Indian Alaska Native
Black
0
0
0
0Total Living Situation 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority
White
0
0
0
0 Limited English Proficiency
Multiple
Unknown
Total Race
0
0
0
0
0
0
Yes
No
Unknown
0
0
0
0
0
0
Total 0 0
Sex Male
Female
Unknown
0
0
0
0
0
0
Total 0 0
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Disaster Assistance Clients for a Provider PSA ALL Provider All Providers Location 0000 Worker All Workers City All Cities Zip Code All Zip Codes Sort By ZIP
Provider 1036 Provider Name Location 0000 Worker CIRTS18634
Need Care Client Name Address City Zip County Phone Asst Reg Situation Relat Care phone Care Name
34946 N WO DA 000 SAINT JAMES DRIVE CENTRAL (025) 101-0620 Test NameTest Name SAINT LUCIE (005) 100-0369 Y
Client is active and no assessment information is available Special Shelter and Special Registry are unknown
Report run on 08312018 1102 AM Page 1 of 8 disaster_by_provrdf
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
Total by PSA 0
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
ALACH BAKER BAY BRADF BREVA BROWA CALHO CHARL CITRUS CLAY COLLIE COLUM DESOT DIXIE DUVAL ESCAM FLAGL FRANK GADSDAssisted Household Report UA ORD RD RD UN OTTE R BIA O BIA ER LIN EN
1 of Household Assisted 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Households AssistedWith Gross Income
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C 100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D 125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
3 Households with at leastOne member
A 60 Years or older 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B Disabled 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C Age 5 years or under 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D Under 60 Years Old 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Undup Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Assisted
Applicant Household Report
of Applicant Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Energy Assisted Household Report
County of Assisted
Households
Households Assisted By Poverty Level
Under 75 75 - 100 101 - 125 126 - 150 Over 150 60 Years or older
At least one member who is
Age 5 years Age 2 years Age 3 years Disabled or younger and younger through 5
Under 60 Years Old
Undup Households
Assisted
Energy Assistance Total
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Unduplicated Total 0 0
County of Assisted
Households Under 75 75 - 100
Households Assisted By Poverty Level
101 - 125 126 - 150 Over 150 60 Years or older Disabled
Age 5 years or younger
Age 2 years and younger
Age 3 years through 5
Under 60 Years Old
At least one member who is
Undup Households
Assisted
Other Assisted Household Report
Other Assistance Total
Report run on 08312018 1107 AM Page 2 of 3 eheap_summaryrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Applicant Household Report
County of Applicant
Households Under 75 75 - 100 101 - 125 126 - 150 Over 150 Income data
unavailable
Total 0
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01
Enrollment Active Consumer Count by Program PSA ALL Provider ALL PROVIDERS
County Description Program Count of Clients
BREVARD
ADI
CCE
HCE
LSP
NDP
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
MLTC
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
31
57
44
5
62
123
141
26
9
7
5
40
5
50
67
129
2
19
42
29
1
233
79
63
8
2
14
3
37
14
47
3
3
33
127
10
02
03
04
ALACHUA
BAKER
BAY
BRADFORD
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Enrollment Terminations with Reasons PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 Program All Programs Program Status ALL Program Status Worker ALL WORKERS
Last First Program Medicaid Provider Start End Name Name Client ID Status Description Worker Number Program Location Enrollment Enrollment
Count 0
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Enrollments with Care Plan Report
PSA ALL Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTIVE STATUS Care Plan Service ALL SERVICES Care Plan Start 01012017 Care Plan End 12312017
Care Plan Care Plan Care Plan Client Name
Unduplicated Client Count 0
Client ID Program Status Worker Start Date End Date Service
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PSA CLIENT_ID CLIENT_NAME OWNER PROVIDER_ID ASSESSMENT_DATE ASSESSOR_NAME MEDICAID_NUMBER CAREGIVER_CHANGE ENVIRONMENT_CHANGE HEALTH_CHANGE INCOME_CHANGE SITUATION_CHANGE INITIAL_ASSM ANNUAL_ASSM SSN REFERRAL_SOURCE 1114 N N N N Y N 771771777 SELFFAMILY 812017 JANE CASEWORKER 2 1001141633 TEST TEST N
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Fixed Service Costs List PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Provider Location County Program Service Reimbursement Unit Rate Provider Cost Per Unit Begin Valid End Valid
Count 0
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CID Service Units and Costs Projections - PSA SummaryPSA ALL Program CCE
Start Date 01012017 End Date 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
PSA County Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
02 LEON CASE MANAGEMENT $2175533 483
EMERGENCY HOME $602000 689DELIVERED SHELF MEALS HOME DELIVERED MEALS $530262 993
MATERIAL AID $1994536 199
County Total $5302331 2364
WAKULLA CASE MANAGEMENT $2175533 483
EMERGENCY HOME $1240200 689DELIVERED SHELF MEALS MATERIAL AID $1994536 199
County Total $5410269 1371
PSA Total $10712599 3735
05 PINELLAS ADULT DAY CARE $000 0
COUNSELING (MENTAL $000 0 HEALTH COUNSELINGSCREENING) - INDIVIDUAL
County Total $000 0
PSA Total $000 0
Report Total $10712599 3735
$900 $900 $900 $1000 $1000 $1000
$6600 $6600 $6600 $7700 $7700 $7700
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CID Service Units and Costs Projections County SummaryPSA 99
Program CCE County LEON
Start Date 01012017 End Date 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
Report Total
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CIE Service Units and Costs Projections - PSA Summary - All Programs
PSA 99 Program FEDERALLY FUNDED (0101 TO 1231) Year 2017 From 01012017 To 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
Program Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
Report Total
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CIE Service Units and Costs Projections - PSA Summary
PSA ALL Program CCE
Start Date 01012017 End Date 12312017
Avg High Low Total Total Avg High Low Provider Provider Provider
StateFederal Projected Reimbursement Reimbursement Reimbursement Cost Cost CostPSA
02
Service
CASE MANAGEMENT
Share
$4351066
Service Units
966
Unit Rate Unit Rate Unit Rate Per Unit Per Unit Per Unit
EMERGENCY HOME DELIVERED SHELF MEALS $1842200 1378
HOME DELIVERED MEALS $530262 993
MATERIAL AID $3989071 398
PSA Total $10712599 3735
05 ADULT DAY CARE $000 0 $900 $900 $900 $1000 $1000 $1000
COUNSELING (MENTAL HEALTH $000 0 $6600 $6600 $6600 $7700 $7700 $7700 COUNSELINGSCREENING) - INDIVIDUAL
PSA Total $000 0
Report Total $10712599 3735
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CAREGIVER SEARCH REPORT
SEARCH RESULTS FOR CONSUMERS
Criteria First Name Last Name SSN PSA ALL
Client Name Client SSN Caregiver Name Caregiver SSN
000000000 000000000 Test Name Test Name
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CARES Referrals in a Time Range PSA ALL
Start Date 01012017 End Date 12312017
Referred to ALL REFERRALS
Referring PSA Employee Name Client Name Client ID
Referral Imminent NH Admit Aging Date Risk Date Referred To Cares Provider Name Received Date
03A 4061561263 Test Name Test Name 09242017 Y 05292017 ARC or ADRC 09252017
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CARES Referrals in a Time Range PSA ALL
Start Date 01012017 End Date 12312017
Referred to ALL REFERRALS
Referring PSA Employee Name Client Name Client ID
Referral Date
Imminent Risk
NH Admit Date Referred To Cares Provider Name
Aging Received Date
04B Test Name Test Name 4061738075 04082017 N ARC or ADRC Test Name 04082017
Total Clients 110
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CARES Referrals not acknowledged by the Aging Network PSA ALL For Referrals after 01012017 Owner ID ALL Owners
Unduplicated Client count Cares Office Total Clients Count
Report Total
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
CIRTS Issue PSA Client ID Client Name Program
Program Status Start Provider Enrollment ID Provider Name
APCL CLIENT WITH DATE OF DEATH 08 4061759417 Test Name OA3B APCL 07232013 1141 WESTERN WORLD RADIO
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
Program Start Provider CIRTS Issue PSA Client ID Client Name Program Status Enrollment ID Provider Name
06 LTCC APCL 01242014 1514 4061713685 Test Name APCL CLIENT WITH DATE OF DEATH CENTRAL THE ORIGINAL HOUSE OF PIES
Count 503
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Civil Rights PSA ALL Provider ALL PROVIDERS Program AC Start Date 01012017 End Date 12312017 The Poverty Level for Single is The Poverty Level for Couple is Sort by County
County Unduplicated Count
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Client Information Report Start Date 01012017 End Date 12312017
Client ID 1001141246
Emergency
Client Name Test Name
Telephone () - Address 78 TEST STREET TALLAHASSEE FL 32399
Most Recent Caregiver Information Date Updated
Doctor
Comments
Client Demographic Information
Birth Date 06041940 Race W
Owner ID Ethnicity O
Most Recent Income Information
Ind Mon Inc Cpl Mon Inc
Ind Assets Couple Assets
Most Recent Assessment Information
Asmt Date Ref Risk Lvl
Asmt Site Spec Shel
AsmtType Spec Reg
Ref Date Primary CG
Ref Source Living Sit
Enrollment Information
Sex
Marital Status
F
S
Medicaid Number
ADL Score
ADL Count
IADL Score
IADL Count
Memory Score
Priority Score
Env Score
Nutr Score
Risk Score
Social Score
Rank
Provider Location Program Program Status Worker Start Date End Date
Care Plan Service Needed
Date Service Units Type Frq End Date
Care Plan Service Planned
Program Service Units Type Frq Start Date End Date
Services Received between 01012017 and 12312017
Service Billed Provider Location Worker Program Service Date Units Unit Type Amount
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Provider N
Client Service Units Report PSA ALL Provider ALL PROVIDERS Location 0000
Program ALL PROGRAMS Service ALL SERVICES Worker ALL WORKERS
City ALL CITIES Include Zero Unit N Include Aggregate N Calculated Amount equals the number of Units Provided times Fixed Cost if it existsService Start Date 01012017 Service End Date 12312017 If Fixed Cost does not exist Calculated
Group by PSA Provider Location Client Name County Worker Amount equals Billed Amount
Unduplicated Client Count 0 Grand Total 000 $000
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Clients In Common PSA All Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 County All Counties Worker All Workers
County JEFFERSON
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
MIAMI-DADE
0 0 0 0 0 0 0 0 0
4061539538 Test NameCounty Count
County
0 01
X
0 1
X
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
4061650856 Test Name X 4061486560 Test Name X 4062452921 Test Name X
Report run on 08312018 1148 AM clients_commonrdfPage 1 of 4 Report run by RSHQALL Dispose of this Report so that it can not be read or reconstructed
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Clients Served Not Enrolled PSA ALL Start Date 01012017 End Date 12312017 Locations 0000 Provider All Providers
Service Service Min Serv Max Serv Program Start End Enrollment PSA Provider Location Program Consumer Name Client ID Service Date Date Status Enrollment Enrollment Provider
Count 0
Report run on 08312018 0201 PM Page 1 of 1 clnts_serv_no_enrrdf
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
4061472791 04
09
1092
1291
0072
0042
LTCC
LTCC
APCL
APCL
4062714543 06
06
1514
1762
0072
5006
LTCC
LTCC
APCL
APPL
4061802246 11
06
1177
1514
0179
0072
LTCC
LTCC
APCL
APCL
4061563719 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062644312 06
08
1514
1771
0072
0896
LTCC
LTCC
APCL
APCL
1001141670 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
1001141671 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
4062375003 07
05
05
07
1263
1755
1638
1263
0368
0072
0072
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062155124 06
06
1762
1514
0072
0072
LTCC
LTCC
APPL
APCL
4061743886 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0369
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4061499927 06
06
1514
1762
0072
5005
LTCC
LTCC
APCL
APPL
4061583524 08
06
1144
1514
0896
0072
LTCC
LTCC
APCL
APCL
4062694843 06
03
1514
1922
0072
0179
LTCC
LTCC
APCL
APCL
4062744517 07
06
1263
1514
0369
0072
LTCC
LTCC
APCL
APCL
4062005488 10
11
10
11
1929
1177
1164
1177
0072
0073
0179
0179
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
Report run on 08312018 0200 PM Page 1 of 2 clnts_mult_enrollrdf
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
Total Count 15
Report run on 08312018 0200 PM Page 2 of 2 clnts_mult_enrollrdf
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CODE DESCRIPTIONS Category ALL STATE TABLES
Code Description Active Available To Code Category
0 UNKNOWN Y CARES SUBJECTIVE_HEALTH_EVALUATION
01 ALACHUA Y COMMON COUNTIES
02 BAKER Y COMMON COUNTIES
03 BAY Y COMMON COUNTIES
04 BRADFORD Y COMMON COUNTIES
05 BREVARD Y COMMON COUNTIES
06 BROWARD Y COMMON COUNTIES
07 CALHOUN Y COMMON COUNTIES
08 CHARLOTTE Y COMMON COUNTIES
09 CITRUS Y COMMON COUNTIES
1 EXCELLENT Y CARES SUBJECTIVE_HEALTH_EVALUATION
10 CLAY Y COMMON COUNTIES
11 COLLIER Y COMMON COUNTIES
12 COLUMBIA Y COMMON COUNTIES
13 MIAMI-DADE Y COMMON COUNTIES
14 DESOTO Y COMMON COUNTIES
15 DIXIE Y COMMON COUNTIES
16 DUVAL Y COMMON COUNTIES
17 ESCAMBIA Y COMMON COUNTIES
18 FLAGLER Y COMMON COUNTIES
19 FRANKLIN Y COMMON COUNTIES
2 GOOD Y CARES SUBJECTIVE_HEALTH_EVALUATION
20 GADSDEN Y COMMON COUNTIES
21 GILCHRIST Y COMMON COUNTIES
22 GLADES Y COMMON COUNTIES
23 GULF Y COMMON COUNTIES
24 HAMILTON Y COMMON COUNTIES
25 HARDEE Y COMMON COUNTIES
26 HENDRY Y COMMON COUNTIES
27 HERNANDO Y COMMON COUNTIES
28 HIGHLANDS Y COMMON COUNTIES
Report run on 08312018 0140 PM Page 1 of 45 state_codesrdf Report run by RSHQALL Dispose of this report so that it cannot be read or reconstructed
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CONSUMER AGE VERIFICATION REPORT PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Program AC
Age at Start
Enroll or Start Enroll Provider Program Description Consumer Name Client ID DOB Svc date or Svc Date
Report run on 08312018 0203 PM Page 1 of 1 age_verifyrdf
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Contract Budget Information PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Program Service Provider Location County Served Provider Contract
Projected Service
Units Unit Measure
Projected Unduplicated
State Federal Share Client Count Begin Date End Date
Row Count 0 Amount Total
Report run on 08312018 0233 PM Page 1 of 1 contract_budgetrdf
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Start Enroll Latest Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Date Asmt Date Worker
O3C1 1036 000 4061653427 Test CENTRAL 34982 W M 07091930 09102013 09102013 CIRTS20804 0 Name
Report run on 08312018 1133 AM Page 1 of 6 actv_by_progrdf
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Start Enroll Date
Latest Asmt Date Worker
4061593624 Test Name CENTRAL 34946 B F 11261940 12012011 12312013 CIRTS23407
Count 164
Unduplicated Client Count 163
Report run on 08312018 1133 AM Page 6 of 6 actv_by_progrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Assessments After DOD Report
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Owner 1025
The shaded records indicate clients who have different DOBs andor different names
Assemt Current PSA Owner Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Owner Assessor
Provider Assessor
Assemt Date
Assemt Type
Unduplicated Count Total 0
Report run on 08312018 0206 PM Page 1 of 1 vs_assmrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Open Enrollments
The Vital Statistics Data for 07192002 - 09112014PSA ALL Provider ALL Program Status ACTV Include MLTC ACTVS N
The shaded records indicate clients who have different DOBs andor different names
Enroll PSA
Enrollment Provider Loc Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Enroll Program Status
Enroll Program
Current Owner ID
02 1065 0072 4062244026 Test Name Test Name 10222004 03231917 03231917 ACTV CCE 1065
Count of enrollments for the Provider 1
Count of enrollments for the PSA 1
Count of enrollments for the Report 1
Unduplicated Count of Individuals with open enrollments and DOD PSA Total Clients Count
02 1
Total 1
Report run on 08312018 0205 PM Page 1 of 1 vs_open_enrollrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Report run on 08312018 0207 PM Page 1 of 3 vs_servicesrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Unduplicated count of individuals with Services after DOD
PSA Total Clients Count
Report Total
Report run on 08312018 0207 PM Page 2 of 3 vs_servicesrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
List of Clients with PSA table entry for SERVICES_AFTER_DOD
Unduplicated Count Total 0
Report run on 08312018 0207 PM Page 3 of 3 vs_servicesrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Age
Provider
Total
Age lt 60 Age 60 - 64 Age 65 - 74 Age 75 - 84 Age 85+ Total Clients Avg Age
Total
Avg Age
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 1 of 5 demo_all_prvrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Ethnicity
Provider Hispanic Other Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Race
American Indian Native Hawaiian Other Provider Asian Alaska Native Black Pacific Islander Minority White Multiple Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Gender
Provider Male Female Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Monthly Income
Provider 0 - - Higher than Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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None
Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Total Persons Served 0
Age lt 60 Years 0 0
Age 60 - 64 0 0
Age 65 - 74 0 0
Age 75 - 84 0 0
Age 85+ 0 0
Total Age 0 0
Average 000
Ethnicity Hispanic 0 0
Other Ethnicity 0 0
Unknown Ethnicity 0 0
Total 0 0
Race Asian 0 0
American Indian Alaska Native 0 0
Black 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority 0 0
White 0 0
Multiple 0 0
Unknown 0 0
Total 0 0
Sex Male 0 0
Female 0 0
Unknown Sex 0 0
Total 0 0
Monthly Income 0 - 0 0
- 0 0
Higher than 0 0
Unknown 0 0
Total 0 0
Report run on 08312018 1058 AM Page 1 of 2 demo_by_prov_detrdf Report run byRSHQALL Dispose of this report so that it can not be read or reconstructed
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Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Client ID Date Of Birth Ethnicity Race Sex Individual Monthly Income
Report run on 08312018 1058 AM Page 2 of 2 demo_by_prov_detrdf Report run byRSHQALL Dispose of this report so that it can not be read or reconstructed
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Demographics of Clients OAA Registered Served Only PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 City All Cities Program All Programs Service All Services County ALL COUNTIES Table OAA Registered Services Only Low Income Medium Income
Total Persons Served 0
Agelt 60 Years
Age 60 - 64
Age 65 - 74
Age 75 - 84
Age 85+
0
0
0
0
0
0
0
0
0
0
Monthly Income
0 -
-Higher than
Unknown
0
0
0
0
0
0
0
0
Total
Average
0
000
0 Total 0 0
Ethnicity Hispanic
Other
Unknown
0
0
0
0
0
0
Living Situation
Alone
Null
Policy Change
0
0
0
0
0
0
Total 0 0 Unknown
With Caregiver
0
0
0
0
Race Asian 0 0
With Other
With Other Caregiver
0
0
0
0
American Indian Alaska Native
Black
0
0
0
0Total Living Situation 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority
White
0
0
0
0 Limited English Proficiency
Multiple
Unknown
Total Race
0
0
0
0
0
0
Yes
No
Unknown
0
0
0
0
0
0
Total 0 0
Sex Male
Female
Unknown
0
0
0
0
0
0
Total 0 0
Report run on 08312018 1056 AM Page 1 of 1 demo_by_provrdf
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Disaster Assistance Clients for a Provider PSA ALL Provider All Providers Location 0000 Worker All Workers City All Cities Zip Code All Zip Codes Sort By ZIP
Provider 1036 Provider Name Location 0000 Worker CIRTS18634
Need Care Client Name Address City Zip County Phone Asst Reg Situation Relat Care phone Care Name
34946 N WO DA 000 SAINT JAMES DRIVE CENTRAL (025) 101-0620 Test NameTest Name SAINT LUCIE (005) 100-0369 Y
Client is active and no assessment information is available Special Shelter and Special Registry are unknown
Report run on 08312018 1102 AM Page 1 of 8 disaster_by_provrdf
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
Total by PSA 0
Report run on 08312018 1111 AM Page 1 of 5 eheap_exceptionsrdf
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
ALACH BAKER BAY BRADF BREVA BROWA CALHO CHARL CITRUS CLAY COLLIE COLUM DESOT DIXIE DUVAL ESCAM FLAGL FRANK GADSDAssisted Household Report UA ORD RD RD UN OTTE R BIA O BIA ER LIN EN
1 of Household Assisted 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Households AssistedWith Gross Income
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C 100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D 125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
3 Households with at leastOne member
A 60 Years or older 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B Disabled 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C Age 5 years or under 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D Under 60 Years Old 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Undup Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Assisted
Applicant Household Report
of Applicant Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Energy Assisted Household Report
County of Assisted
Households
Households Assisted By Poverty Level
Under 75 75 - 100 101 - 125 126 - 150 Over 150 60 Years or older
At least one member who is
Age 5 years Age 2 years Age 3 years Disabled or younger and younger through 5
Under 60 Years Old
Undup Households
Assisted
Energy Assistance Total
Report run on 08312018 1107 AM Page 1 of 3 eheap_summaryrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Unduplicated Total 0 0
County of Assisted
Households Under 75 75 - 100
Households Assisted By Poverty Level
101 - 125 126 - 150 Over 150 60 Years or older Disabled
Age 5 years or younger
Age 2 years and younger
Age 3 years through 5
Under 60 Years Old
At least one member who is
Undup Households
Assisted
Other Assisted Household Report
Other Assistance Total
Report run on 08312018 1107 AM Page 2 of 3 eheap_summaryrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Applicant Household Report
County of Applicant
Households Under 75 75 - 100 101 - 125 126 - 150 Over 150 Income data
unavailable
Total 0
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01
Enrollment Active Consumer Count by Program PSA ALL Provider ALL PROVIDERS
County Description Program Count of Clients
BREVARD
ADI
CCE
HCE
LSP
NDP
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
MLTC
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
31
57
44
5
62
123
141
26
9
7
5
40
5
50
67
129
2
19
42
29
1
233
79
63
8
2
14
3
37
14
47
3
3
33
127
10
02
03
04
ALACHUA
BAKER
BAY
BRADFORD
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Enrollment Terminations with Reasons PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 Program All Programs Program Status ALL Program Status Worker ALL WORKERS
Last First Program Medicaid Provider Start End Name Name Client ID Status Description Worker Number Program Location Enrollment Enrollment
Count 0
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Enrollments with Care Plan Report
PSA ALL Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTIVE STATUS Care Plan Service ALL SERVICES Care Plan Start 01012017 Care Plan End 12312017
Care Plan Care Plan Care Plan Client Name
Unduplicated Client Count 0
Client ID Program Status Worker Start Date End Date Service
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PSA CLIENT_ID CLIENT_NAME OWNER PROVIDER_ID ASSESSMENT_DATE ASSESSOR_NAME MEDICAID_NUMBER CAREGIVER_CHANGE ENVIRONMENT_CHANGE HEALTH_CHANGE INCOME_CHANGE SITUATION_CHANGE INITIAL_ASSM ANNUAL_ASSM SSN REFERRAL_SOURCE 1114 N N N N Y N 771771777 SELFFAMILY 812017 JANE CASEWORKER 2 1001141633 TEST TEST N
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Fixed Service Costs List PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Provider Location County Program Service Reimbursement Unit Rate Provider Cost Per Unit Begin Valid End Valid
Count 0
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CID Service Units and Costs Projections County SummaryPSA 99
Program CCE County LEON
Start Date 01012017 End Date 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
Report Total
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CIE Service Units and Costs Projections - PSA Summary - All Programs
PSA 99 Program FEDERALLY FUNDED (0101 TO 1231) Year 2017 From 01012017 To 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
Program Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
Report Total
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CIE Service Units and Costs Projections - PSA Summary
PSA ALL Program CCE
Start Date 01012017 End Date 12312017
Avg High Low Total Total Avg High Low Provider Provider Provider
StateFederal Projected Reimbursement Reimbursement Reimbursement Cost Cost CostPSA
02
Service
CASE MANAGEMENT
Share
$4351066
Service Units
966
Unit Rate Unit Rate Unit Rate Per Unit Per Unit Per Unit
EMERGENCY HOME DELIVERED SHELF MEALS $1842200 1378
HOME DELIVERED MEALS $530262 993
MATERIAL AID $3989071 398
PSA Total $10712599 3735
05 ADULT DAY CARE $000 0 $900 $900 $900 $1000 $1000 $1000
COUNSELING (MENTAL HEALTH $000 0 $6600 $6600 $6600 $7700 $7700 $7700 COUNSELINGSCREENING) - INDIVIDUAL
PSA Total $000 0
Report Total $10712599 3735
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CAREGIVER SEARCH REPORT
SEARCH RESULTS FOR CONSUMERS
Criteria First Name Last Name SSN PSA ALL
Client Name Client SSN Caregiver Name Caregiver SSN
000000000 000000000 Test Name Test Name
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CARES Referrals in a Time Range PSA ALL
Start Date 01012017 End Date 12312017
Referred to ALL REFERRALS
Referring PSA Employee Name Client Name Client ID
Referral Imminent NH Admit Aging Date Risk Date Referred To Cares Provider Name Received Date
03A 4061561263 Test Name Test Name 09242017 Y 05292017 ARC or ADRC 09252017
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CARES Referrals in a Time Range PSA ALL
Start Date 01012017 End Date 12312017
Referred to ALL REFERRALS
Referring PSA Employee Name Client Name Client ID
Referral Date
Imminent Risk
NH Admit Date Referred To Cares Provider Name
Aging Received Date
04B Test Name Test Name 4061738075 04082017 N ARC or ADRC Test Name 04082017
Total Clients 110
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CARES Referrals not acknowledged by the Aging Network PSA ALL For Referrals after 01012017 Owner ID ALL Owners
Unduplicated Client count Cares Office Total Clients Count
Report Total
Report run on 08312018 0158 PM Page 1 of 1 cares_not_ackrdf
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
CIRTS Issue PSA Client ID Client Name Program
Program Status Start Provider Enrollment ID Provider Name
APCL CLIENT WITH DATE OF DEATH 08 4061759417 Test Name OA3B APCL 07232013 1141 WESTERN WORLD RADIO
Report run on 08312018 0224 PM
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
Program Start Provider CIRTS Issue PSA Client ID Client Name Program Status Enrollment ID Provider Name
06 LTCC APCL 01242014 1514 4061713685 Test Name APCL CLIENT WITH DATE OF DEATH CENTRAL THE ORIGINAL HOUSE OF PIES
Count 503
Report run on 08312018 0224 PM Page 22 of 22 data_cleanuprdf Report run by RSHQALL Dispose of this report so that it can not be read or reconstructed
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Civil Rights PSA ALL Provider ALL PROVIDERS Program AC Start Date 01012017 End Date 12312017 The Poverty Level for Single is The Poverty Level for Couple is Sort by County
County Unduplicated Count
Report run on 08312018 1055 AM Page 1 of 1 civil_rightsrdf
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Client Information Report Start Date 01012017 End Date 12312017
Client ID 1001141246
Emergency
Client Name Test Name
Telephone () - Address 78 TEST STREET TALLAHASSEE FL 32399
Most Recent Caregiver Information Date Updated
Doctor
Comments
Client Demographic Information
Birth Date 06041940 Race W
Owner ID Ethnicity O
Most Recent Income Information
Ind Mon Inc Cpl Mon Inc
Ind Assets Couple Assets
Most Recent Assessment Information
Asmt Date Ref Risk Lvl
Asmt Site Spec Shel
AsmtType Spec Reg
Ref Date Primary CG
Ref Source Living Sit
Enrollment Information
Sex
Marital Status
F
S
Medicaid Number
ADL Score
ADL Count
IADL Score
IADL Count
Memory Score
Priority Score
Env Score
Nutr Score
Risk Score
Social Score
Rank
Provider Location Program Program Status Worker Start Date End Date
Care Plan Service Needed
Date Service Units Type Frq End Date
Care Plan Service Planned
Program Service Units Type Frq Start Date End Date
Services Received between 01012017 and 12312017
Service Billed Provider Location Worker Program Service Date Units Unit Type Amount
Report run on 08312018 0159 PM Page 1 of 1 client_info_formrdf
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Provider N
Client Service Units Report PSA ALL Provider ALL PROVIDERS Location 0000
Program ALL PROGRAMS Service ALL SERVICES Worker ALL WORKERS
City ALL CITIES Include Zero Unit N Include Aggregate N Calculated Amount equals the number of Units Provided times Fixed Cost if it existsService Start Date 01012017 Service End Date 12312017 If Fixed Cost does not exist Calculated
Group by PSA Provider Location Client Name County Worker Amount equals Billed Amount
Unduplicated Client Count 0 Grand Total 000 $000
Report run on 08312018 0234 PM Page 1 of 1 clnt_serv_unitsrdf
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Clients In Common PSA All Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 County All Counties Worker All Workers
County JEFFERSON
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
MIAMI-DADE
0 0 0 0 0 0 0 0 0
4061539538 Test NameCounty Count
County
0 01
X
0 1
X
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
4061650856 Test Name X 4061486560 Test Name X 4062452921 Test Name X
Report run on 08312018 1148 AM clients_commonrdfPage 1 of 4 Report run by RSHQALL Dispose of this Report so that it can not be read or reconstructed
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Clients Served Not Enrolled PSA ALL Start Date 01012017 End Date 12312017 Locations 0000 Provider All Providers
Service Service Min Serv Max Serv Program Start End Enrollment PSA Provider Location Program Consumer Name Client ID Service Date Date Status Enrollment Enrollment Provider
Count 0
Report run on 08312018 0201 PM Page 1 of 1 clnts_serv_no_enrrdf
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
4061472791 04
09
1092
1291
0072
0042
LTCC
LTCC
APCL
APCL
4062714543 06
06
1514
1762
0072
5006
LTCC
LTCC
APCL
APPL
4061802246 11
06
1177
1514
0179
0072
LTCC
LTCC
APCL
APCL
4061563719 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062644312 06
08
1514
1771
0072
0896
LTCC
LTCC
APCL
APCL
1001141670 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
1001141671 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
4062375003 07
05
05
07
1263
1755
1638
1263
0368
0072
0072
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062155124 06
06
1762
1514
0072
0072
LTCC
LTCC
APPL
APCL
4061743886 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0369
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4061499927 06
06
1514
1762
0072
5005
LTCC
LTCC
APCL
APPL
4061583524 08
06
1144
1514
0896
0072
LTCC
LTCC
APCL
APCL
4062694843 06
03
1514
1922
0072
0179
LTCC
LTCC
APCL
APCL
4062744517 07
06
1263
1514
0369
0072
LTCC
LTCC
APCL
APCL
4062005488 10
11
10
11
1929
1177
1164
1177
0072
0073
0179
0179
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
Report run on 08312018 0200 PM Page 1 of 2 clnts_mult_enrollrdf
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
Total Count 15
Report run on 08312018 0200 PM Page 2 of 2 clnts_mult_enrollrdf
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CODE DESCRIPTIONS Category ALL STATE TABLES
Code Description Active Available To Code Category
0 UNKNOWN Y CARES SUBJECTIVE_HEALTH_EVALUATION
01 ALACHUA Y COMMON COUNTIES
02 BAKER Y COMMON COUNTIES
03 BAY Y COMMON COUNTIES
04 BRADFORD Y COMMON COUNTIES
05 BREVARD Y COMMON COUNTIES
06 BROWARD Y COMMON COUNTIES
07 CALHOUN Y COMMON COUNTIES
08 CHARLOTTE Y COMMON COUNTIES
09 CITRUS Y COMMON COUNTIES
1 EXCELLENT Y CARES SUBJECTIVE_HEALTH_EVALUATION
10 CLAY Y COMMON COUNTIES
11 COLLIER Y COMMON COUNTIES
12 COLUMBIA Y COMMON COUNTIES
13 MIAMI-DADE Y COMMON COUNTIES
14 DESOTO Y COMMON COUNTIES
15 DIXIE Y COMMON COUNTIES
16 DUVAL Y COMMON COUNTIES
17 ESCAMBIA Y COMMON COUNTIES
18 FLAGLER Y COMMON COUNTIES
19 FRANKLIN Y COMMON COUNTIES
2 GOOD Y CARES SUBJECTIVE_HEALTH_EVALUATION
20 GADSDEN Y COMMON COUNTIES
21 GILCHRIST Y COMMON COUNTIES
22 GLADES Y COMMON COUNTIES
23 GULF Y COMMON COUNTIES
24 HAMILTON Y COMMON COUNTIES
25 HARDEE Y COMMON COUNTIES
26 HENDRY Y COMMON COUNTIES
27 HERNANDO Y COMMON COUNTIES
28 HIGHLANDS Y COMMON COUNTIES
Report run on 08312018 0140 PM Page 1 of 45 state_codesrdf Report run by RSHQALL Dispose of this report so that it cannot be read or reconstructed
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CONSUMER AGE VERIFICATION REPORT PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Program AC
Age at Start
Enroll or Start Enroll Provider Program Description Consumer Name Client ID DOB Svc date or Svc Date
Report run on 08312018 0203 PM Page 1 of 1 age_verifyrdf
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Contract Budget Information PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Program Service Provider Location County Served Provider Contract
Projected Service
Units Unit Measure
Projected Unduplicated
State Federal Share Client Count Begin Date End Date
Row Count 0 Amount Total
Report run on 08312018 0233 PM Page 1 of 1 contract_budgetrdf
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Start Enroll Latest Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Date Asmt Date Worker
O3C1 1036 000 4061653427 Test CENTRAL 34982 W M 07091930 09102013 09102013 CIRTS20804 0 Name
Report run on 08312018 1133 AM Page 1 of 6 actv_by_progrdf
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Start Enroll Date
Latest Asmt Date Worker
4061593624 Test Name CENTRAL 34946 B F 11261940 12012011 12312013 CIRTS23407
Count 164
Unduplicated Client Count 163
Report run on 08312018 1133 AM Page 6 of 6 actv_by_progrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Assessments After DOD Report
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Owner 1025
The shaded records indicate clients who have different DOBs andor different names
Assemt Current PSA Owner Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Owner Assessor
Provider Assessor
Assemt Date
Assemt Type
Unduplicated Count Total 0
Report run on 08312018 0206 PM Page 1 of 1 vs_assmrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Open Enrollments
The Vital Statistics Data for 07192002 - 09112014PSA ALL Provider ALL Program Status ACTV Include MLTC ACTVS N
The shaded records indicate clients who have different DOBs andor different names
Enroll PSA
Enrollment Provider Loc Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Enroll Program Status
Enroll Program
Current Owner ID
02 1065 0072 4062244026 Test Name Test Name 10222004 03231917 03231917 ACTV CCE 1065
Count of enrollments for the Provider 1
Count of enrollments for the PSA 1
Count of enrollments for the Report 1
Unduplicated Count of Individuals with open enrollments and DOD PSA Total Clients Count
02 1
Total 1
Report run on 08312018 0205 PM Page 1 of 1 vs_open_enrollrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Report run on 08312018 0207 PM Page 1 of 3 vs_servicesrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Unduplicated count of individuals with Services after DOD
PSA Total Clients Count
Report Total
Report run on 08312018 0207 PM Page 2 of 3 vs_servicesrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
List of Clients with PSA table entry for SERVICES_AFTER_DOD
Unduplicated Count Total 0
Report run on 08312018 0207 PM Page 3 of 3 vs_servicesrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Age
Provider
Total
Age lt 60 Age 60 - 64 Age 65 - 74 Age 75 - 84 Age 85+ Total Clients Avg Age
Total
Avg Age
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 1 of 5 demo_all_prvrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Ethnicity
Provider Hispanic Other Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Race
American Indian Native Hawaiian Other Provider Asian Alaska Native Black Pacific Islander Minority White Multiple Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Gender
Provider Male Female Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Monthly Income
Provider 0 - - Higher than Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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None
Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Total Persons Served 0
Age lt 60 Years 0 0
Age 60 - 64 0 0
Age 65 - 74 0 0
Age 75 - 84 0 0
Age 85+ 0 0
Total Age 0 0
Average 000
Ethnicity Hispanic 0 0
Other Ethnicity 0 0
Unknown Ethnicity 0 0
Total 0 0
Race Asian 0 0
American Indian Alaska Native 0 0
Black 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority 0 0
White 0 0
Multiple 0 0
Unknown 0 0
Total 0 0
Sex Male 0 0
Female 0 0
Unknown Sex 0 0
Total 0 0
Monthly Income 0 - 0 0
- 0 0
Higher than 0 0
Unknown 0 0
Total 0 0
Report run on 08312018 1058 AM Page 1 of 2 demo_by_prov_detrdf Report run byRSHQALL Dispose of this report so that it can not be read or reconstructed
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Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Client ID Date Of Birth Ethnicity Race Sex Individual Monthly Income
Report run on 08312018 1058 AM Page 2 of 2 demo_by_prov_detrdf Report run byRSHQALL Dispose of this report so that it can not be read or reconstructed
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Demographics of Clients OAA Registered Served Only PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 City All Cities Program All Programs Service All Services County ALL COUNTIES Table OAA Registered Services Only Low Income Medium Income
Total Persons Served 0
Agelt 60 Years
Age 60 - 64
Age 65 - 74
Age 75 - 84
Age 85+
0
0
0
0
0
0
0
0
0
0
Monthly Income
0 -
-Higher than
Unknown
0
0
0
0
0
0
0
0
Total
Average
0
000
0 Total 0 0
Ethnicity Hispanic
Other
Unknown
0
0
0
0
0
0
Living Situation
Alone
Null
Policy Change
0
0
0
0
0
0
Total 0 0 Unknown
With Caregiver
0
0
0
0
Race Asian 0 0
With Other
With Other Caregiver
0
0
0
0
American Indian Alaska Native
Black
0
0
0
0Total Living Situation 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority
White
0
0
0
0 Limited English Proficiency
Multiple
Unknown
Total Race
0
0
0
0
0
0
Yes
No
Unknown
0
0
0
0
0
0
Total 0 0
Sex Male
Female
Unknown
0
0
0
0
0
0
Total 0 0
Report run on 08312018 1056 AM Page 1 of 1 demo_by_provrdf
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Disaster Assistance Clients for a Provider PSA ALL Provider All Providers Location 0000 Worker All Workers City All Cities Zip Code All Zip Codes Sort By ZIP
Provider 1036 Provider Name Location 0000 Worker CIRTS18634
Need Care Client Name Address City Zip County Phone Asst Reg Situation Relat Care phone Care Name
34946 N WO DA 000 SAINT JAMES DRIVE CENTRAL (025) 101-0620 Test NameTest Name SAINT LUCIE (005) 100-0369 Y
Client is active and no assessment information is available Special Shelter and Special Registry are unknown
Report run on 08312018 1102 AM Page 1 of 8 disaster_by_provrdf
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
Total by PSA 0
Report run on 08312018 1111 AM Page 1 of 5 eheap_exceptionsrdf
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
ALACH BAKER BAY BRADF BREVA BROWA CALHO CHARL CITRUS CLAY COLLIE COLUM DESOT DIXIE DUVAL ESCAM FLAGL FRANK GADSDAssisted Household Report UA ORD RD RD UN OTTE R BIA O BIA ER LIN EN
1 of Household Assisted 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Households AssistedWith Gross Income
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C 100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D 125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
3 Households with at leastOne member
A 60 Years or older 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B Disabled 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C Age 5 years or under 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D Under 60 Years Old 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Undup Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Assisted
Applicant Household Report
of Applicant Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Energy Assisted Household Report
County of Assisted
Households
Households Assisted By Poverty Level
Under 75 75 - 100 101 - 125 126 - 150 Over 150 60 Years or older
At least one member who is
Age 5 years Age 2 years Age 3 years Disabled or younger and younger through 5
Under 60 Years Old
Undup Households
Assisted
Energy Assistance Total
Report run on 08312018 1107 AM Page 1 of 3 eheap_summaryrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Unduplicated Total 0 0
County of Assisted
Households Under 75 75 - 100
Households Assisted By Poverty Level
101 - 125 126 - 150 Over 150 60 Years or older Disabled
Age 5 years or younger
Age 2 years and younger
Age 3 years through 5
Under 60 Years Old
At least one member who is
Undup Households
Assisted
Other Assisted Household Report
Other Assistance Total
Report run on 08312018 1107 AM Page 2 of 3 eheap_summaryrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Applicant Household Report
County of Applicant
Households Under 75 75 - 100 101 - 125 126 - 150 Over 150 Income data
unavailable
Total 0
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01
Enrollment Active Consumer Count by Program PSA ALL Provider ALL PROVIDERS
County Description Program Count of Clients
BREVARD
ADI
CCE
HCE
LSP
NDP
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
MLTC
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
31
57
44
5
62
123
141
26
9
7
5
40
5
50
67
129
2
19
42
29
1
233
79
63
8
2
14
3
37
14
47
3
3
33
127
10
02
03
04
ALACHUA
BAKER
BAY
BRADFORD
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Enrollment Terminations with Reasons PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 Program All Programs Program Status ALL Program Status Worker ALL WORKERS
Last First Program Medicaid Provider Start End Name Name Client ID Status Description Worker Number Program Location Enrollment Enrollment
Count 0
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Enrollments with Care Plan Report
PSA ALL Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTIVE STATUS Care Plan Service ALL SERVICES Care Plan Start 01012017 Care Plan End 12312017
Care Plan Care Plan Care Plan Client Name
Unduplicated Client Count 0
Client ID Program Status Worker Start Date End Date Service
Report run on 08312018 1054 AM Page 1 of 1 enroll_careplrdf Report run by RSHQALL Dispose of this report so that it cannot be read or reconstructed
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PSA CLIENT_ID CLIENT_NAME OWNER PROVIDER_ID ASSESSMENT_DATE ASSESSOR_NAME MEDICAID_NUMBER CAREGIVER_CHANGE ENVIRONMENT_CHANGE HEALTH_CHANGE INCOME_CHANGE SITUATION_CHANGE INITIAL_ASSM ANNUAL_ASSM SSN REFERRAL_SOURCE 1114 N N N N Y N 771771777 SELFFAMILY 812017 JANE CASEWORKER 2 1001141633 TEST TEST N
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Fixed Service Costs List PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Provider Location County Program Service Reimbursement Unit Rate Provider Cost Per Unit Begin Valid End Valid
Count 0
Report run on 08312018 0233 PM Page 1 of 1 fixed_service_costrdf
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CIE Service Units and Costs Projections - PSA Summary - All Programs
PSA 99 Program FEDERALLY FUNDED (0101 TO 1231) Year 2017 From 01012017 To 12312017
Total Total Avg High Low Avg High Low StateFederal Projected Reimbursement Reimbursement Reimbursement Provider Provider Provider
Program Service Share Service Units Unit Rate Unit Rate Unit Rate Cost Per Unit Cost Per Unit Cost Per Unit
Report Total
Report run on 08312018 0246 PM Page 1 of 1 cie_serv_all_progrdf
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CIE Service Units and Costs Projections - PSA Summary
PSA ALL Program CCE
Start Date 01012017 End Date 12312017
Avg High Low Total Total Avg High Low Provider Provider Provider
StateFederal Projected Reimbursement Reimbursement Reimbursement Cost Cost CostPSA
02
Service
CASE MANAGEMENT
Share
$4351066
Service Units
966
Unit Rate Unit Rate Unit Rate Per Unit Per Unit Per Unit
EMERGENCY HOME DELIVERED SHELF MEALS $1842200 1378
HOME DELIVERED MEALS $530262 993
MATERIAL AID $3989071 398
PSA Total $10712599 3735
05 ADULT DAY CARE $000 0 $900 $900 $900 $1000 $1000 $1000
COUNSELING (MENTAL HEALTH $000 0 $6600 $6600 $6600 $7700 $7700 $7700 COUNSELINGSCREENING) - INDIVIDUAL
PSA Total $000 0
Report Total $10712599 3735
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CAREGIVER SEARCH REPORT
SEARCH RESULTS FOR CONSUMERS
Criteria First Name Last Name SSN PSA ALL
Client Name Client SSN Caregiver Name Caregiver SSN
000000000 000000000 Test Name Test Name
Report run on 08312018 1050 AM Page 1 of 4074 cg_searchrdf
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CARES Referrals in a Time Range PSA ALL
Start Date 01012017 End Date 12312017
Referred to ALL REFERRALS
Referring PSA Employee Name Client Name Client ID
Referral Imminent NH Admit Aging Date Risk Date Referred To Cares Provider Name Received Date
03A 4061561263 Test Name Test Name 09242017 Y 05292017 ARC or ADRC 09252017
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CARES Referrals in a Time Range PSA ALL
Start Date 01012017 End Date 12312017
Referred to ALL REFERRALS
Referring PSA Employee Name Client Name Client ID
Referral Date
Imminent Risk
NH Admit Date Referred To Cares Provider Name
Aging Received Date
04B Test Name Test Name 4061738075 04082017 N ARC or ADRC Test Name 04082017
Total Clients 110
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CARES Referrals not acknowledged by the Aging Network PSA ALL For Referrals after 01012017 Owner ID ALL Owners
Unduplicated Client count Cares Office Total Clients Count
Report Total
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
CIRTS Issue PSA Client ID Client Name Program
Program Status Start Provider Enrollment ID Provider Name
APCL CLIENT WITH DATE OF DEATH 08 4061759417 Test Name OA3B APCL 07232013 1141 WESTERN WORLD RADIO
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
Program Start Provider CIRTS Issue PSA Client ID Client Name Program Status Enrollment ID Provider Name
06 LTCC APCL 01242014 1514 4061713685 Test Name APCL CLIENT WITH DATE OF DEATH CENTRAL THE ORIGINAL HOUSE OF PIES
Count 503
Report run on 08312018 0224 PM Page 22 of 22 data_cleanuprdf Report run by RSHQALL Dispose of this report so that it can not be read or reconstructed
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Civil Rights PSA ALL Provider ALL PROVIDERS Program AC Start Date 01012017 End Date 12312017 The Poverty Level for Single is The Poverty Level for Couple is Sort by County
County Unduplicated Count
Report run on 08312018 1055 AM Page 1 of 1 civil_rightsrdf
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Client Information Report Start Date 01012017 End Date 12312017
Client ID 1001141246
Emergency
Client Name Test Name
Telephone () - Address 78 TEST STREET TALLAHASSEE FL 32399
Most Recent Caregiver Information Date Updated
Doctor
Comments
Client Demographic Information
Birth Date 06041940 Race W
Owner ID Ethnicity O
Most Recent Income Information
Ind Mon Inc Cpl Mon Inc
Ind Assets Couple Assets
Most Recent Assessment Information
Asmt Date Ref Risk Lvl
Asmt Site Spec Shel
AsmtType Spec Reg
Ref Date Primary CG
Ref Source Living Sit
Enrollment Information
Sex
Marital Status
F
S
Medicaid Number
ADL Score
ADL Count
IADL Score
IADL Count
Memory Score
Priority Score
Env Score
Nutr Score
Risk Score
Social Score
Rank
Provider Location Program Program Status Worker Start Date End Date
Care Plan Service Needed
Date Service Units Type Frq End Date
Care Plan Service Planned
Program Service Units Type Frq Start Date End Date
Services Received between 01012017 and 12312017
Service Billed Provider Location Worker Program Service Date Units Unit Type Amount
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Provider N
Client Service Units Report PSA ALL Provider ALL PROVIDERS Location 0000
Program ALL PROGRAMS Service ALL SERVICES Worker ALL WORKERS
City ALL CITIES Include Zero Unit N Include Aggregate N Calculated Amount equals the number of Units Provided times Fixed Cost if it existsService Start Date 01012017 Service End Date 12312017 If Fixed Cost does not exist Calculated
Group by PSA Provider Location Client Name County Worker Amount equals Billed Amount
Unduplicated Client Count 0 Grand Total 000 $000
Report run on 08312018 0234 PM Page 1 of 1 clnt_serv_unitsrdf
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Clients In Common PSA All Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 County All Counties Worker All Workers
County JEFFERSON
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
MIAMI-DADE
0 0 0 0 0 0 0 0 0
4061539538 Test NameCounty Count
County
0 01
X
0 1
X
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
4061650856 Test Name X 4061486560 Test Name X 4062452921 Test Name X
Report run on 08312018 1148 AM clients_commonrdfPage 1 of 4 Report run by RSHQALL Dispose of this Report so that it can not be read or reconstructed
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Clients Served Not Enrolled PSA ALL Start Date 01012017 End Date 12312017 Locations 0000 Provider All Providers
Service Service Min Serv Max Serv Program Start End Enrollment PSA Provider Location Program Consumer Name Client ID Service Date Date Status Enrollment Enrollment Provider
Count 0
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
4061472791 04
09
1092
1291
0072
0042
LTCC
LTCC
APCL
APCL
4062714543 06
06
1514
1762
0072
5006
LTCC
LTCC
APCL
APPL
4061802246 11
06
1177
1514
0179
0072
LTCC
LTCC
APCL
APCL
4061563719 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062644312 06
08
1514
1771
0072
0896
LTCC
LTCC
APCL
APCL
1001141670 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
1001141671 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
4062375003 07
05
05
07
1263
1755
1638
1263
0368
0072
0072
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062155124 06
06
1762
1514
0072
0072
LTCC
LTCC
APPL
APCL
4061743886 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0369
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4061499927 06
06
1514
1762
0072
5005
LTCC
LTCC
APCL
APPL
4061583524 08
06
1144
1514
0896
0072
LTCC
LTCC
APCL
APCL
4062694843 06
03
1514
1922
0072
0179
LTCC
LTCC
APCL
APCL
4062744517 07
06
1263
1514
0369
0072
LTCC
LTCC
APCL
APCL
4062005488 10
11
10
11
1929
1177
1164
1177
0072
0073
0179
0179
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
Total Count 15
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CODE DESCRIPTIONS Category ALL STATE TABLES
Code Description Active Available To Code Category
0 UNKNOWN Y CARES SUBJECTIVE_HEALTH_EVALUATION
01 ALACHUA Y COMMON COUNTIES
02 BAKER Y COMMON COUNTIES
03 BAY Y COMMON COUNTIES
04 BRADFORD Y COMMON COUNTIES
05 BREVARD Y COMMON COUNTIES
06 BROWARD Y COMMON COUNTIES
07 CALHOUN Y COMMON COUNTIES
08 CHARLOTTE Y COMMON COUNTIES
09 CITRUS Y COMMON COUNTIES
1 EXCELLENT Y CARES SUBJECTIVE_HEALTH_EVALUATION
10 CLAY Y COMMON COUNTIES
11 COLLIER Y COMMON COUNTIES
12 COLUMBIA Y COMMON COUNTIES
13 MIAMI-DADE Y COMMON COUNTIES
14 DESOTO Y COMMON COUNTIES
15 DIXIE Y COMMON COUNTIES
16 DUVAL Y COMMON COUNTIES
17 ESCAMBIA Y COMMON COUNTIES
18 FLAGLER Y COMMON COUNTIES
19 FRANKLIN Y COMMON COUNTIES
2 GOOD Y CARES SUBJECTIVE_HEALTH_EVALUATION
20 GADSDEN Y COMMON COUNTIES
21 GILCHRIST Y COMMON COUNTIES
22 GLADES Y COMMON COUNTIES
23 GULF Y COMMON COUNTIES
24 HAMILTON Y COMMON COUNTIES
25 HARDEE Y COMMON COUNTIES
26 HENDRY Y COMMON COUNTIES
27 HERNANDO Y COMMON COUNTIES
28 HIGHLANDS Y COMMON COUNTIES
Report run on 08312018 0140 PM Page 1 of 45 state_codesrdf Report run by RSHQALL Dispose of this report so that it cannot be read or reconstructed
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CONSUMER AGE VERIFICATION REPORT PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Program AC
Age at Start
Enroll or Start Enroll Provider Program Description Consumer Name Client ID DOB Svc date or Svc Date
Report run on 08312018 0203 PM Page 1 of 1 age_verifyrdf
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Contract Budget Information PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Program Service Provider Location County Served Provider Contract
Projected Service
Units Unit Measure
Projected Unduplicated
State Federal Share Client Count Begin Date End Date
Row Count 0 Amount Total
Report run on 08312018 0233 PM Page 1 of 1 contract_budgetrdf
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Start Enroll Latest Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Date Asmt Date Worker
O3C1 1036 000 4061653427 Test CENTRAL 34982 W M 07091930 09102013 09102013 CIRTS20804 0 Name
Report run on 08312018 1133 AM Page 1 of 6 actv_by_progrdf
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Start Enroll Date
Latest Asmt Date Worker
4061593624 Test Name CENTRAL 34946 B F 11261940 12012011 12312013 CIRTS23407
Count 164
Unduplicated Client Count 163
Report run on 08312018 1133 AM Page 6 of 6 actv_by_progrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Assessments After DOD Report
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Owner 1025
The shaded records indicate clients who have different DOBs andor different names
Assemt Current PSA Owner Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Owner Assessor
Provider Assessor
Assemt Date
Assemt Type
Unduplicated Count Total 0
Report run on 08312018 0206 PM Page 1 of 1 vs_assmrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Open Enrollments
The Vital Statistics Data for 07192002 - 09112014PSA ALL Provider ALL Program Status ACTV Include MLTC ACTVS N
The shaded records indicate clients who have different DOBs andor different names
Enroll PSA
Enrollment Provider Loc Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Enroll Program Status
Enroll Program
Current Owner ID
02 1065 0072 4062244026 Test Name Test Name 10222004 03231917 03231917 ACTV CCE 1065
Count of enrollments for the Provider 1
Count of enrollments for the PSA 1
Count of enrollments for the Report 1
Unduplicated Count of Individuals with open enrollments and DOD PSA Total Clients Count
02 1
Total 1
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Report run on 08312018 0207 PM Page 1 of 3 vs_servicesrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Unduplicated count of individuals with Services after DOD
PSA Total Clients Count
Report Total
Report run on 08312018 0207 PM Page 2 of 3 vs_servicesrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
List of Clients with PSA table entry for SERVICES_AFTER_DOD
Unduplicated Count Total 0
Report run on 08312018 0207 PM Page 3 of 3 vs_servicesrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Age
Provider
Total
Age lt 60 Age 60 - 64 Age 65 - 74 Age 75 - 84 Age 85+ Total Clients Avg Age
Total
Avg Age
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Ethnicity
Provider Hispanic Other Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Race
American Indian Native Hawaiian Other Provider Asian Alaska Native Black Pacific Islander Minority White Multiple Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Gender
Provider Male Female Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Monthly Income
Provider 0 - - Higher than Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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None
Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Total Persons Served 0
Age lt 60 Years 0 0
Age 60 - 64 0 0
Age 65 - 74 0 0
Age 75 - 84 0 0
Age 85+ 0 0
Total Age 0 0
Average 000
Ethnicity Hispanic 0 0
Other Ethnicity 0 0
Unknown Ethnicity 0 0
Total 0 0
Race Asian 0 0
American Indian Alaska Native 0 0
Black 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority 0 0
White 0 0
Multiple 0 0
Unknown 0 0
Total 0 0
Sex Male 0 0
Female 0 0
Unknown Sex 0 0
Total 0 0
Monthly Income 0 - 0 0
- 0 0
Higher than 0 0
Unknown 0 0
Total 0 0
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Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Client ID Date Of Birth Ethnicity Race Sex Individual Monthly Income
Report run on 08312018 1058 AM Page 2 of 2 demo_by_prov_detrdf Report run byRSHQALL Dispose of this report so that it can not be read or reconstructed
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Demographics of Clients OAA Registered Served Only PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 City All Cities Program All Programs Service All Services County ALL COUNTIES Table OAA Registered Services Only Low Income Medium Income
Total Persons Served 0
Agelt 60 Years
Age 60 - 64
Age 65 - 74
Age 75 - 84
Age 85+
0
0
0
0
0
0
0
0
0
0
Monthly Income
0 -
-Higher than
Unknown
0
0
0
0
0
0
0
0
Total
Average
0
000
0 Total 0 0
Ethnicity Hispanic
Other
Unknown
0
0
0
0
0
0
Living Situation
Alone
Null
Policy Change
0
0
0
0
0
0
Total 0 0 Unknown
With Caregiver
0
0
0
0
Race Asian 0 0
With Other
With Other Caregiver
0
0
0
0
American Indian Alaska Native
Black
0
0
0
0Total Living Situation 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority
White
0
0
0
0 Limited English Proficiency
Multiple
Unknown
Total Race
0
0
0
0
0
0
Yes
No
Unknown
0
0
0
0
0
0
Total 0 0
Sex Male
Female
Unknown
0
0
0
0
0
0
Total 0 0
Report run on 08312018 1056 AM Page 1 of 1 demo_by_provrdf
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Disaster Assistance Clients for a Provider PSA ALL Provider All Providers Location 0000 Worker All Workers City All Cities Zip Code All Zip Codes Sort By ZIP
Provider 1036 Provider Name Location 0000 Worker CIRTS18634
Need Care Client Name Address City Zip County Phone Asst Reg Situation Relat Care phone Care Name
34946 N WO DA 000 SAINT JAMES DRIVE CENTRAL (025) 101-0620 Test NameTest Name SAINT LUCIE (005) 100-0369 Y
Client is active and no assessment information is available Special Shelter and Special Registry are unknown
Report run on 08312018 1102 AM Page 1 of 8 disaster_by_provrdf
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
Total by PSA 0
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
ALACH BAKER BAY BRADF BREVA BROWA CALHO CHARL CITRUS CLAY COLLIE COLUM DESOT DIXIE DUVAL ESCAM FLAGL FRANK GADSDAssisted Household Report UA ORD RD RD UN OTTE R BIA O BIA ER LIN EN
1 of Household Assisted 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Households AssistedWith Gross Income
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C 100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D 125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
3 Households with at leastOne member
A 60 Years or older 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B Disabled 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C Age 5 years or under 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D Under 60 Years Old 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Undup Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Assisted
Applicant Household Report
of Applicant Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
Report run on 08312018 1111 AM Page 2 of 5 eheap_exceptionsrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Energy Assisted Household Report
County of Assisted
Households
Households Assisted By Poverty Level
Under 75 75 - 100 101 - 125 126 - 150 Over 150 60 Years or older
At least one member who is
Age 5 years Age 2 years Age 3 years Disabled or younger and younger through 5
Under 60 Years Old
Undup Households
Assisted
Energy Assistance Total
Report run on 08312018 1107 AM Page 1 of 3 eheap_summaryrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Unduplicated Total 0 0
County of Assisted
Households Under 75 75 - 100
Households Assisted By Poverty Level
101 - 125 126 - 150 Over 150 60 Years or older Disabled
Age 5 years or younger
Age 2 years and younger
Age 3 years through 5
Under 60 Years Old
At least one member who is
Undup Households
Assisted
Other Assisted Household Report
Other Assistance Total
Report run on 08312018 1107 AM Page 2 of 3 eheap_summaryrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Applicant Household Report
County of Applicant
Households Under 75 75 - 100 101 - 125 126 - 150 Over 150 Income data
unavailable
Total 0
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01
Enrollment Active Consumer Count by Program PSA ALL Provider ALL PROVIDERS
County Description Program Count of Clients
BREVARD
ADI
CCE
HCE
LSP
NDP
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
MLTC
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
31
57
44
5
62
123
141
26
9
7
5
40
5
50
67
129
2
19
42
29
1
233
79
63
8
2
14
3
37
14
47
3
3
33
127
10
02
03
04
ALACHUA
BAKER
BAY
BRADFORD
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Enrollment Terminations with Reasons PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 Program All Programs Program Status ALL Program Status Worker ALL WORKERS
Last First Program Medicaid Provider Start End Name Name Client ID Status Description Worker Number Program Location Enrollment Enrollment
Count 0
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Enrollments with Care Plan Report
PSA ALL Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTIVE STATUS Care Plan Service ALL SERVICES Care Plan Start 01012017 Care Plan End 12312017
Care Plan Care Plan Care Plan Client Name
Unduplicated Client Count 0
Client ID Program Status Worker Start Date End Date Service
Report run on 08312018 1054 AM Page 1 of 1 enroll_careplrdf Report run by RSHQALL Dispose of this report so that it cannot be read or reconstructed
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PSA CLIENT_ID CLIENT_NAME OWNER PROVIDER_ID ASSESSMENT_DATE ASSESSOR_NAME MEDICAID_NUMBER CAREGIVER_CHANGE ENVIRONMENT_CHANGE HEALTH_CHANGE INCOME_CHANGE SITUATION_CHANGE INITIAL_ASSM ANNUAL_ASSM SSN REFERRAL_SOURCE 1114 N N N N Y N 771771777 SELFFAMILY 812017 JANE CASEWORKER 2 1001141633 TEST TEST N
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Fixed Service Costs List PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Provider Location County Program Service Reimbursement Unit Rate Provider Cost Per Unit Begin Valid End Valid
Count 0
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CIE Service Units and Costs Projections - PSA Summary
PSA ALL Program CCE
Start Date 01012017 End Date 12312017
Avg High Low Total Total Avg High Low Provider Provider Provider
StateFederal Projected Reimbursement Reimbursement Reimbursement Cost Cost CostPSA
02
Service
CASE MANAGEMENT
Share
$4351066
Service Units
966
Unit Rate Unit Rate Unit Rate Per Unit Per Unit Per Unit
EMERGENCY HOME DELIVERED SHELF MEALS $1842200 1378
HOME DELIVERED MEALS $530262 993
MATERIAL AID $3989071 398
PSA Total $10712599 3735
05 ADULT DAY CARE $000 0 $900 $900 $900 $1000 $1000 $1000
COUNSELING (MENTAL HEALTH $000 0 $6600 $6600 $6600 $7700 $7700 $7700 COUNSELINGSCREENING) - INDIVIDUAL
PSA Total $000 0
Report Total $10712599 3735
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CAREGIVER SEARCH REPORT
SEARCH RESULTS FOR CONSUMERS
Criteria First Name Last Name SSN PSA ALL
Client Name Client SSN Caregiver Name Caregiver SSN
000000000 000000000 Test Name Test Name
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CARES Referrals in a Time Range PSA ALL
Start Date 01012017 End Date 12312017
Referred to ALL REFERRALS
Referring PSA Employee Name Client Name Client ID
Referral Imminent NH Admit Aging Date Risk Date Referred To Cares Provider Name Received Date
03A 4061561263 Test Name Test Name 09242017 Y 05292017 ARC or ADRC 09252017
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CARES Referrals in a Time Range PSA ALL
Start Date 01012017 End Date 12312017
Referred to ALL REFERRALS
Referring PSA Employee Name Client Name Client ID
Referral Date
Imminent Risk
NH Admit Date Referred To Cares Provider Name
Aging Received Date
04B Test Name Test Name 4061738075 04082017 N ARC or ADRC Test Name 04082017
Total Clients 110
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CARES Referrals not acknowledged by the Aging Network PSA ALL For Referrals after 01012017 Owner ID ALL Owners
Unduplicated Client count Cares Office Total Clients Count
Report Total
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
CIRTS Issue PSA Client ID Client Name Program
Program Status Start Provider Enrollment ID Provider Name
APCL CLIENT WITH DATE OF DEATH 08 4061759417 Test Name OA3B APCL 07232013 1141 WESTERN WORLD RADIO
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
Program Start Provider CIRTS Issue PSA Client ID Client Name Program Status Enrollment ID Provider Name
06 LTCC APCL 01242014 1514 4061713685 Test Name APCL CLIENT WITH DATE OF DEATH CENTRAL THE ORIGINAL HOUSE OF PIES
Count 503
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Civil Rights PSA ALL Provider ALL PROVIDERS Program AC Start Date 01012017 End Date 12312017 The Poverty Level for Single is The Poverty Level for Couple is Sort by County
County Unduplicated Count
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Client Information Report Start Date 01012017 End Date 12312017
Client ID 1001141246
Emergency
Client Name Test Name
Telephone () - Address 78 TEST STREET TALLAHASSEE FL 32399
Most Recent Caregiver Information Date Updated
Doctor
Comments
Client Demographic Information
Birth Date 06041940 Race W
Owner ID Ethnicity O
Most Recent Income Information
Ind Mon Inc Cpl Mon Inc
Ind Assets Couple Assets
Most Recent Assessment Information
Asmt Date Ref Risk Lvl
Asmt Site Spec Shel
AsmtType Spec Reg
Ref Date Primary CG
Ref Source Living Sit
Enrollment Information
Sex
Marital Status
F
S
Medicaid Number
ADL Score
ADL Count
IADL Score
IADL Count
Memory Score
Priority Score
Env Score
Nutr Score
Risk Score
Social Score
Rank
Provider Location Program Program Status Worker Start Date End Date
Care Plan Service Needed
Date Service Units Type Frq End Date
Care Plan Service Planned
Program Service Units Type Frq Start Date End Date
Services Received between 01012017 and 12312017
Service Billed Provider Location Worker Program Service Date Units Unit Type Amount
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Provider N
Client Service Units Report PSA ALL Provider ALL PROVIDERS Location 0000
Program ALL PROGRAMS Service ALL SERVICES Worker ALL WORKERS
City ALL CITIES Include Zero Unit N Include Aggregate N Calculated Amount equals the number of Units Provided times Fixed Cost if it existsService Start Date 01012017 Service End Date 12312017 If Fixed Cost does not exist Calculated
Group by PSA Provider Location Client Name County Worker Amount equals Billed Amount
Unduplicated Client Count 0 Grand Total 000 $000
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Clients In Common PSA All Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 County All Counties Worker All Workers
County JEFFERSON
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
MIAMI-DADE
0 0 0 0 0 0 0 0 0
4061539538 Test NameCounty Count
County
0 01
X
0 1
X
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
4061650856 Test Name X 4061486560 Test Name X 4062452921 Test Name X
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Clients Served Not Enrolled PSA ALL Start Date 01012017 End Date 12312017 Locations 0000 Provider All Providers
Service Service Min Serv Max Serv Program Start End Enrollment PSA Provider Location Program Consumer Name Client ID Service Date Date Status Enrollment Enrollment Provider
Count 0
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
4061472791 04
09
1092
1291
0072
0042
LTCC
LTCC
APCL
APCL
4062714543 06
06
1514
1762
0072
5006
LTCC
LTCC
APCL
APPL
4061802246 11
06
1177
1514
0179
0072
LTCC
LTCC
APCL
APCL
4061563719 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062644312 06
08
1514
1771
0072
0896
LTCC
LTCC
APCL
APCL
1001141670 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
1001141671 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
4062375003 07
05
05
07
1263
1755
1638
1263
0368
0072
0072
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062155124 06
06
1762
1514
0072
0072
LTCC
LTCC
APPL
APCL
4061743886 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0369
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4061499927 06
06
1514
1762
0072
5005
LTCC
LTCC
APCL
APPL
4061583524 08
06
1144
1514
0896
0072
LTCC
LTCC
APCL
APCL
4062694843 06
03
1514
1922
0072
0179
LTCC
LTCC
APCL
APCL
4062744517 07
06
1263
1514
0369
0072
LTCC
LTCC
APCL
APCL
4062005488 10
11
10
11
1929
1177
1164
1177
0072
0073
0179
0179
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
Total Count 15
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CODE DESCRIPTIONS Category ALL STATE TABLES
Code Description Active Available To Code Category
0 UNKNOWN Y CARES SUBJECTIVE_HEALTH_EVALUATION
01 ALACHUA Y COMMON COUNTIES
02 BAKER Y COMMON COUNTIES
03 BAY Y COMMON COUNTIES
04 BRADFORD Y COMMON COUNTIES
05 BREVARD Y COMMON COUNTIES
06 BROWARD Y COMMON COUNTIES
07 CALHOUN Y COMMON COUNTIES
08 CHARLOTTE Y COMMON COUNTIES
09 CITRUS Y COMMON COUNTIES
1 EXCELLENT Y CARES SUBJECTIVE_HEALTH_EVALUATION
10 CLAY Y COMMON COUNTIES
11 COLLIER Y COMMON COUNTIES
12 COLUMBIA Y COMMON COUNTIES
13 MIAMI-DADE Y COMMON COUNTIES
14 DESOTO Y COMMON COUNTIES
15 DIXIE Y COMMON COUNTIES
16 DUVAL Y COMMON COUNTIES
17 ESCAMBIA Y COMMON COUNTIES
18 FLAGLER Y COMMON COUNTIES
19 FRANKLIN Y COMMON COUNTIES
2 GOOD Y CARES SUBJECTIVE_HEALTH_EVALUATION
20 GADSDEN Y COMMON COUNTIES
21 GILCHRIST Y COMMON COUNTIES
22 GLADES Y COMMON COUNTIES
23 GULF Y COMMON COUNTIES
24 HAMILTON Y COMMON COUNTIES
25 HARDEE Y COMMON COUNTIES
26 HENDRY Y COMMON COUNTIES
27 HERNANDO Y COMMON COUNTIES
28 HIGHLANDS Y COMMON COUNTIES
Report run on 08312018 0140 PM Page 1 of 45 state_codesrdf Report run by RSHQALL Dispose of this report so that it cannot be read or reconstructed
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CONSUMER AGE VERIFICATION REPORT PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Program AC
Age at Start
Enroll or Start Enroll Provider Program Description Consumer Name Client ID DOB Svc date or Svc Date
Report run on 08312018 0203 PM Page 1 of 1 age_verifyrdf
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Contract Budget Information PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Program Service Provider Location County Served Provider Contract
Projected Service
Units Unit Measure
Projected Unduplicated
State Federal Share Client Count Begin Date End Date
Row Count 0 Amount Total
Report run on 08312018 0233 PM Page 1 of 1 contract_budgetrdf
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Start Enroll Latest Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Date Asmt Date Worker
O3C1 1036 000 4061653427 Test CENTRAL 34982 W M 07091930 09102013 09102013 CIRTS20804 0 Name
Report run on 08312018 1133 AM Page 1 of 6 actv_by_progrdf
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Start Enroll Date
Latest Asmt Date Worker
4061593624 Test Name CENTRAL 34946 B F 11261940 12012011 12312013 CIRTS23407
Count 164
Unduplicated Client Count 163
Report run on 08312018 1133 AM Page 6 of 6 actv_by_progrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Assessments After DOD Report
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Owner 1025
The shaded records indicate clients who have different DOBs andor different names
Assemt Current PSA Owner Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Owner Assessor
Provider Assessor
Assemt Date
Assemt Type
Unduplicated Count Total 0
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Open Enrollments
The Vital Statistics Data for 07192002 - 09112014PSA ALL Provider ALL Program Status ACTV Include MLTC ACTVS N
The shaded records indicate clients who have different DOBs andor different names
Enroll PSA
Enrollment Provider Loc Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Enroll Program Status
Enroll Program
Current Owner ID
02 1065 0072 4062244026 Test Name Test Name 10222004 03231917 03231917 ACTV CCE 1065
Count of enrollments for the Provider 1
Count of enrollments for the PSA 1
Count of enrollments for the Report 1
Unduplicated Count of Individuals with open enrollments and DOD PSA Total Clients Count
02 1
Total 1
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Report run on 08312018 0207 PM Page 1 of 3 vs_servicesrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Unduplicated count of individuals with Services after DOD
PSA Total Clients Count
Report Total
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
List of Clients with PSA table entry for SERVICES_AFTER_DOD
Unduplicated Count Total 0
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Age
Provider
Total
Age lt 60 Age 60 - 64 Age 65 - 74 Age 75 - 84 Age 85+ Total Clients Avg Age
Total
Avg Age
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Ethnicity
Provider Hispanic Other Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Race
American Indian Native Hawaiian Other Provider Asian Alaska Native Black Pacific Islander Minority White Multiple Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Gender
Provider Male Female Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Monthly Income
Provider 0 - - Higher than Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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None
Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Total Persons Served 0
Age lt 60 Years 0 0
Age 60 - 64 0 0
Age 65 - 74 0 0
Age 75 - 84 0 0
Age 85+ 0 0
Total Age 0 0
Average 000
Ethnicity Hispanic 0 0
Other Ethnicity 0 0
Unknown Ethnicity 0 0
Total 0 0
Race Asian 0 0
American Indian Alaska Native 0 0
Black 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority 0 0
White 0 0
Multiple 0 0
Unknown 0 0
Total 0 0
Sex Male 0 0
Female 0 0
Unknown Sex 0 0
Total 0 0
Monthly Income 0 - 0 0
- 0 0
Higher than 0 0
Unknown 0 0
Total 0 0
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Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Client ID Date Of Birth Ethnicity Race Sex Individual Monthly Income
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Demographics of Clients OAA Registered Served Only PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 City All Cities Program All Programs Service All Services County ALL COUNTIES Table OAA Registered Services Only Low Income Medium Income
Total Persons Served 0
Agelt 60 Years
Age 60 - 64
Age 65 - 74
Age 75 - 84
Age 85+
0
0
0
0
0
0
0
0
0
0
Monthly Income
0 -
-Higher than
Unknown
0
0
0
0
0
0
0
0
Total
Average
0
000
0 Total 0 0
Ethnicity Hispanic
Other
Unknown
0
0
0
0
0
0
Living Situation
Alone
Null
Policy Change
0
0
0
0
0
0
Total 0 0 Unknown
With Caregiver
0
0
0
0
Race Asian 0 0
With Other
With Other Caregiver
0
0
0
0
American Indian Alaska Native
Black
0
0
0
0Total Living Situation 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority
White
0
0
0
0 Limited English Proficiency
Multiple
Unknown
Total Race
0
0
0
0
0
0
Yes
No
Unknown
0
0
0
0
0
0
Total 0 0
Sex Male
Female
Unknown
0
0
0
0
0
0
Total 0 0
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Disaster Assistance Clients for a Provider PSA ALL Provider All Providers Location 0000 Worker All Workers City All Cities Zip Code All Zip Codes Sort By ZIP
Provider 1036 Provider Name Location 0000 Worker CIRTS18634
Need Care Client Name Address City Zip County Phone Asst Reg Situation Relat Care phone Care Name
34946 N WO DA 000 SAINT JAMES DRIVE CENTRAL (025) 101-0620 Test NameTest Name SAINT LUCIE (005) 100-0369 Y
Client is active and no assessment information is available Special Shelter and Special Registry are unknown
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
Total by PSA 0
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
ALACH BAKER BAY BRADF BREVA BROWA CALHO CHARL CITRUS CLAY COLLIE COLUM DESOT DIXIE DUVAL ESCAM FLAGL FRANK GADSDAssisted Household Report UA ORD RD RD UN OTTE R BIA O BIA ER LIN EN
1 of Household Assisted 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Households AssistedWith Gross Income
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C 100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D 125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
3 Households with at leastOne member
A 60 Years or older 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B Disabled 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C Age 5 years or under 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D Under 60 Years Old 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Undup Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Assisted
Applicant Household Report
of Applicant Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
Report run on 08312018 1111 AM Page 2 of 5 eheap_exceptionsrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Energy Assisted Household Report
County of Assisted
Households
Households Assisted By Poverty Level
Under 75 75 - 100 101 - 125 126 - 150 Over 150 60 Years or older
At least one member who is
Age 5 years Age 2 years Age 3 years Disabled or younger and younger through 5
Under 60 Years Old
Undup Households
Assisted
Energy Assistance Total
Report run on 08312018 1107 AM Page 1 of 3 eheap_summaryrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Unduplicated Total 0 0
County of Assisted
Households Under 75 75 - 100
Households Assisted By Poverty Level
101 - 125 126 - 150 Over 150 60 Years or older Disabled
Age 5 years or younger
Age 2 years and younger
Age 3 years through 5
Under 60 Years Old
At least one member who is
Undup Households
Assisted
Other Assisted Household Report
Other Assistance Total
Report run on 08312018 1107 AM Page 2 of 3 eheap_summaryrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Applicant Household Report
County of Applicant
Households Under 75 75 - 100 101 - 125 126 - 150 Over 150 Income data
unavailable
Total 0
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01
Enrollment Active Consumer Count by Program PSA ALL Provider ALL PROVIDERS
County Description Program Count of Clients
BREVARD
ADI
CCE
HCE
LSP
NDP
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
MLTC
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
31
57
44
5
62
123
141
26
9
7
5
40
5
50
67
129
2
19
42
29
1
233
79
63
8
2
14
3
37
14
47
3
3
33
127
10
02
03
04
ALACHUA
BAKER
BAY
BRADFORD
Report run on 08312018 1148 AM Page 1 of 18 actv_countrdf
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Enrollment Terminations with Reasons PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 Program All Programs Program Status ALL Program Status Worker ALL WORKERS
Last First Program Medicaid Provider Start End Name Name Client ID Status Description Worker Number Program Location Enrollment Enrollment
Count 0
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Enrollments with Care Plan Report
PSA ALL Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTIVE STATUS Care Plan Service ALL SERVICES Care Plan Start 01012017 Care Plan End 12312017
Care Plan Care Plan Care Plan Client Name
Unduplicated Client Count 0
Client ID Program Status Worker Start Date End Date Service
Report run on 08312018 1054 AM Page 1 of 1 enroll_careplrdf Report run by RSHQALL Dispose of this report so that it cannot be read or reconstructed
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PSA CLIENT_ID CLIENT_NAME OWNER PROVIDER_ID ASSESSMENT_DATE ASSESSOR_NAME MEDICAID_NUMBER CAREGIVER_CHANGE ENVIRONMENT_CHANGE HEALTH_CHANGE INCOME_CHANGE SITUATION_CHANGE INITIAL_ASSM ANNUAL_ASSM SSN REFERRAL_SOURCE 1114 N N N N Y N 771771777 SELFFAMILY 812017 JANE CASEWORKER 2 1001141633 TEST TEST N
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Fixed Service Costs List PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Provider Location County Program Service Reimbursement Unit Rate Provider Cost Per Unit Begin Valid End Valid
Count 0
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CAREGIVER SEARCH REPORT
SEARCH RESULTS FOR CONSUMERS
Criteria First Name Last Name SSN PSA ALL
Client Name Client SSN Caregiver Name Caregiver SSN
000000000 000000000 Test Name Test Name
Report run on 08312018 1050 AM Page 1 of 4074 cg_searchrdf
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CARES Referrals in a Time Range PSA ALL
Start Date 01012017 End Date 12312017
Referred to ALL REFERRALS
Referring PSA Employee Name Client Name Client ID
Referral Imminent NH Admit Aging Date Risk Date Referred To Cares Provider Name Received Date
03A 4061561263 Test Name Test Name 09242017 Y 05292017 ARC or ADRC 09252017
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CARES Referrals in a Time Range PSA ALL
Start Date 01012017 End Date 12312017
Referred to ALL REFERRALS
Referring PSA Employee Name Client Name Client ID
Referral Date
Imminent Risk
NH Admit Date Referred To Cares Provider Name
Aging Received Date
04B Test Name Test Name 4061738075 04082017 N ARC or ADRC Test Name 04082017
Total Clients 110
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CARES Referrals not acknowledged by the Aging Network PSA ALL For Referrals after 01012017 Owner ID ALL Owners
Unduplicated Client count Cares Office Total Clients Count
Report Total
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
CIRTS Issue PSA Client ID Client Name Program
Program Status Start Provider Enrollment ID Provider Name
APCL CLIENT WITH DATE OF DEATH 08 4061759417 Test Name OA3B APCL 07232013 1141 WESTERN WORLD RADIO
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
Program Start Provider CIRTS Issue PSA Client ID Client Name Program Status Enrollment ID Provider Name
06 LTCC APCL 01242014 1514 4061713685 Test Name APCL CLIENT WITH DATE OF DEATH CENTRAL THE ORIGINAL HOUSE OF PIES
Count 503
Report run on 08312018 0224 PM Page 22 of 22 data_cleanuprdf Report run by RSHQALL Dispose of this report so that it can not be read or reconstructed
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Civil Rights PSA ALL Provider ALL PROVIDERS Program AC Start Date 01012017 End Date 12312017 The Poverty Level for Single is The Poverty Level for Couple is Sort by County
County Unduplicated Count
Report run on 08312018 1055 AM Page 1 of 1 civil_rightsrdf
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Client Information Report Start Date 01012017 End Date 12312017
Client ID 1001141246
Emergency
Client Name Test Name
Telephone () - Address 78 TEST STREET TALLAHASSEE FL 32399
Most Recent Caregiver Information Date Updated
Doctor
Comments
Client Demographic Information
Birth Date 06041940 Race W
Owner ID Ethnicity O
Most Recent Income Information
Ind Mon Inc Cpl Mon Inc
Ind Assets Couple Assets
Most Recent Assessment Information
Asmt Date Ref Risk Lvl
Asmt Site Spec Shel
AsmtType Spec Reg
Ref Date Primary CG
Ref Source Living Sit
Enrollment Information
Sex
Marital Status
F
S
Medicaid Number
ADL Score
ADL Count
IADL Score
IADL Count
Memory Score
Priority Score
Env Score
Nutr Score
Risk Score
Social Score
Rank
Provider Location Program Program Status Worker Start Date End Date
Care Plan Service Needed
Date Service Units Type Frq End Date
Care Plan Service Planned
Program Service Units Type Frq Start Date End Date
Services Received between 01012017 and 12312017
Service Billed Provider Location Worker Program Service Date Units Unit Type Amount
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Provider N
Client Service Units Report PSA ALL Provider ALL PROVIDERS Location 0000
Program ALL PROGRAMS Service ALL SERVICES Worker ALL WORKERS
City ALL CITIES Include Zero Unit N Include Aggregate N Calculated Amount equals the number of Units Provided times Fixed Cost if it existsService Start Date 01012017 Service End Date 12312017 If Fixed Cost does not exist Calculated
Group by PSA Provider Location Client Name County Worker Amount equals Billed Amount
Unduplicated Client Count 0 Grand Total 000 $000
Report run on 08312018 0234 PM Page 1 of 1 clnt_serv_unitsrdf
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Clients In Common PSA All Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 County All Counties Worker All Workers
County JEFFERSON
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
MIAMI-DADE
0 0 0 0 0 0 0 0 0
4061539538 Test NameCounty Count
County
0 01
X
0 1
X
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
4061650856 Test Name X 4061486560 Test Name X 4062452921 Test Name X
Report run on 08312018 1148 AM clients_commonrdfPage 1 of 4 Report run by RSHQALL Dispose of this Report so that it can not be read or reconstructed
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Clients Served Not Enrolled PSA ALL Start Date 01012017 End Date 12312017 Locations 0000 Provider All Providers
Service Service Min Serv Max Serv Program Start End Enrollment PSA Provider Location Program Consumer Name Client ID Service Date Date Status Enrollment Enrollment Provider
Count 0
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
4061472791 04
09
1092
1291
0072
0042
LTCC
LTCC
APCL
APCL
4062714543 06
06
1514
1762
0072
5006
LTCC
LTCC
APCL
APPL
4061802246 11
06
1177
1514
0179
0072
LTCC
LTCC
APCL
APCL
4061563719 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062644312 06
08
1514
1771
0072
0896
LTCC
LTCC
APCL
APCL
1001141670 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
1001141671 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
4062375003 07
05
05
07
1263
1755
1638
1263
0368
0072
0072
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062155124 06
06
1762
1514
0072
0072
LTCC
LTCC
APPL
APCL
4061743886 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0369
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4061499927 06
06
1514
1762
0072
5005
LTCC
LTCC
APCL
APPL
4061583524 08
06
1144
1514
0896
0072
LTCC
LTCC
APCL
APCL
4062694843 06
03
1514
1922
0072
0179
LTCC
LTCC
APCL
APCL
4062744517 07
06
1263
1514
0369
0072
LTCC
LTCC
APCL
APCL
4062005488 10
11
10
11
1929
1177
1164
1177
0072
0073
0179
0179
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
Total Count 15
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CODE DESCRIPTIONS Category ALL STATE TABLES
Code Description Active Available To Code Category
0 UNKNOWN Y CARES SUBJECTIVE_HEALTH_EVALUATION
01 ALACHUA Y COMMON COUNTIES
02 BAKER Y COMMON COUNTIES
03 BAY Y COMMON COUNTIES
04 BRADFORD Y COMMON COUNTIES
05 BREVARD Y COMMON COUNTIES
06 BROWARD Y COMMON COUNTIES
07 CALHOUN Y COMMON COUNTIES
08 CHARLOTTE Y COMMON COUNTIES
09 CITRUS Y COMMON COUNTIES
1 EXCELLENT Y CARES SUBJECTIVE_HEALTH_EVALUATION
10 CLAY Y COMMON COUNTIES
11 COLLIER Y COMMON COUNTIES
12 COLUMBIA Y COMMON COUNTIES
13 MIAMI-DADE Y COMMON COUNTIES
14 DESOTO Y COMMON COUNTIES
15 DIXIE Y COMMON COUNTIES
16 DUVAL Y COMMON COUNTIES
17 ESCAMBIA Y COMMON COUNTIES
18 FLAGLER Y COMMON COUNTIES
19 FRANKLIN Y COMMON COUNTIES
2 GOOD Y CARES SUBJECTIVE_HEALTH_EVALUATION
20 GADSDEN Y COMMON COUNTIES
21 GILCHRIST Y COMMON COUNTIES
22 GLADES Y COMMON COUNTIES
23 GULF Y COMMON COUNTIES
24 HAMILTON Y COMMON COUNTIES
25 HARDEE Y COMMON COUNTIES
26 HENDRY Y COMMON COUNTIES
27 HERNANDO Y COMMON COUNTIES
28 HIGHLANDS Y COMMON COUNTIES
Report run on 08312018 0140 PM Page 1 of 45 state_codesrdf Report run by RSHQALL Dispose of this report so that it cannot be read or reconstructed
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CONSUMER AGE VERIFICATION REPORT PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Program AC
Age at Start
Enroll or Start Enroll Provider Program Description Consumer Name Client ID DOB Svc date or Svc Date
Report run on 08312018 0203 PM Page 1 of 1 age_verifyrdf
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Contract Budget Information PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Program Service Provider Location County Served Provider Contract
Projected Service
Units Unit Measure
Projected Unduplicated
State Federal Share Client Count Begin Date End Date
Row Count 0 Amount Total
Report run on 08312018 0233 PM Page 1 of 1 contract_budgetrdf
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Start Enroll Latest Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Date Asmt Date Worker
O3C1 1036 000 4061653427 Test CENTRAL 34982 W M 07091930 09102013 09102013 CIRTS20804 0 Name
Report run on 08312018 1133 AM Page 1 of 6 actv_by_progrdf
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Start Enroll Date
Latest Asmt Date Worker
4061593624 Test Name CENTRAL 34946 B F 11261940 12012011 12312013 CIRTS23407
Count 164
Unduplicated Client Count 163
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Assessments After DOD Report
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Owner 1025
The shaded records indicate clients who have different DOBs andor different names
Assemt Current PSA Owner Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Owner Assessor
Provider Assessor
Assemt Date
Assemt Type
Unduplicated Count Total 0
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Open Enrollments
The Vital Statistics Data for 07192002 - 09112014PSA ALL Provider ALL Program Status ACTV Include MLTC ACTVS N
The shaded records indicate clients who have different DOBs andor different names
Enroll PSA
Enrollment Provider Loc Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Enroll Program Status
Enroll Program
Current Owner ID
02 1065 0072 4062244026 Test Name Test Name 10222004 03231917 03231917 ACTV CCE 1065
Count of enrollments for the Provider 1
Count of enrollments for the PSA 1
Count of enrollments for the Report 1
Unduplicated Count of Individuals with open enrollments and DOD PSA Total Clients Count
02 1
Total 1
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Report run on 08312018 0207 PM Page 1 of 3 vs_servicesrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Unduplicated count of individuals with Services after DOD
PSA Total Clients Count
Report Total
Report run on 08312018 0207 PM Page 2 of 3 vs_servicesrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
List of Clients with PSA table entry for SERVICES_AFTER_DOD
Unduplicated Count Total 0
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Age
Provider
Total
Age lt 60 Age 60 - 64 Age 65 - 74 Age 75 - 84 Age 85+ Total Clients Avg Age
Total
Avg Age
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Ethnicity
Provider Hispanic Other Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Race
American Indian Native Hawaiian Other Provider Asian Alaska Native Black Pacific Islander Minority White Multiple Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Gender
Provider Male Female Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Monthly Income
Provider 0 - - Higher than Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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None
Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Total Persons Served 0
Age lt 60 Years 0 0
Age 60 - 64 0 0
Age 65 - 74 0 0
Age 75 - 84 0 0
Age 85+ 0 0
Total Age 0 0
Average 000
Ethnicity Hispanic 0 0
Other Ethnicity 0 0
Unknown Ethnicity 0 0
Total 0 0
Race Asian 0 0
American Indian Alaska Native 0 0
Black 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority 0 0
White 0 0
Multiple 0 0
Unknown 0 0
Total 0 0
Sex Male 0 0
Female 0 0
Unknown Sex 0 0
Total 0 0
Monthly Income 0 - 0 0
- 0 0
Higher than 0 0
Unknown 0 0
Total 0 0
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Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Client ID Date Of Birth Ethnicity Race Sex Individual Monthly Income
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Demographics of Clients OAA Registered Served Only PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 City All Cities Program All Programs Service All Services County ALL COUNTIES Table OAA Registered Services Only Low Income Medium Income
Total Persons Served 0
Agelt 60 Years
Age 60 - 64
Age 65 - 74
Age 75 - 84
Age 85+
0
0
0
0
0
0
0
0
0
0
Monthly Income
0 -
-Higher than
Unknown
0
0
0
0
0
0
0
0
Total
Average
0
000
0 Total 0 0
Ethnicity Hispanic
Other
Unknown
0
0
0
0
0
0
Living Situation
Alone
Null
Policy Change
0
0
0
0
0
0
Total 0 0 Unknown
With Caregiver
0
0
0
0
Race Asian 0 0
With Other
With Other Caregiver
0
0
0
0
American Indian Alaska Native
Black
0
0
0
0Total Living Situation 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority
White
0
0
0
0 Limited English Proficiency
Multiple
Unknown
Total Race
0
0
0
0
0
0
Yes
No
Unknown
0
0
0
0
0
0
Total 0 0
Sex Male
Female
Unknown
0
0
0
0
0
0
Total 0 0
Report run on 08312018 1056 AM Page 1 of 1 demo_by_provrdf
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Disaster Assistance Clients for a Provider PSA ALL Provider All Providers Location 0000 Worker All Workers City All Cities Zip Code All Zip Codes Sort By ZIP
Provider 1036 Provider Name Location 0000 Worker CIRTS18634
Need Care Client Name Address City Zip County Phone Asst Reg Situation Relat Care phone Care Name
34946 N WO DA 000 SAINT JAMES DRIVE CENTRAL (025) 101-0620 Test NameTest Name SAINT LUCIE (005) 100-0369 Y
Client is active and no assessment information is available Special Shelter and Special Registry are unknown
Report run on 08312018 1102 AM Page 1 of 8 disaster_by_provrdf
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
Total by PSA 0
Report run on 08312018 1111 AM Page 1 of 5 eheap_exceptionsrdf
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
ALACH BAKER BAY BRADF BREVA BROWA CALHO CHARL CITRUS CLAY COLLIE COLUM DESOT DIXIE DUVAL ESCAM FLAGL FRANK GADSDAssisted Household Report UA ORD RD RD UN OTTE R BIA O BIA ER LIN EN
1 of Household Assisted 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Households AssistedWith Gross Income
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C 100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D 125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
3 Households with at leastOne member
A 60 Years or older 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B Disabled 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C Age 5 years or under 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D Under 60 Years Old 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Undup Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Assisted
Applicant Household Report
of Applicant Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
Report run on 08312018 1111 AM Page 2 of 5 eheap_exceptionsrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Energy Assisted Household Report
County of Assisted
Households
Households Assisted By Poverty Level
Under 75 75 - 100 101 - 125 126 - 150 Over 150 60 Years or older
At least one member who is
Age 5 years Age 2 years Age 3 years Disabled or younger and younger through 5
Under 60 Years Old
Undup Households
Assisted
Energy Assistance Total
Report run on 08312018 1107 AM Page 1 of 3 eheap_summaryrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Unduplicated Total 0 0
County of Assisted
Households Under 75 75 - 100
Households Assisted By Poverty Level
101 - 125 126 - 150 Over 150 60 Years or older Disabled
Age 5 years or younger
Age 2 years and younger
Age 3 years through 5
Under 60 Years Old
At least one member who is
Undup Households
Assisted
Other Assisted Household Report
Other Assistance Total
Report run on 08312018 1107 AM Page 2 of 3 eheap_summaryrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Applicant Household Report
County of Applicant
Households Under 75 75 - 100 101 - 125 126 - 150 Over 150 Income data
unavailable
Total 0
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01
Enrollment Active Consumer Count by Program PSA ALL Provider ALL PROVIDERS
County Description Program Count of Clients
BREVARD
ADI
CCE
HCE
LSP
NDP
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
MLTC
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
31
57
44
5
62
123
141
26
9
7
5
40
5
50
67
129
2
19
42
29
1
233
79
63
8
2
14
3
37
14
47
3
3
33
127
10
02
03
04
ALACHUA
BAKER
BAY
BRADFORD
Report run on 08312018 1148 AM Page 1 of 18 actv_countrdf
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Enrollment Terminations with Reasons PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 Program All Programs Program Status ALL Program Status Worker ALL WORKERS
Last First Program Medicaid Provider Start End Name Name Client ID Status Description Worker Number Program Location Enrollment Enrollment
Count 0
Report run on 08312018 1150 AM Page 1 of 1 enroll_term_reasonrdf
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Enrollments with Care Plan Report
PSA ALL Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTIVE STATUS Care Plan Service ALL SERVICES Care Plan Start 01012017 Care Plan End 12312017
Care Plan Care Plan Care Plan Client Name
Unduplicated Client Count 0
Client ID Program Status Worker Start Date End Date Service
Report run on 08312018 1054 AM Page 1 of 1 enroll_careplrdf Report run by RSHQALL Dispose of this report so that it cannot be read or reconstructed
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PSA CLIENT_ID CLIENT_NAME OWNER PROVIDER_ID ASSESSMENT_DATE ASSESSOR_NAME MEDICAID_NUMBER CAREGIVER_CHANGE ENVIRONMENT_CHANGE HEALTH_CHANGE INCOME_CHANGE SITUATION_CHANGE INITIAL_ASSM ANNUAL_ASSM SSN REFERRAL_SOURCE 1114 N N N N Y N 771771777 SELFFAMILY 812017 JANE CASEWORKER 2 1001141633 TEST TEST N
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Fixed Service Costs List PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Provider Location County Program Service Reimbursement Unit Rate Provider Cost Per Unit Begin Valid End Valid
Count 0
Report run on 08312018 0233 PM Page 1 of 1 fixed_service_costrdf
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CARES Referrals in a Time Range PSA ALL
Start Date 01012017 End Date 12312017
Referred to ALL REFERRALS
Referring PSA Employee Name Client Name Client ID
Referral Imminent NH Admit Aging Date Risk Date Referred To Cares Provider Name Received Date
03A 4061561263 Test Name Test Name 09242017 Y 05292017 ARC or ADRC 09252017
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CARES Referrals in a Time Range PSA ALL
Start Date 01012017 End Date 12312017
Referred to ALL REFERRALS
Referring PSA Employee Name Client Name Client ID
Referral Date
Imminent Risk
NH Admit Date Referred To Cares Provider Name
Aging Received Date
04B Test Name Test Name 4061738075 04082017 N ARC or ADRC Test Name 04082017
Total Clients 110
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CARES Referrals not acknowledged by the Aging Network PSA ALL For Referrals after 01012017 Owner ID ALL Owners
Unduplicated Client count Cares Office Total Clients Count
Report Total
Report run on 08312018 0158 PM Page 1 of 1 cares_not_ackrdf
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
CIRTS Issue PSA Client ID Client Name Program
Program Status Start Provider Enrollment ID Provider Name
APCL CLIENT WITH DATE OF DEATH 08 4061759417 Test Name OA3B APCL 07232013 1141 WESTERN WORLD RADIO
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
Program Start Provider CIRTS Issue PSA Client ID Client Name Program Status Enrollment ID Provider Name
06 LTCC APCL 01242014 1514 4061713685 Test Name APCL CLIENT WITH DATE OF DEATH CENTRAL THE ORIGINAL HOUSE OF PIES
Count 503
Report run on 08312018 0224 PM Page 22 of 22 data_cleanuprdf Report run by RSHQALL Dispose of this report so that it can not be read or reconstructed
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Civil Rights PSA ALL Provider ALL PROVIDERS Program AC Start Date 01012017 End Date 12312017 The Poverty Level for Single is The Poverty Level for Couple is Sort by County
County Unduplicated Count
Report run on 08312018 1055 AM Page 1 of 1 civil_rightsrdf
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Client Information Report Start Date 01012017 End Date 12312017
Client ID 1001141246
Emergency
Client Name Test Name
Telephone () - Address 78 TEST STREET TALLAHASSEE FL 32399
Most Recent Caregiver Information Date Updated
Doctor
Comments
Client Demographic Information
Birth Date 06041940 Race W
Owner ID Ethnicity O
Most Recent Income Information
Ind Mon Inc Cpl Mon Inc
Ind Assets Couple Assets
Most Recent Assessment Information
Asmt Date Ref Risk Lvl
Asmt Site Spec Shel
AsmtType Spec Reg
Ref Date Primary CG
Ref Source Living Sit
Enrollment Information
Sex
Marital Status
F
S
Medicaid Number
ADL Score
ADL Count
IADL Score
IADL Count
Memory Score
Priority Score
Env Score
Nutr Score
Risk Score
Social Score
Rank
Provider Location Program Program Status Worker Start Date End Date
Care Plan Service Needed
Date Service Units Type Frq End Date
Care Plan Service Planned
Program Service Units Type Frq Start Date End Date
Services Received between 01012017 and 12312017
Service Billed Provider Location Worker Program Service Date Units Unit Type Amount
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Provider N
Client Service Units Report PSA ALL Provider ALL PROVIDERS Location 0000
Program ALL PROGRAMS Service ALL SERVICES Worker ALL WORKERS
City ALL CITIES Include Zero Unit N Include Aggregate N Calculated Amount equals the number of Units Provided times Fixed Cost if it existsService Start Date 01012017 Service End Date 12312017 If Fixed Cost does not exist Calculated
Group by PSA Provider Location Client Name County Worker Amount equals Billed Amount
Unduplicated Client Count 0 Grand Total 000 $000
Report run on 08312018 0234 PM Page 1 of 1 clnt_serv_unitsrdf
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Clients In Common PSA All Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 County All Counties Worker All Workers
County JEFFERSON
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
MIAMI-DADE
0 0 0 0 0 0 0 0 0
4061539538 Test NameCounty Count
County
0 01
X
0 1
X
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
4061650856 Test Name X 4061486560 Test Name X 4062452921 Test Name X
Report run on 08312018 1148 AM clients_commonrdfPage 1 of 4 Report run by RSHQALL Dispose of this Report so that it can not be read or reconstructed
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Clients Served Not Enrolled PSA ALL Start Date 01012017 End Date 12312017 Locations 0000 Provider All Providers
Service Service Min Serv Max Serv Program Start End Enrollment PSA Provider Location Program Consumer Name Client ID Service Date Date Status Enrollment Enrollment Provider
Count 0
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
4061472791 04
09
1092
1291
0072
0042
LTCC
LTCC
APCL
APCL
4062714543 06
06
1514
1762
0072
5006
LTCC
LTCC
APCL
APPL
4061802246 11
06
1177
1514
0179
0072
LTCC
LTCC
APCL
APCL
4061563719 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062644312 06
08
1514
1771
0072
0896
LTCC
LTCC
APCL
APCL
1001141670 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
1001141671 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
4062375003 07
05
05
07
1263
1755
1638
1263
0368
0072
0072
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062155124 06
06
1762
1514
0072
0072
LTCC
LTCC
APPL
APCL
4061743886 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0369
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4061499927 06
06
1514
1762
0072
5005
LTCC
LTCC
APCL
APPL
4061583524 08
06
1144
1514
0896
0072
LTCC
LTCC
APCL
APCL
4062694843 06
03
1514
1922
0072
0179
LTCC
LTCC
APCL
APCL
4062744517 07
06
1263
1514
0369
0072
LTCC
LTCC
APCL
APCL
4062005488 10
11
10
11
1929
1177
1164
1177
0072
0073
0179
0179
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
Report run on 08312018 0200 PM Page 1 of 2 clnts_mult_enrollrdf
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
Total Count 15
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CODE DESCRIPTIONS Category ALL STATE TABLES
Code Description Active Available To Code Category
0 UNKNOWN Y CARES SUBJECTIVE_HEALTH_EVALUATION
01 ALACHUA Y COMMON COUNTIES
02 BAKER Y COMMON COUNTIES
03 BAY Y COMMON COUNTIES
04 BRADFORD Y COMMON COUNTIES
05 BREVARD Y COMMON COUNTIES
06 BROWARD Y COMMON COUNTIES
07 CALHOUN Y COMMON COUNTIES
08 CHARLOTTE Y COMMON COUNTIES
09 CITRUS Y COMMON COUNTIES
1 EXCELLENT Y CARES SUBJECTIVE_HEALTH_EVALUATION
10 CLAY Y COMMON COUNTIES
11 COLLIER Y COMMON COUNTIES
12 COLUMBIA Y COMMON COUNTIES
13 MIAMI-DADE Y COMMON COUNTIES
14 DESOTO Y COMMON COUNTIES
15 DIXIE Y COMMON COUNTIES
16 DUVAL Y COMMON COUNTIES
17 ESCAMBIA Y COMMON COUNTIES
18 FLAGLER Y COMMON COUNTIES
19 FRANKLIN Y COMMON COUNTIES
2 GOOD Y CARES SUBJECTIVE_HEALTH_EVALUATION
20 GADSDEN Y COMMON COUNTIES
21 GILCHRIST Y COMMON COUNTIES
22 GLADES Y COMMON COUNTIES
23 GULF Y COMMON COUNTIES
24 HAMILTON Y COMMON COUNTIES
25 HARDEE Y COMMON COUNTIES
26 HENDRY Y COMMON COUNTIES
27 HERNANDO Y COMMON COUNTIES
28 HIGHLANDS Y COMMON COUNTIES
Report run on 08312018 0140 PM Page 1 of 45 state_codesrdf Report run by RSHQALL Dispose of this report so that it cannot be read or reconstructed
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CONSUMER AGE VERIFICATION REPORT PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Program AC
Age at Start
Enroll or Start Enroll Provider Program Description Consumer Name Client ID DOB Svc date or Svc Date
Report run on 08312018 0203 PM Page 1 of 1 age_verifyrdf
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Contract Budget Information PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Program Service Provider Location County Served Provider Contract
Projected Service
Units Unit Measure
Projected Unduplicated
State Federal Share Client Count Begin Date End Date
Row Count 0 Amount Total
Report run on 08312018 0233 PM Page 1 of 1 contract_budgetrdf
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Start Enroll Latest Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Date Asmt Date Worker
O3C1 1036 000 4061653427 Test CENTRAL 34982 W M 07091930 09102013 09102013 CIRTS20804 0 Name
Report run on 08312018 1133 AM Page 1 of 6 actv_by_progrdf
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Start Enroll Date
Latest Asmt Date Worker
4061593624 Test Name CENTRAL 34946 B F 11261940 12012011 12312013 CIRTS23407
Count 164
Unduplicated Client Count 163
Report run on 08312018 1133 AM Page 6 of 6 actv_by_progrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Assessments After DOD Report
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Owner 1025
The shaded records indicate clients who have different DOBs andor different names
Assemt Current PSA Owner Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Owner Assessor
Provider Assessor
Assemt Date
Assemt Type
Unduplicated Count Total 0
Report run on 08312018 0206 PM Page 1 of 1 vs_assmrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Open Enrollments
The Vital Statistics Data for 07192002 - 09112014PSA ALL Provider ALL Program Status ACTV Include MLTC ACTVS N
The shaded records indicate clients who have different DOBs andor different names
Enroll PSA
Enrollment Provider Loc Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Enroll Program Status
Enroll Program
Current Owner ID
02 1065 0072 4062244026 Test Name Test Name 10222004 03231917 03231917 ACTV CCE 1065
Count of enrollments for the Provider 1
Count of enrollments for the PSA 1
Count of enrollments for the Report 1
Unduplicated Count of Individuals with open enrollments and DOD PSA Total Clients Count
02 1
Total 1
Report run on 08312018 0205 PM Page 1 of 1 vs_open_enrollrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Report run on 08312018 0207 PM Page 1 of 3 vs_servicesrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Unduplicated count of individuals with Services after DOD
PSA Total Clients Count
Report Total
Report run on 08312018 0207 PM Page 2 of 3 vs_servicesrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
List of Clients with PSA table entry for SERVICES_AFTER_DOD
Unduplicated Count Total 0
Report run on 08312018 0207 PM Page 3 of 3 vs_servicesrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Age
Provider
Total
Age lt 60 Age 60 - 64 Age 65 - 74 Age 75 - 84 Age 85+ Total Clients Avg Age
Total
Avg Age
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Ethnicity
Provider Hispanic Other Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Race
American Indian Native Hawaiian Other Provider Asian Alaska Native Black Pacific Islander Minority White Multiple Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Gender
Provider Male Female Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Monthly Income
Provider 0 - - Higher than Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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None
Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Total Persons Served 0
Age lt 60 Years 0 0
Age 60 - 64 0 0
Age 65 - 74 0 0
Age 75 - 84 0 0
Age 85+ 0 0
Total Age 0 0
Average 000
Ethnicity Hispanic 0 0
Other Ethnicity 0 0
Unknown Ethnicity 0 0
Total 0 0
Race Asian 0 0
American Indian Alaska Native 0 0
Black 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority 0 0
White 0 0
Multiple 0 0
Unknown 0 0
Total 0 0
Sex Male 0 0
Female 0 0
Unknown Sex 0 0
Total 0 0
Monthly Income 0 - 0 0
- 0 0
Higher than 0 0
Unknown 0 0
Total 0 0
Report run on 08312018 1058 AM Page 1 of 2 demo_by_prov_detrdf Report run byRSHQALL Dispose of this report so that it can not be read or reconstructed
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Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Client ID Date Of Birth Ethnicity Race Sex Individual Monthly Income
Report run on 08312018 1058 AM Page 2 of 2 demo_by_prov_detrdf Report run byRSHQALL Dispose of this report so that it can not be read or reconstructed
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Demographics of Clients OAA Registered Served Only PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 City All Cities Program All Programs Service All Services County ALL COUNTIES Table OAA Registered Services Only Low Income Medium Income
Total Persons Served 0
Agelt 60 Years
Age 60 - 64
Age 65 - 74
Age 75 - 84
Age 85+
0
0
0
0
0
0
0
0
0
0
Monthly Income
0 -
-Higher than
Unknown
0
0
0
0
0
0
0
0
Total
Average
0
000
0 Total 0 0
Ethnicity Hispanic
Other
Unknown
0
0
0
0
0
0
Living Situation
Alone
Null
Policy Change
0
0
0
0
0
0
Total 0 0 Unknown
With Caregiver
0
0
0
0
Race Asian 0 0
With Other
With Other Caregiver
0
0
0
0
American Indian Alaska Native
Black
0
0
0
0Total Living Situation 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority
White
0
0
0
0 Limited English Proficiency
Multiple
Unknown
Total Race
0
0
0
0
0
0
Yes
No
Unknown
0
0
0
0
0
0
Total 0 0
Sex Male
Female
Unknown
0
0
0
0
0
0
Total 0 0
Report run on 08312018 1056 AM Page 1 of 1 demo_by_provrdf
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Disaster Assistance Clients for a Provider PSA ALL Provider All Providers Location 0000 Worker All Workers City All Cities Zip Code All Zip Codes Sort By ZIP
Provider 1036 Provider Name Location 0000 Worker CIRTS18634
Need Care Client Name Address City Zip County Phone Asst Reg Situation Relat Care phone Care Name
34946 N WO DA 000 SAINT JAMES DRIVE CENTRAL (025) 101-0620 Test NameTest Name SAINT LUCIE (005) 100-0369 Y
Client is active and no assessment information is available Special Shelter and Special Registry are unknown
Report run on 08312018 1102 AM Page 1 of 8 disaster_by_provrdf
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
Total by PSA 0
Report run on 08312018 1111 AM Page 1 of 5 eheap_exceptionsrdf
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
ALACH BAKER BAY BRADF BREVA BROWA CALHO CHARL CITRUS CLAY COLLIE COLUM DESOT DIXIE DUVAL ESCAM FLAGL FRANK GADSDAssisted Household Report UA ORD RD RD UN OTTE R BIA O BIA ER LIN EN
1 of Household Assisted 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Households AssistedWith Gross Income
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C 100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D 125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
3 Households with at leastOne member
A 60 Years or older 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B Disabled 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C Age 5 years or under 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D Under 60 Years Old 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Undup Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Assisted
Applicant Household Report
of Applicant Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Energy Assisted Household Report
County of Assisted
Households
Households Assisted By Poverty Level
Under 75 75 - 100 101 - 125 126 - 150 Over 150 60 Years or older
At least one member who is
Age 5 years Age 2 years Age 3 years Disabled or younger and younger through 5
Under 60 Years Old
Undup Households
Assisted
Energy Assistance Total
Report run on 08312018 1107 AM Page 1 of 3 eheap_summaryrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Unduplicated Total 0 0
County of Assisted
Households Under 75 75 - 100
Households Assisted By Poverty Level
101 - 125 126 - 150 Over 150 60 Years or older Disabled
Age 5 years or younger
Age 2 years and younger
Age 3 years through 5
Under 60 Years Old
At least one member who is
Undup Households
Assisted
Other Assisted Household Report
Other Assistance Total
Report run on 08312018 1107 AM Page 2 of 3 eheap_summaryrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Applicant Household Report
County of Applicant
Households Under 75 75 - 100 101 - 125 126 - 150 Over 150 Income data
unavailable
Total 0
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01
Enrollment Active Consumer Count by Program PSA ALL Provider ALL PROVIDERS
County Description Program Count of Clients
BREVARD
ADI
CCE
HCE
LSP
NDP
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
MLTC
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
31
57
44
5
62
123
141
26
9
7
5
40
5
50
67
129
2
19
42
29
1
233
79
63
8
2
14
3
37
14
47
3
3
33
127
10
02
03
04
ALACHUA
BAKER
BAY
BRADFORD
Report run on 08312018 1148 AM Page 1 of 18 actv_countrdf
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Enrollment Terminations with Reasons PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 Program All Programs Program Status ALL Program Status Worker ALL WORKERS
Last First Program Medicaid Provider Start End Name Name Client ID Status Description Worker Number Program Location Enrollment Enrollment
Count 0
Report run on 08312018 1150 AM Page 1 of 1 enroll_term_reasonrdf
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Enrollments with Care Plan Report
PSA ALL Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTIVE STATUS Care Plan Service ALL SERVICES Care Plan Start 01012017 Care Plan End 12312017
Care Plan Care Plan Care Plan Client Name
Unduplicated Client Count 0
Client ID Program Status Worker Start Date End Date Service
Report run on 08312018 1054 AM Page 1 of 1 enroll_careplrdf Report run by RSHQALL Dispose of this report so that it cannot be read or reconstructed
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PSA CLIENT_ID CLIENT_NAME OWNER PROVIDER_ID ASSESSMENT_DATE ASSESSOR_NAME MEDICAID_NUMBER CAREGIVER_CHANGE ENVIRONMENT_CHANGE HEALTH_CHANGE INCOME_CHANGE SITUATION_CHANGE INITIAL_ASSM ANNUAL_ASSM SSN REFERRAL_SOURCE 1114 N N N N Y N 771771777 SELFFAMILY 812017 JANE CASEWORKER 2 1001141633 TEST TEST N
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Fixed Service Costs List PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Provider Location County Program Service Reimbursement Unit Rate Provider Cost Per Unit Begin Valid End Valid
Count 0
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CARES Referrals in a Time Range PSA ALL
Start Date 01012017 End Date 12312017
Referred to ALL REFERRALS
Referring PSA Employee Name Client Name Client ID
Referral Date
Imminent Risk
NH Admit Date Referred To Cares Provider Name
Aging Received Date
04B Test Name Test Name 4061738075 04082017 N ARC or ADRC Test Name 04082017
Total Clients 110
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CARES Referrals not acknowledged by the Aging Network PSA ALL For Referrals after 01012017 Owner ID ALL Owners
Unduplicated Client count Cares Office Total Clients Count
Report Total
Report run on 08312018 0158 PM Page 1 of 1 cares_not_ackrdf
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
CIRTS Issue PSA Client ID Client Name Program
Program Status Start Provider Enrollment ID Provider Name
APCL CLIENT WITH DATE OF DEATH 08 4061759417 Test Name OA3B APCL 07232013 1141 WESTERN WORLD RADIO
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
Program Start Provider CIRTS Issue PSA Client ID Client Name Program Status Enrollment ID Provider Name
06 LTCC APCL 01242014 1514 4061713685 Test Name APCL CLIENT WITH DATE OF DEATH CENTRAL THE ORIGINAL HOUSE OF PIES
Count 503
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Civil Rights PSA ALL Provider ALL PROVIDERS Program AC Start Date 01012017 End Date 12312017 The Poverty Level for Single is The Poverty Level for Couple is Sort by County
County Unduplicated Count
Report run on 08312018 1055 AM Page 1 of 1 civil_rightsrdf
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Client Information Report Start Date 01012017 End Date 12312017
Client ID 1001141246
Emergency
Client Name Test Name
Telephone () - Address 78 TEST STREET TALLAHASSEE FL 32399
Most Recent Caregiver Information Date Updated
Doctor
Comments
Client Demographic Information
Birth Date 06041940 Race W
Owner ID Ethnicity O
Most Recent Income Information
Ind Mon Inc Cpl Mon Inc
Ind Assets Couple Assets
Most Recent Assessment Information
Asmt Date Ref Risk Lvl
Asmt Site Spec Shel
AsmtType Spec Reg
Ref Date Primary CG
Ref Source Living Sit
Enrollment Information
Sex
Marital Status
F
S
Medicaid Number
ADL Score
ADL Count
IADL Score
IADL Count
Memory Score
Priority Score
Env Score
Nutr Score
Risk Score
Social Score
Rank
Provider Location Program Program Status Worker Start Date End Date
Care Plan Service Needed
Date Service Units Type Frq End Date
Care Plan Service Planned
Program Service Units Type Frq Start Date End Date
Services Received between 01012017 and 12312017
Service Billed Provider Location Worker Program Service Date Units Unit Type Amount
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Provider N
Client Service Units Report PSA ALL Provider ALL PROVIDERS Location 0000
Program ALL PROGRAMS Service ALL SERVICES Worker ALL WORKERS
City ALL CITIES Include Zero Unit N Include Aggregate N Calculated Amount equals the number of Units Provided times Fixed Cost if it existsService Start Date 01012017 Service End Date 12312017 If Fixed Cost does not exist Calculated
Group by PSA Provider Location Client Name County Worker Amount equals Billed Amount
Unduplicated Client Count 0 Grand Total 000 $000
Report run on 08312018 0234 PM Page 1 of 1 clnt_serv_unitsrdf
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Clients In Common PSA All Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 County All Counties Worker All Workers
County JEFFERSON
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
MIAMI-DADE
0 0 0 0 0 0 0 0 0
4061539538 Test NameCounty Count
County
0 01
X
0 1
X
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
4061650856 Test Name X 4061486560 Test Name X 4062452921 Test Name X
Report run on 08312018 1148 AM clients_commonrdfPage 1 of 4 Report run by RSHQALL Dispose of this Report so that it can not be read or reconstructed
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Clients Served Not Enrolled PSA ALL Start Date 01012017 End Date 12312017 Locations 0000 Provider All Providers
Service Service Min Serv Max Serv Program Start End Enrollment PSA Provider Location Program Consumer Name Client ID Service Date Date Status Enrollment Enrollment Provider
Count 0
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
4061472791 04
09
1092
1291
0072
0042
LTCC
LTCC
APCL
APCL
4062714543 06
06
1514
1762
0072
5006
LTCC
LTCC
APCL
APPL
4061802246 11
06
1177
1514
0179
0072
LTCC
LTCC
APCL
APCL
4061563719 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062644312 06
08
1514
1771
0072
0896
LTCC
LTCC
APCL
APCL
1001141670 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
1001141671 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
4062375003 07
05
05
07
1263
1755
1638
1263
0368
0072
0072
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062155124 06
06
1762
1514
0072
0072
LTCC
LTCC
APPL
APCL
4061743886 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0369
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4061499927 06
06
1514
1762
0072
5005
LTCC
LTCC
APCL
APPL
4061583524 08
06
1144
1514
0896
0072
LTCC
LTCC
APCL
APCL
4062694843 06
03
1514
1922
0072
0179
LTCC
LTCC
APCL
APCL
4062744517 07
06
1263
1514
0369
0072
LTCC
LTCC
APCL
APCL
4062005488 10
11
10
11
1929
1177
1164
1177
0072
0073
0179
0179
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
Report run on 08312018 0200 PM Page 1 of 2 clnts_mult_enrollrdf
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
Total Count 15
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CODE DESCRIPTIONS Category ALL STATE TABLES
Code Description Active Available To Code Category
0 UNKNOWN Y CARES SUBJECTIVE_HEALTH_EVALUATION
01 ALACHUA Y COMMON COUNTIES
02 BAKER Y COMMON COUNTIES
03 BAY Y COMMON COUNTIES
04 BRADFORD Y COMMON COUNTIES
05 BREVARD Y COMMON COUNTIES
06 BROWARD Y COMMON COUNTIES
07 CALHOUN Y COMMON COUNTIES
08 CHARLOTTE Y COMMON COUNTIES
09 CITRUS Y COMMON COUNTIES
1 EXCELLENT Y CARES SUBJECTIVE_HEALTH_EVALUATION
10 CLAY Y COMMON COUNTIES
11 COLLIER Y COMMON COUNTIES
12 COLUMBIA Y COMMON COUNTIES
13 MIAMI-DADE Y COMMON COUNTIES
14 DESOTO Y COMMON COUNTIES
15 DIXIE Y COMMON COUNTIES
16 DUVAL Y COMMON COUNTIES
17 ESCAMBIA Y COMMON COUNTIES
18 FLAGLER Y COMMON COUNTIES
19 FRANKLIN Y COMMON COUNTIES
2 GOOD Y CARES SUBJECTIVE_HEALTH_EVALUATION
20 GADSDEN Y COMMON COUNTIES
21 GILCHRIST Y COMMON COUNTIES
22 GLADES Y COMMON COUNTIES
23 GULF Y COMMON COUNTIES
24 HAMILTON Y COMMON COUNTIES
25 HARDEE Y COMMON COUNTIES
26 HENDRY Y COMMON COUNTIES
27 HERNANDO Y COMMON COUNTIES
28 HIGHLANDS Y COMMON COUNTIES
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CONSUMER AGE VERIFICATION REPORT PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Program AC
Age at Start
Enroll or Start Enroll Provider Program Description Consumer Name Client ID DOB Svc date or Svc Date
Report run on 08312018 0203 PM Page 1 of 1 age_verifyrdf
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Contract Budget Information PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Program Service Provider Location County Served Provider Contract
Projected Service
Units Unit Measure
Projected Unduplicated
State Federal Share Client Count Begin Date End Date
Row Count 0 Amount Total
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Start Enroll Latest Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Date Asmt Date Worker
O3C1 1036 000 4061653427 Test CENTRAL 34982 W M 07091930 09102013 09102013 CIRTS20804 0 Name
Report run on 08312018 1133 AM Page 1 of 6 actv_by_progrdf
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Start Enroll Date
Latest Asmt Date Worker
4061593624 Test Name CENTRAL 34946 B F 11261940 12012011 12312013 CIRTS23407
Count 164
Unduplicated Client Count 163
Report run on 08312018 1133 AM Page 6 of 6 actv_by_progrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Assessments After DOD Report
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Owner 1025
The shaded records indicate clients who have different DOBs andor different names
Assemt Current PSA Owner Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Owner Assessor
Provider Assessor
Assemt Date
Assemt Type
Unduplicated Count Total 0
Report run on 08312018 0206 PM Page 1 of 1 vs_assmrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Open Enrollments
The Vital Statistics Data for 07192002 - 09112014PSA ALL Provider ALL Program Status ACTV Include MLTC ACTVS N
The shaded records indicate clients who have different DOBs andor different names
Enroll PSA
Enrollment Provider Loc Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Enroll Program Status
Enroll Program
Current Owner ID
02 1065 0072 4062244026 Test Name Test Name 10222004 03231917 03231917 ACTV CCE 1065
Count of enrollments for the Provider 1
Count of enrollments for the PSA 1
Count of enrollments for the Report 1
Unduplicated Count of Individuals with open enrollments and DOD PSA Total Clients Count
02 1
Total 1
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Report run on 08312018 0207 PM Page 1 of 3 vs_servicesrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Unduplicated count of individuals with Services after DOD
PSA Total Clients Count
Report Total
Report run on 08312018 0207 PM Page 2 of 3 vs_servicesrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
List of Clients with PSA table entry for SERVICES_AFTER_DOD
Unduplicated Count Total 0
Report run on 08312018 0207 PM Page 3 of 3 vs_servicesrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Age
Provider
Total
Age lt 60 Age 60 - 64 Age 65 - 74 Age 75 - 84 Age 85+ Total Clients Avg Age
Total
Avg Age
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Ethnicity
Provider Hispanic Other Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Race
American Indian Native Hawaiian Other Provider Asian Alaska Native Black Pacific Islander Minority White Multiple Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Gender
Provider Male Female Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Monthly Income
Provider 0 - - Higher than Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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None
Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Total Persons Served 0
Age lt 60 Years 0 0
Age 60 - 64 0 0
Age 65 - 74 0 0
Age 75 - 84 0 0
Age 85+ 0 0
Total Age 0 0
Average 000
Ethnicity Hispanic 0 0
Other Ethnicity 0 0
Unknown Ethnicity 0 0
Total 0 0
Race Asian 0 0
American Indian Alaska Native 0 0
Black 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority 0 0
White 0 0
Multiple 0 0
Unknown 0 0
Total 0 0
Sex Male 0 0
Female 0 0
Unknown Sex 0 0
Total 0 0
Monthly Income 0 - 0 0
- 0 0
Higher than 0 0
Unknown 0 0
Total 0 0
Report run on 08312018 1058 AM Page 1 of 2 demo_by_prov_detrdf Report run byRSHQALL Dispose of this report so that it can not be read or reconstructed
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Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Client ID Date Of Birth Ethnicity Race Sex Individual Monthly Income
Report run on 08312018 1058 AM Page 2 of 2 demo_by_prov_detrdf Report run byRSHQALL Dispose of this report so that it can not be read or reconstructed
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Demographics of Clients OAA Registered Served Only PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 City All Cities Program All Programs Service All Services County ALL COUNTIES Table OAA Registered Services Only Low Income Medium Income
Total Persons Served 0
Agelt 60 Years
Age 60 - 64
Age 65 - 74
Age 75 - 84
Age 85+
0
0
0
0
0
0
0
0
0
0
Monthly Income
0 -
-Higher than
Unknown
0
0
0
0
0
0
0
0
Total
Average
0
000
0 Total 0 0
Ethnicity Hispanic
Other
Unknown
0
0
0
0
0
0
Living Situation
Alone
Null
Policy Change
0
0
0
0
0
0
Total 0 0 Unknown
With Caregiver
0
0
0
0
Race Asian 0 0
With Other
With Other Caregiver
0
0
0
0
American Indian Alaska Native
Black
0
0
0
0Total Living Situation 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority
White
0
0
0
0 Limited English Proficiency
Multiple
Unknown
Total Race
0
0
0
0
0
0
Yes
No
Unknown
0
0
0
0
0
0
Total 0 0
Sex Male
Female
Unknown
0
0
0
0
0
0
Total 0 0
Report run on 08312018 1056 AM Page 1 of 1 demo_by_provrdf
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Disaster Assistance Clients for a Provider PSA ALL Provider All Providers Location 0000 Worker All Workers City All Cities Zip Code All Zip Codes Sort By ZIP
Provider 1036 Provider Name Location 0000 Worker CIRTS18634
Need Care Client Name Address City Zip County Phone Asst Reg Situation Relat Care phone Care Name
34946 N WO DA 000 SAINT JAMES DRIVE CENTRAL (025) 101-0620 Test NameTest Name SAINT LUCIE (005) 100-0369 Y
Client is active and no assessment information is available Special Shelter and Special Registry are unknown
Report run on 08312018 1102 AM Page 1 of 8 disaster_by_provrdf
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
Total by PSA 0
Report run on 08312018 1111 AM Page 1 of 5 eheap_exceptionsrdf
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
ALACH BAKER BAY BRADF BREVA BROWA CALHO CHARL CITRUS CLAY COLLIE COLUM DESOT DIXIE DUVAL ESCAM FLAGL FRANK GADSDAssisted Household Report UA ORD RD RD UN OTTE R BIA O BIA ER LIN EN
1 of Household Assisted 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Households AssistedWith Gross Income
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C 100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D 125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
3 Households with at leastOne member
A 60 Years or older 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B Disabled 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C Age 5 years or under 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D Under 60 Years Old 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Undup Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Assisted
Applicant Household Report
of Applicant Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Energy Assisted Household Report
County of Assisted
Households
Households Assisted By Poverty Level
Under 75 75 - 100 101 - 125 126 - 150 Over 150 60 Years or older
At least one member who is
Age 5 years Age 2 years Age 3 years Disabled or younger and younger through 5
Under 60 Years Old
Undup Households
Assisted
Energy Assistance Total
Report run on 08312018 1107 AM Page 1 of 3 eheap_summaryrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Unduplicated Total 0 0
County of Assisted
Households Under 75 75 - 100
Households Assisted By Poverty Level
101 - 125 126 - 150 Over 150 60 Years or older Disabled
Age 5 years or younger
Age 2 years and younger
Age 3 years through 5
Under 60 Years Old
At least one member who is
Undup Households
Assisted
Other Assisted Household Report
Other Assistance Total
Report run on 08312018 1107 AM Page 2 of 3 eheap_summaryrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Applicant Household Report
County of Applicant
Households Under 75 75 - 100 101 - 125 126 - 150 Over 150 Income data
unavailable
Total 0
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01
Enrollment Active Consumer Count by Program PSA ALL Provider ALL PROVIDERS
County Description Program Count of Clients
BREVARD
ADI
CCE
HCE
LSP
NDP
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
MLTC
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
31
57
44
5
62
123
141
26
9
7
5
40
5
50
67
129
2
19
42
29
1
233
79
63
8
2
14
3
37
14
47
3
3
33
127
10
02
03
04
ALACHUA
BAKER
BAY
BRADFORD
Report run on 08312018 1148 AM Page 1 of 18 actv_countrdf
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Enrollment Terminations with Reasons PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 Program All Programs Program Status ALL Program Status Worker ALL WORKERS
Last First Program Medicaid Provider Start End Name Name Client ID Status Description Worker Number Program Location Enrollment Enrollment
Count 0
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Enrollments with Care Plan Report
PSA ALL Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTIVE STATUS Care Plan Service ALL SERVICES Care Plan Start 01012017 Care Plan End 12312017
Care Plan Care Plan Care Plan Client Name
Unduplicated Client Count 0
Client ID Program Status Worker Start Date End Date Service
Report run on 08312018 1054 AM Page 1 of 1 enroll_careplrdf Report run by RSHQALL Dispose of this report so that it cannot be read or reconstructed
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PSA CLIENT_ID CLIENT_NAME OWNER PROVIDER_ID ASSESSMENT_DATE ASSESSOR_NAME MEDICAID_NUMBER CAREGIVER_CHANGE ENVIRONMENT_CHANGE HEALTH_CHANGE INCOME_CHANGE SITUATION_CHANGE INITIAL_ASSM ANNUAL_ASSM SSN REFERRAL_SOURCE 1114 N N N N Y N 771771777 SELFFAMILY 812017 JANE CASEWORKER 2 1001141633 TEST TEST N
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Fixed Service Costs List PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Provider Location County Program Service Reimbursement Unit Rate Provider Cost Per Unit Begin Valid End Valid
Count 0
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CARES Referrals not acknowledged by the Aging Network PSA ALL For Referrals after 01012017 Owner ID ALL Owners
Unduplicated Client count Cares Office Total Clients Count
Report Total
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
CIRTS Issue PSA Client ID Client Name Program
Program Status Start Provider Enrollment ID Provider Name
APCL CLIENT WITH DATE OF DEATH 08 4061759417 Test Name OA3B APCL 07232013 1141 WESTERN WORLD RADIO
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
Program Start Provider CIRTS Issue PSA Client ID Client Name Program Status Enrollment ID Provider Name
06 LTCC APCL 01242014 1514 4061713685 Test Name APCL CLIENT WITH DATE OF DEATH CENTRAL THE ORIGINAL HOUSE OF PIES
Count 503
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Civil Rights PSA ALL Provider ALL PROVIDERS Program AC Start Date 01012017 End Date 12312017 The Poverty Level for Single is The Poverty Level for Couple is Sort by County
County Unduplicated Count
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Client Information Report Start Date 01012017 End Date 12312017
Client ID 1001141246
Emergency
Client Name Test Name
Telephone () - Address 78 TEST STREET TALLAHASSEE FL 32399
Most Recent Caregiver Information Date Updated
Doctor
Comments
Client Demographic Information
Birth Date 06041940 Race W
Owner ID Ethnicity O
Most Recent Income Information
Ind Mon Inc Cpl Mon Inc
Ind Assets Couple Assets
Most Recent Assessment Information
Asmt Date Ref Risk Lvl
Asmt Site Spec Shel
AsmtType Spec Reg
Ref Date Primary CG
Ref Source Living Sit
Enrollment Information
Sex
Marital Status
F
S
Medicaid Number
ADL Score
ADL Count
IADL Score
IADL Count
Memory Score
Priority Score
Env Score
Nutr Score
Risk Score
Social Score
Rank
Provider Location Program Program Status Worker Start Date End Date
Care Plan Service Needed
Date Service Units Type Frq End Date
Care Plan Service Planned
Program Service Units Type Frq Start Date End Date
Services Received between 01012017 and 12312017
Service Billed Provider Location Worker Program Service Date Units Unit Type Amount
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Provider N
Client Service Units Report PSA ALL Provider ALL PROVIDERS Location 0000
Program ALL PROGRAMS Service ALL SERVICES Worker ALL WORKERS
City ALL CITIES Include Zero Unit N Include Aggregate N Calculated Amount equals the number of Units Provided times Fixed Cost if it existsService Start Date 01012017 Service End Date 12312017 If Fixed Cost does not exist Calculated
Group by PSA Provider Location Client Name County Worker Amount equals Billed Amount
Unduplicated Client Count 0 Grand Total 000 $000
Report run on 08312018 0234 PM Page 1 of 1 clnt_serv_unitsrdf
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Clients In Common PSA All Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 County All Counties Worker All Workers
County JEFFERSON
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
MIAMI-DADE
0 0 0 0 0 0 0 0 0
4061539538 Test NameCounty Count
County
0 01
X
0 1
X
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
4061650856 Test Name X 4061486560 Test Name X 4062452921 Test Name X
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Clients Served Not Enrolled PSA ALL Start Date 01012017 End Date 12312017 Locations 0000 Provider All Providers
Service Service Min Serv Max Serv Program Start End Enrollment PSA Provider Location Program Consumer Name Client ID Service Date Date Status Enrollment Enrollment Provider
Count 0
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
4061472791 04
09
1092
1291
0072
0042
LTCC
LTCC
APCL
APCL
4062714543 06
06
1514
1762
0072
5006
LTCC
LTCC
APCL
APPL
4061802246 11
06
1177
1514
0179
0072
LTCC
LTCC
APCL
APCL
4061563719 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062644312 06
08
1514
1771
0072
0896
LTCC
LTCC
APCL
APCL
1001141670 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
1001141671 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
4062375003 07
05
05
07
1263
1755
1638
1263
0368
0072
0072
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062155124 06
06
1762
1514
0072
0072
LTCC
LTCC
APPL
APCL
4061743886 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0369
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4061499927 06
06
1514
1762
0072
5005
LTCC
LTCC
APCL
APPL
4061583524 08
06
1144
1514
0896
0072
LTCC
LTCC
APCL
APCL
4062694843 06
03
1514
1922
0072
0179
LTCC
LTCC
APCL
APCL
4062744517 07
06
1263
1514
0369
0072
LTCC
LTCC
APCL
APCL
4062005488 10
11
10
11
1929
1177
1164
1177
0072
0073
0179
0179
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
Total Count 15
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CODE DESCRIPTIONS Category ALL STATE TABLES
Code Description Active Available To Code Category
0 UNKNOWN Y CARES SUBJECTIVE_HEALTH_EVALUATION
01 ALACHUA Y COMMON COUNTIES
02 BAKER Y COMMON COUNTIES
03 BAY Y COMMON COUNTIES
04 BRADFORD Y COMMON COUNTIES
05 BREVARD Y COMMON COUNTIES
06 BROWARD Y COMMON COUNTIES
07 CALHOUN Y COMMON COUNTIES
08 CHARLOTTE Y COMMON COUNTIES
09 CITRUS Y COMMON COUNTIES
1 EXCELLENT Y CARES SUBJECTIVE_HEALTH_EVALUATION
10 CLAY Y COMMON COUNTIES
11 COLLIER Y COMMON COUNTIES
12 COLUMBIA Y COMMON COUNTIES
13 MIAMI-DADE Y COMMON COUNTIES
14 DESOTO Y COMMON COUNTIES
15 DIXIE Y COMMON COUNTIES
16 DUVAL Y COMMON COUNTIES
17 ESCAMBIA Y COMMON COUNTIES
18 FLAGLER Y COMMON COUNTIES
19 FRANKLIN Y COMMON COUNTIES
2 GOOD Y CARES SUBJECTIVE_HEALTH_EVALUATION
20 GADSDEN Y COMMON COUNTIES
21 GILCHRIST Y COMMON COUNTIES
22 GLADES Y COMMON COUNTIES
23 GULF Y COMMON COUNTIES
24 HAMILTON Y COMMON COUNTIES
25 HARDEE Y COMMON COUNTIES
26 HENDRY Y COMMON COUNTIES
27 HERNANDO Y COMMON COUNTIES
28 HIGHLANDS Y COMMON COUNTIES
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CONSUMER AGE VERIFICATION REPORT PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Program AC
Age at Start
Enroll or Start Enroll Provider Program Description Consumer Name Client ID DOB Svc date or Svc Date
Report run on 08312018 0203 PM Page 1 of 1 age_verifyrdf
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Contract Budget Information PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Program Service Provider Location County Served Provider Contract
Projected Service
Units Unit Measure
Projected Unduplicated
State Federal Share Client Count Begin Date End Date
Row Count 0 Amount Total
Report run on 08312018 0233 PM Page 1 of 1 contract_budgetrdf
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Start Enroll Latest Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Date Asmt Date Worker
O3C1 1036 000 4061653427 Test CENTRAL 34982 W M 07091930 09102013 09102013 CIRTS20804 0 Name
Report run on 08312018 1133 AM Page 1 of 6 actv_by_progrdf
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Start Enroll Date
Latest Asmt Date Worker
4061593624 Test Name CENTRAL 34946 B F 11261940 12012011 12312013 CIRTS23407
Count 164
Unduplicated Client Count 163
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Assessments After DOD Report
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Owner 1025
The shaded records indicate clients who have different DOBs andor different names
Assemt Current PSA Owner Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Owner Assessor
Provider Assessor
Assemt Date
Assemt Type
Unduplicated Count Total 0
Report run on 08312018 0206 PM Page 1 of 1 vs_assmrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Open Enrollments
The Vital Statistics Data for 07192002 - 09112014PSA ALL Provider ALL Program Status ACTV Include MLTC ACTVS N
The shaded records indicate clients who have different DOBs andor different names
Enroll PSA
Enrollment Provider Loc Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Enroll Program Status
Enroll Program
Current Owner ID
02 1065 0072 4062244026 Test Name Test Name 10222004 03231917 03231917 ACTV CCE 1065
Count of enrollments for the Provider 1
Count of enrollments for the PSA 1
Count of enrollments for the Report 1
Unduplicated Count of Individuals with open enrollments and DOD PSA Total Clients Count
02 1
Total 1
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Report run on 08312018 0207 PM Page 1 of 3 vs_servicesrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Unduplicated count of individuals with Services after DOD
PSA Total Clients Count
Report Total
Report run on 08312018 0207 PM Page 2 of 3 vs_servicesrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
List of Clients with PSA table entry for SERVICES_AFTER_DOD
Unduplicated Count Total 0
Report run on 08312018 0207 PM Page 3 of 3 vs_servicesrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Age
Provider
Total
Age lt 60 Age 60 - 64 Age 65 - 74 Age 75 - 84 Age 85+ Total Clients Avg Age
Total
Avg Age
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Ethnicity
Provider Hispanic Other Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Race
American Indian Native Hawaiian Other Provider Asian Alaska Native Black Pacific Islander Minority White Multiple Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Gender
Provider Male Female Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Monthly Income
Provider 0 - - Higher than Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 5 of 5 demo_all_prvrdf
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None
Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Total Persons Served 0
Age lt 60 Years 0 0
Age 60 - 64 0 0
Age 65 - 74 0 0
Age 75 - 84 0 0
Age 85+ 0 0
Total Age 0 0
Average 000
Ethnicity Hispanic 0 0
Other Ethnicity 0 0
Unknown Ethnicity 0 0
Total 0 0
Race Asian 0 0
American Indian Alaska Native 0 0
Black 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority 0 0
White 0 0
Multiple 0 0
Unknown 0 0
Total 0 0
Sex Male 0 0
Female 0 0
Unknown Sex 0 0
Total 0 0
Monthly Income 0 - 0 0
- 0 0
Higher than 0 0
Unknown 0 0
Total 0 0
Report run on 08312018 1058 AM Page 1 of 2 demo_by_prov_detrdf Report run byRSHQALL Dispose of this report so that it can not be read or reconstructed
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Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Client ID Date Of Birth Ethnicity Race Sex Individual Monthly Income
Report run on 08312018 1058 AM Page 2 of 2 demo_by_prov_detrdf Report run byRSHQALL Dispose of this report so that it can not be read or reconstructed
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Demographics of Clients OAA Registered Served Only PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 City All Cities Program All Programs Service All Services County ALL COUNTIES Table OAA Registered Services Only Low Income Medium Income
Total Persons Served 0
Agelt 60 Years
Age 60 - 64
Age 65 - 74
Age 75 - 84
Age 85+
0
0
0
0
0
0
0
0
0
0
Monthly Income
0 -
-Higher than
Unknown
0
0
0
0
0
0
0
0
Total
Average
0
000
0 Total 0 0
Ethnicity Hispanic
Other
Unknown
0
0
0
0
0
0
Living Situation
Alone
Null
Policy Change
0
0
0
0
0
0
Total 0 0 Unknown
With Caregiver
0
0
0
0
Race Asian 0 0
With Other
With Other Caregiver
0
0
0
0
American Indian Alaska Native
Black
0
0
0
0Total Living Situation 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority
White
0
0
0
0 Limited English Proficiency
Multiple
Unknown
Total Race
0
0
0
0
0
0
Yes
No
Unknown
0
0
0
0
0
0
Total 0 0
Sex Male
Female
Unknown
0
0
0
0
0
0
Total 0 0
Report run on 08312018 1056 AM Page 1 of 1 demo_by_provrdf
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Disaster Assistance Clients for a Provider PSA ALL Provider All Providers Location 0000 Worker All Workers City All Cities Zip Code All Zip Codes Sort By ZIP
Provider 1036 Provider Name Location 0000 Worker CIRTS18634
Need Care Client Name Address City Zip County Phone Asst Reg Situation Relat Care phone Care Name
34946 N WO DA 000 SAINT JAMES DRIVE CENTRAL (025) 101-0620 Test NameTest Name SAINT LUCIE (005) 100-0369 Y
Client is active and no assessment information is available Special Shelter and Special Registry are unknown
Report run on 08312018 1102 AM Page 1 of 8 disaster_by_provrdf
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
Total by PSA 0
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
ALACH BAKER BAY BRADF BREVA BROWA CALHO CHARL CITRUS CLAY COLLIE COLUM DESOT DIXIE DUVAL ESCAM FLAGL FRANK GADSDAssisted Household Report UA ORD RD RD UN OTTE R BIA O BIA ER LIN EN
1 of Household Assisted 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Households AssistedWith Gross Income
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C 100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D 125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
3 Households with at leastOne member
A 60 Years or older 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B Disabled 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C Age 5 years or under 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D Under 60 Years Old 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Undup Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Assisted
Applicant Household Report
of Applicant Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Energy Assisted Household Report
County of Assisted
Households
Households Assisted By Poverty Level
Under 75 75 - 100 101 - 125 126 - 150 Over 150 60 Years or older
At least one member who is
Age 5 years Age 2 years Age 3 years Disabled or younger and younger through 5
Under 60 Years Old
Undup Households
Assisted
Energy Assistance Total
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Unduplicated Total 0 0
County of Assisted
Households Under 75 75 - 100
Households Assisted By Poverty Level
101 - 125 126 - 150 Over 150 60 Years or older Disabled
Age 5 years or younger
Age 2 years and younger
Age 3 years through 5
Under 60 Years Old
At least one member who is
Undup Households
Assisted
Other Assisted Household Report
Other Assistance Total
Report run on 08312018 1107 AM Page 2 of 3 eheap_summaryrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Applicant Household Report
County of Applicant
Households Under 75 75 - 100 101 - 125 126 - 150 Over 150 Income data
unavailable
Total 0
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01
Enrollment Active Consumer Count by Program PSA ALL Provider ALL PROVIDERS
County Description Program Count of Clients
BREVARD
ADI
CCE
HCE
LSP
NDP
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
MLTC
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
31
57
44
5
62
123
141
26
9
7
5
40
5
50
67
129
2
19
42
29
1
233
79
63
8
2
14
3
37
14
47
3
3
33
127
10
02
03
04
ALACHUA
BAKER
BAY
BRADFORD
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Enrollment Terminations with Reasons PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 Program All Programs Program Status ALL Program Status Worker ALL WORKERS
Last First Program Medicaid Provider Start End Name Name Client ID Status Description Worker Number Program Location Enrollment Enrollment
Count 0
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Enrollments with Care Plan Report
PSA ALL Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTIVE STATUS Care Plan Service ALL SERVICES Care Plan Start 01012017 Care Plan End 12312017
Care Plan Care Plan Care Plan Client Name
Unduplicated Client Count 0
Client ID Program Status Worker Start Date End Date Service
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PSA CLIENT_ID CLIENT_NAME OWNER PROVIDER_ID ASSESSMENT_DATE ASSESSOR_NAME MEDICAID_NUMBER CAREGIVER_CHANGE ENVIRONMENT_CHANGE HEALTH_CHANGE INCOME_CHANGE SITUATION_CHANGE INITIAL_ASSM ANNUAL_ASSM SSN REFERRAL_SOURCE 1114 N N N N Y N 771771777 SELFFAMILY 812017 JANE CASEWORKER 2 1001141633 TEST TEST N
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Fixed Service Costs List PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Provider Location County Program Service Reimbursement Unit Rate Provider Cost Per Unit Begin Valid End Valid
Count 0
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
CIRTS Issue PSA Client ID Client Name Program
Program Status Start Provider Enrollment ID Provider Name
APCL CLIENT WITH DATE OF DEATH 08 4061759417 Test Name OA3B APCL 07232013 1141 WESTERN WORLD RADIO
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
Program Start Provider CIRTS Issue PSA Client ID Client Name Program Status Enrollment ID Provider Name
06 LTCC APCL 01242014 1514 4061713685 Test Name APCL CLIENT WITH DATE OF DEATH CENTRAL THE ORIGINAL HOUSE OF PIES
Count 503
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Civil Rights PSA ALL Provider ALL PROVIDERS Program AC Start Date 01012017 End Date 12312017 The Poverty Level for Single is The Poverty Level for Couple is Sort by County
County Unduplicated Count
Report run on 08312018 1055 AM Page 1 of 1 civil_rightsrdf
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Client Information Report Start Date 01012017 End Date 12312017
Client ID 1001141246
Emergency
Client Name Test Name
Telephone () - Address 78 TEST STREET TALLAHASSEE FL 32399
Most Recent Caregiver Information Date Updated
Doctor
Comments
Client Demographic Information
Birth Date 06041940 Race W
Owner ID Ethnicity O
Most Recent Income Information
Ind Mon Inc Cpl Mon Inc
Ind Assets Couple Assets
Most Recent Assessment Information
Asmt Date Ref Risk Lvl
Asmt Site Spec Shel
AsmtType Spec Reg
Ref Date Primary CG
Ref Source Living Sit
Enrollment Information
Sex
Marital Status
F
S
Medicaid Number
ADL Score
ADL Count
IADL Score
IADL Count
Memory Score
Priority Score
Env Score
Nutr Score
Risk Score
Social Score
Rank
Provider Location Program Program Status Worker Start Date End Date
Care Plan Service Needed
Date Service Units Type Frq End Date
Care Plan Service Planned
Program Service Units Type Frq Start Date End Date
Services Received between 01012017 and 12312017
Service Billed Provider Location Worker Program Service Date Units Unit Type Amount
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Provider N
Client Service Units Report PSA ALL Provider ALL PROVIDERS Location 0000
Program ALL PROGRAMS Service ALL SERVICES Worker ALL WORKERS
City ALL CITIES Include Zero Unit N Include Aggregate N Calculated Amount equals the number of Units Provided times Fixed Cost if it existsService Start Date 01012017 Service End Date 12312017 If Fixed Cost does not exist Calculated
Group by PSA Provider Location Client Name County Worker Amount equals Billed Amount
Unduplicated Client Count 0 Grand Total 000 $000
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Clients In Common PSA All Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 County All Counties Worker All Workers
County JEFFERSON
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
MIAMI-DADE
0 0 0 0 0 0 0 0 0
4061539538 Test NameCounty Count
County
0 01
X
0 1
X
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
4061650856 Test Name X 4061486560 Test Name X 4062452921 Test Name X
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Clients Served Not Enrolled PSA ALL Start Date 01012017 End Date 12312017 Locations 0000 Provider All Providers
Service Service Min Serv Max Serv Program Start End Enrollment PSA Provider Location Program Consumer Name Client ID Service Date Date Status Enrollment Enrollment Provider
Count 0
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
4061472791 04
09
1092
1291
0072
0042
LTCC
LTCC
APCL
APCL
4062714543 06
06
1514
1762
0072
5006
LTCC
LTCC
APCL
APPL
4061802246 11
06
1177
1514
0179
0072
LTCC
LTCC
APCL
APCL
4061563719 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062644312 06
08
1514
1771
0072
0896
LTCC
LTCC
APCL
APCL
1001141670 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
1001141671 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
4062375003 07
05
05
07
1263
1755
1638
1263
0368
0072
0072
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062155124 06
06
1762
1514
0072
0072
LTCC
LTCC
APPL
APCL
4061743886 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0369
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4061499927 06
06
1514
1762
0072
5005
LTCC
LTCC
APCL
APPL
4061583524 08
06
1144
1514
0896
0072
LTCC
LTCC
APCL
APCL
4062694843 06
03
1514
1922
0072
0179
LTCC
LTCC
APCL
APCL
4062744517 07
06
1263
1514
0369
0072
LTCC
LTCC
APCL
APCL
4062005488 10
11
10
11
1929
1177
1164
1177
0072
0073
0179
0179
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
Total Count 15
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CODE DESCRIPTIONS Category ALL STATE TABLES
Code Description Active Available To Code Category
0 UNKNOWN Y CARES SUBJECTIVE_HEALTH_EVALUATION
01 ALACHUA Y COMMON COUNTIES
02 BAKER Y COMMON COUNTIES
03 BAY Y COMMON COUNTIES
04 BRADFORD Y COMMON COUNTIES
05 BREVARD Y COMMON COUNTIES
06 BROWARD Y COMMON COUNTIES
07 CALHOUN Y COMMON COUNTIES
08 CHARLOTTE Y COMMON COUNTIES
09 CITRUS Y COMMON COUNTIES
1 EXCELLENT Y CARES SUBJECTIVE_HEALTH_EVALUATION
10 CLAY Y COMMON COUNTIES
11 COLLIER Y COMMON COUNTIES
12 COLUMBIA Y COMMON COUNTIES
13 MIAMI-DADE Y COMMON COUNTIES
14 DESOTO Y COMMON COUNTIES
15 DIXIE Y COMMON COUNTIES
16 DUVAL Y COMMON COUNTIES
17 ESCAMBIA Y COMMON COUNTIES
18 FLAGLER Y COMMON COUNTIES
19 FRANKLIN Y COMMON COUNTIES
2 GOOD Y CARES SUBJECTIVE_HEALTH_EVALUATION
20 GADSDEN Y COMMON COUNTIES
21 GILCHRIST Y COMMON COUNTIES
22 GLADES Y COMMON COUNTIES
23 GULF Y COMMON COUNTIES
24 HAMILTON Y COMMON COUNTIES
25 HARDEE Y COMMON COUNTIES
26 HENDRY Y COMMON COUNTIES
27 HERNANDO Y COMMON COUNTIES
28 HIGHLANDS Y COMMON COUNTIES
Report run on 08312018 0140 PM Page 1 of 45 state_codesrdf Report run by RSHQALL Dispose of this report so that it cannot be read or reconstructed
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CONSUMER AGE VERIFICATION REPORT PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Program AC
Age at Start
Enroll or Start Enroll Provider Program Description Consumer Name Client ID DOB Svc date or Svc Date
Report run on 08312018 0203 PM Page 1 of 1 age_verifyrdf
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Contract Budget Information PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Program Service Provider Location County Served Provider Contract
Projected Service
Units Unit Measure
Projected Unduplicated
State Federal Share Client Count Begin Date End Date
Row Count 0 Amount Total
Report run on 08312018 0233 PM Page 1 of 1 contract_budgetrdf
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Start Enroll Latest Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Date Asmt Date Worker
O3C1 1036 000 4061653427 Test CENTRAL 34982 W M 07091930 09102013 09102013 CIRTS20804 0 Name
Report run on 08312018 1133 AM Page 1 of 6 actv_by_progrdf
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Start Enroll Date
Latest Asmt Date Worker
4061593624 Test Name CENTRAL 34946 B F 11261940 12012011 12312013 CIRTS23407
Count 164
Unduplicated Client Count 163
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Assessments After DOD Report
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Owner 1025
The shaded records indicate clients who have different DOBs andor different names
Assemt Current PSA Owner Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Owner Assessor
Provider Assessor
Assemt Date
Assemt Type
Unduplicated Count Total 0
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Open Enrollments
The Vital Statistics Data for 07192002 - 09112014PSA ALL Provider ALL Program Status ACTV Include MLTC ACTVS N
The shaded records indicate clients who have different DOBs andor different names
Enroll PSA
Enrollment Provider Loc Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Enroll Program Status
Enroll Program
Current Owner ID
02 1065 0072 4062244026 Test Name Test Name 10222004 03231917 03231917 ACTV CCE 1065
Count of enrollments for the Provider 1
Count of enrollments for the PSA 1
Count of enrollments for the Report 1
Unduplicated Count of Individuals with open enrollments and DOD PSA Total Clients Count
02 1
Total 1
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Report run on 08312018 0207 PM Page 1 of 3 vs_servicesrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Unduplicated count of individuals with Services after DOD
PSA Total Clients Count
Report Total
Report run on 08312018 0207 PM Page 2 of 3 vs_servicesrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
List of Clients with PSA table entry for SERVICES_AFTER_DOD
Unduplicated Count Total 0
Report run on 08312018 0207 PM Page 3 of 3 vs_servicesrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Age
Provider
Total
Age lt 60 Age 60 - 64 Age 65 - 74 Age 75 - 84 Age 85+ Total Clients Avg Age
Total
Avg Age
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Ethnicity
Provider Hispanic Other Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Race
American Indian Native Hawaiian Other Provider Asian Alaska Native Black Pacific Islander Minority White Multiple Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Gender
Provider Male Female Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Monthly Income
Provider 0 - - Higher than Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 5 of 5 demo_all_prvrdf
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None
Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Total Persons Served 0
Age lt 60 Years 0 0
Age 60 - 64 0 0
Age 65 - 74 0 0
Age 75 - 84 0 0
Age 85+ 0 0
Total Age 0 0
Average 000
Ethnicity Hispanic 0 0
Other Ethnicity 0 0
Unknown Ethnicity 0 0
Total 0 0
Race Asian 0 0
American Indian Alaska Native 0 0
Black 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority 0 0
White 0 0
Multiple 0 0
Unknown 0 0
Total 0 0
Sex Male 0 0
Female 0 0
Unknown Sex 0 0
Total 0 0
Monthly Income 0 - 0 0
- 0 0
Higher than 0 0
Unknown 0 0
Total 0 0
Report run on 08312018 1058 AM Page 1 of 2 demo_by_prov_detrdf Report run byRSHQALL Dispose of this report so that it can not be read or reconstructed
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Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Client ID Date Of Birth Ethnicity Race Sex Individual Monthly Income
Report run on 08312018 1058 AM Page 2 of 2 demo_by_prov_detrdf Report run byRSHQALL Dispose of this report so that it can not be read or reconstructed
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Demographics of Clients OAA Registered Served Only PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 City All Cities Program All Programs Service All Services County ALL COUNTIES Table OAA Registered Services Only Low Income Medium Income
Total Persons Served 0
Agelt 60 Years
Age 60 - 64
Age 65 - 74
Age 75 - 84
Age 85+
0
0
0
0
0
0
0
0
0
0
Monthly Income
0 -
-Higher than
Unknown
0
0
0
0
0
0
0
0
Total
Average
0
000
0 Total 0 0
Ethnicity Hispanic
Other
Unknown
0
0
0
0
0
0
Living Situation
Alone
Null
Policy Change
0
0
0
0
0
0
Total 0 0 Unknown
With Caregiver
0
0
0
0
Race Asian 0 0
With Other
With Other Caregiver
0
0
0
0
American Indian Alaska Native
Black
0
0
0
0Total Living Situation 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority
White
0
0
0
0 Limited English Proficiency
Multiple
Unknown
Total Race
0
0
0
0
0
0
Yes
No
Unknown
0
0
0
0
0
0
Total 0 0
Sex Male
Female
Unknown
0
0
0
0
0
0
Total 0 0
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Disaster Assistance Clients for a Provider PSA ALL Provider All Providers Location 0000 Worker All Workers City All Cities Zip Code All Zip Codes Sort By ZIP
Provider 1036 Provider Name Location 0000 Worker CIRTS18634
Need Care Client Name Address City Zip County Phone Asst Reg Situation Relat Care phone Care Name
34946 N WO DA 000 SAINT JAMES DRIVE CENTRAL (025) 101-0620 Test NameTest Name SAINT LUCIE (005) 100-0369 Y
Client is active and no assessment information is available Special Shelter and Special Registry are unknown
Report run on 08312018 1102 AM Page 1 of 8 disaster_by_provrdf
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
Total by PSA 0
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
ALACH BAKER BAY BRADF BREVA BROWA CALHO CHARL CITRUS CLAY COLLIE COLUM DESOT DIXIE DUVAL ESCAM FLAGL FRANK GADSDAssisted Household Report UA ORD RD RD UN OTTE R BIA O BIA ER LIN EN
1 of Household Assisted 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Households AssistedWith Gross Income
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C 100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D 125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
3 Households with at leastOne member
A 60 Years or older 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B Disabled 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C Age 5 years or under 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D Under 60 Years Old 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Undup Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Assisted
Applicant Household Report
of Applicant Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Energy Assisted Household Report
County of Assisted
Households
Households Assisted By Poverty Level
Under 75 75 - 100 101 - 125 126 - 150 Over 150 60 Years or older
At least one member who is
Age 5 years Age 2 years Age 3 years Disabled or younger and younger through 5
Under 60 Years Old
Undup Households
Assisted
Energy Assistance Total
Report run on 08312018 1107 AM Page 1 of 3 eheap_summaryrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Unduplicated Total 0 0
County of Assisted
Households Under 75 75 - 100
Households Assisted By Poverty Level
101 - 125 126 - 150 Over 150 60 Years or older Disabled
Age 5 years or younger
Age 2 years and younger
Age 3 years through 5
Under 60 Years Old
At least one member who is
Undup Households
Assisted
Other Assisted Household Report
Other Assistance Total
Report run on 08312018 1107 AM Page 2 of 3 eheap_summaryrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Applicant Household Report
County of Applicant
Households Under 75 75 - 100 101 - 125 126 - 150 Over 150 Income data
unavailable
Total 0
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01
Enrollment Active Consumer Count by Program PSA ALL Provider ALL PROVIDERS
County Description Program Count of Clients
BREVARD
ADI
CCE
HCE
LSP
NDP
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
MLTC
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
31
57
44
5
62
123
141
26
9
7
5
40
5
50
67
129
2
19
42
29
1
233
79
63
8
2
14
3
37
14
47
3
3
33
127
10
02
03
04
ALACHUA
BAKER
BAY
BRADFORD
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Enrollment Terminations with Reasons PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 Program All Programs Program Status ALL Program Status Worker ALL WORKERS
Last First Program Medicaid Provider Start End Name Name Client ID Status Description Worker Number Program Location Enrollment Enrollment
Count 0
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Enrollments with Care Plan Report
PSA ALL Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTIVE STATUS Care Plan Service ALL SERVICES Care Plan Start 01012017 Care Plan End 12312017
Care Plan Care Plan Care Plan Client Name
Unduplicated Client Count 0
Client ID Program Status Worker Start Date End Date Service
Report run on 08312018 1054 AM Page 1 of 1 enroll_careplrdf Report run by RSHQALL Dispose of this report so that it cannot be read or reconstructed
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PSA CLIENT_ID CLIENT_NAME OWNER PROVIDER_ID ASSESSMENT_DATE ASSESSOR_NAME MEDICAID_NUMBER CAREGIVER_CHANGE ENVIRONMENT_CHANGE HEALTH_CHANGE INCOME_CHANGE SITUATION_CHANGE INITIAL_ASSM ANNUAL_ASSM SSN REFERRAL_SOURCE 1114 N N N N Y N 771771777 SELFFAMILY 812017 JANE CASEWORKER 2 1001141633 TEST TEST N
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Fixed Service Costs List PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Provider Location County Program Service Reimbursement Unit Rate Provider Cost Per Unit Begin Valid End Valid
Count 0
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CIRTS Data Clean-up Report PSA ALL
Provider ALL PROVIDERS
Program Start Provider CIRTS Issue PSA Client ID Client Name Program Status Enrollment ID Provider Name
06 LTCC APCL 01242014 1514 4061713685 Test Name APCL CLIENT WITH DATE OF DEATH CENTRAL THE ORIGINAL HOUSE OF PIES
Count 503
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Civil Rights PSA ALL Provider ALL PROVIDERS Program AC Start Date 01012017 End Date 12312017 The Poverty Level for Single is The Poverty Level for Couple is Sort by County
County Unduplicated Count
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Client Information Report Start Date 01012017 End Date 12312017
Client ID 1001141246
Emergency
Client Name Test Name
Telephone () - Address 78 TEST STREET TALLAHASSEE FL 32399
Most Recent Caregiver Information Date Updated
Doctor
Comments
Client Demographic Information
Birth Date 06041940 Race W
Owner ID Ethnicity O
Most Recent Income Information
Ind Mon Inc Cpl Mon Inc
Ind Assets Couple Assets
Most Recent Assessment Information
Asmt Date Ref Risk Lvl
Asmt Site Spec Shel
AsmtType Spec Reg
Ref Date Primary CG
Ref Source Living Sit
Enrollment Information
Sex
Marital Status
F
S
Medicaid Number
ADL Score
ADL Count
IADL Score
IADL Count
Memory Score
Priority Score
Env Score
Nutr Score
Risk Score
Social Score
Rank
Provider Location Program Program Status Worker Start Date End Date
Care Plan Service Needed
Date Service Units Type Frq End Date
Care Plan Service Planned
Program Service Units Type Frq Start Date End Date
Services Received between 01012017 and 12312017
Service Billed Provider Location Worker Program Service Date Units Unit Type Amount
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Provider N
Client Service Units Report PSA ALL Provider ALL PROVIDERS Location 0000
Program ALL PROGRAMS Service ALL SERVICES Worker ALL WORKERS
City ALL CITIES Include Zero Unit N Include Aggregate N Calculated Amount equals the number of Units Provided times Fixed Cost if it existsService Start Date 01012017 Service End Date 12312017 If Fixed Cost does not exist Calculated
Group by PSA Provider Location Client Name County Worker Amount equals Billed Amount
Unduplicated Client Count 0 Grand Total 000 $000
Report run on 08312018 0234 PM Page 1 of 1 clnt_serv_unitsrdf
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Clients In Common PSA All Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 County All Counties Worker All Workers
County JEFFERSON
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
MIAMI-DADE
0 0 0 0 0 0 0 0 0
4061539538 Test NameCounty Count
County
0 01
X
0 1
X
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
4061650856 Test Name X 4061486560 Test Name X 4062452921 Test Name X
Report run on 08312018 1148 AM clients_commonrdfPage 1 of 4 Report run by RSHQALL Dispose of this Report so that it can not be read or reconstructed
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Clients Served Not Enrolled PSA ALL Start Date 01012017 End Date 12312017 Locations 0000 Provider All Providers
Service Service Min Serv Max Serv Program Start End Enrollment PSA Provider Location Program Consumer Name Client ID Service Date Date Status Enrollment Enrollment Provider
Count 0
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
4061472791 04
09
1092
1291
0072
0042
LTCC
LTCC
APCL
APCL
4062714543 06
06
1514
1762
0072
5006
LTCC
LTCC
APCL
APPL
4061802246 11
06
1177
1514
0179
0072
LTCC
LTCC
APCL
APCL
4061563719 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062644312 06
08
1514
1771
0072
0896
LTCC
LTCC
APCL
APCL
1001141670 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
1001141671 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
4062375003 07
05
05
07
1263
1755
1638
1263
0368
0072
0072
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062155124 06
06
1762
1514
0072
0072
LTCC
LTCC
APPL
APCL
4061743886 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0369
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4061499927 06
06
1514
1762
0072
5005
LTCC
LTCC
APCL
APPL
4061583524 08
06
1144
1514
0896
0072
LTCC
LTCC
APCL
APCL
4062694843 06
03
1514
1922
0072
0179
LTCC
LTCC
APCL
APCL
4062744517 07
06
1263
1514
0369
0072
LTCC
LTCC
APCL
APCL
4062005488 10
11
10
11
1929
1177
1164
1177
0072
0073
0179
0179
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
Report run on 08312018 0200 PM Page 1 of 2 clnts_mult_enrollrdf
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
Total Count 15
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CODE DESCRIPTIONS Category ALL STATE TABLES
Code Description Active Available To Code Category
0 UNKNOWN Y CARES SUBJECTIVE_HEALTH_EVALUATION
01 ALACHUA Y COMMON COUNTIES
02 BAKER Y COMMON COUNTIES
03 BAY Y COMMON COUNTIES
04 BRADFORD Y COMMON COUNTIES
05 BREVARD Y COMMON COUNTIES
06 BROWARD Y COMMON COUNTIES
07 CALHOUN Y COMMON COUNTIES
08 CHARLOTTE Y COMMON COUNTIES
09 CITRUS Y COMMON COUNTIES
1 EXCELLENT Y CARES SUBJECTIVE_HEALTH_EVALUATION
10 CLAY Y COMMON COUNTIES
11 COLLIER Y COMMON COUNTIES
12 COLUMBIA Y COMMON COUNTIES
13 MIAMI-DADE Y COMMON COUNTIES
14 DESOTO Y COMMON COUNTIES
15 DIXIE Y COMMON COUNTIES
16 DUVAL Y COMMON COUNTIES
17 ESCAMBIA Y COMMON COUNTIES
18 FLAGLER Y COMMON COUNTIES
19 FRANKLIN Y COMMON COUNTIES
2 GOOD Y CARES SUBJECTIVE_HEALTH_EVALUATION
20 GADSDEN Y COMMON COUNTIES
21 GILCHRIST Y COMMON COUNTIES
22 GLADES Y COMMON COUNTIES
23 GULF Y COMMON COUNTIES
24 HAMILTON Y COMMON COUNTIES
25 HARDEE Y COMMON COUNTIES
26 HENDRY Y COMMON COUNTIES
27 HERNANDO Y COMMON COUNTIES
28 HIGHLANDS Y COMMON COUNTIES
Report run on 08312018 0140 PM Page 1 of 45 state_codesrdf Report run by RSHQALL Dispose of this report so that it cannot be read or reconstructed
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CONSUMER AGE VERIFICATION REPORT PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Program AC
Age at Start
Enroll or Start Enroll Provider Program Description Consumer Name Client ID DOB Svc date or Svc Date
Report run on 08312018 0203 PM Page 1 of 1 age_verifyrdf
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Contract Budget Information PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Program Service Provider Location County Served Provider Contract
Projected Service
Units Unit Measure
Projected Unduplicated
State Federal Share Client Count Begin Date End Date
Row Count 0 Amount Total
Report run on 08312018 0233 PM Page 1 of 1 contract_budgetrdf
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Start Enroll Latest Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Date Asmt Date Worker
O3C1 1036 000 4061653427 Test CENTRAL 34982 W M 07091930 09102013 09102013 CIRTS20804 0 Name
Report run on 08312018 1133 AM Page 1 of 6 actv_by_progrdf
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Start Enroll Date
Latest Asmt Date Worker
4061593624 Test Name CENTRAL 34946 B F 11261940 12012011 12312013 CIRTS23407
Count 164
Unduplicated Client Count 163
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Assessments After DOD Report
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Owner 1025
The shaded records indicate clients who have different DOBs andor different names
Assemt Current PSA Owner Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Owner Assessor
Provider Assessor
Assemt Date
Assemt Type
Unduplicated Count Total 0
Report run on 08312018 0206 PM Page 1 of 1 vs_assmrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Open Enrollments
The Vital Statistics Data for 07192002 - 09112014PSA ALL Provider ALL Program Status ACTV Include MLTC ACTVS N
The shaded records indicate clients who have different DOBs andor different names
Enroll PSA
Enrollment Provider Loc Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Enroll Program Status
Enroll Program
Current Owner ID
02 1065 0072 4062244026 Test Name Test Name 10222004 03231917 03231917 ACTV CCE 1065
Count of enrollments for the Provider 1
Count of enrollments for the PSA 1
Count of enrollments for the Report 1
Unduplicated Count of Individuals with open enrollments and DOD PSA Total Clients Count
02 1
Total 1
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Report run on 08312018 0207 PM Page 1 of 3 vs_servicesrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Unduplicated count of individuals with Services after DOD
PSA Total Clients Count
Report Total
Report run on 08312018 0207 PM Page 2 of 3 vs_servicesrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
List of Clients with PSA table entry for SERVICES_AFTER_DOD
Unduplicated Count Total 0
Report run on 08312018 0207 PM Page 3 of 3 vs_servicesrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Age
Provider
Total
Age lt 60 Age 60 - 64 Age 65 - 74 Age 75 - 84 Age 85+ Total Clients Avg Age
Total
Avg Age
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Ethnicity
Provider Hispanic Other Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Race
American Indian Native Hawaiian Other Provider Asian Alaska Native Black Pacific Islander Minority White Multiple Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Gender
Provider Male Female Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Monthly Income
Provider 0 - - Higher than Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 5 of 5 demo_all_prvrdf
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None
Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Total Persons Served 0
Age lt 60 Years 0 0
Age 60 - 64 0 0
Age 65 - 74 0 0
Age 75 - 84 0 0
Age 85+ 0 0
Total Age 0 0
Average 000
Ethnicity Hispanic 0 0
Other Ethnicity 0 0
Unknown Ethnicity 0 0
Total 0 0
Race Asian 0 0
American Indian Alaska Native 0 0
Black 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority 0 0
White 0 0
Multiple 0 0
Unknown 0 0
Total 0 0
Sex Male 0 0
Female 0 0
Unknown Sex 0 0
Total 0 0
Monthly Income 0 - 0 0
- 0 0
Higher than 0 0
Unknown 0 0
Total 0 0
Report run on 08312018 1058 AM Page 1 of 2 demo_by_prov_detrdf Report run byRSHQALL Dispose of this report so that it can not be read or reconstructed
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Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Client ID Date Of Birth Ethnicity Race Sex Individual Monthly Income
Report run on 08312018 1058 AM Page 2 of 2 demo_by_prov_detrdf Report run byRSHQALL Dispose of this report so that it can not be read or reconstructed
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Demographics of Clients OAA Registered Served Only PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 City All Cities Program All Programs Service All Services County ALL COUNTIES Table OAA Registered Services Only Low Income Medium Income
Total Persons Served 0
Agelt 60 Years
Age 60 - 64
Age 65 - 74
Age 75 - 84
Age 85+
0
0
0
0
0
0
0
0
0
0
Monthly Income
0 -
-Higher than
Unknown
0
0
0
0
0
0
0
0
Total
Average
0
000
0 Total 0 0
Ethnicity Hispanic
Other
Unknown
0
0
0
0
0
0
Living Situation
Alone
Null
Policy Change
0
0
0
0
0
0
Total 0 0 Unknown
With Caregiver
0
0
0
0
Race Asian 0 0
With Other
With Other Caregiver
0
0
0
0
American Indian Alaska Native
Black
0
0
0
0Total Living Situation 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority
White
0
0
0
0 Limited English Proficiency
Multiple
Unknown
Total Race
0
0
0
0
0
0
Yes
No
Unknown
0
0
0
0
0
0
Total 0 0
Sex Male
Female
Unknown
0
0
0
0
0
0
Total 0 0
Report run on 08312018 1056 AM Page 1 of 1 demo_by_provrdf
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Disaster Assistance Clients for a Provider PSA ALL Provider All Providers Location 0000 Worker All Workers City All Cities Zip Code All Zip Codes Sort By ZIP
Provider 1036 Provider Name Location 0000 Worker CIRTS18634
Need Care Client Name Address City Zip County Phone Asst Reg Situation Relat Care phone Care Name
34946 N WO DA 000 SAINT JAMES DRIVE CENTRAL (025) 101-0620 Test NameTest Name SAINT LUCIE (005) 100-0369 Y
Client is active and no assessment information is available Special Shelter and Special Registry are unknown
Report run on 08312018 1102 AM Page 1 of 8 disaster_by_provrdf
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
Total by PSA 0
Report run on 08312018 1111 AM Page 1 of 5 eheap_exceptionsrdf
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
ALACH BAKER BAY BRADF BREVA BROWA CALHO CHARL CITRUS CLAY COLLIE COLUM DESOT DIXIE DUVAL ESCAM FLAGL FRANK GADSDAssisted Household Report UA ORD RD RD UN OTTE R BIA O BIA ER LIN EN
1 of Household Assisted 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Households AssistedWith Gross Income
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C 100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D 125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
3 Households with at leastOne member
A 60 Years or older 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B Disabled 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C Age 5 years or under 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D Under 60 Years Old 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Undup Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Assisted
Applicant Household Report
of Applicant Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
Report run on 08312018 1111 AM Page 2 of 5 eheap_exceptionsrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Energy Assisted Household Report
County of Assisted
Households
Households Assisted By Poverty Level
Under 75 75 - 100 101 - 125 126 - 150 Over 150 60 Years or older
At least one member who is
Age 5 years Age 2 years Age 3 years Disabled or younger and younger through 5
Under 60 Years Old
Undup Households
Assisted
Energy Assistance Total
Report run on 08312018 1107 AM Page 1 of 3 eheap_summaryrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Unduplicated Total 0 0
County of Assisted
Households Under 75 75 - 100
Households Assisted By Poverty Level
101 - 125 126 - 150 Over 150 60 Years or older Disabled
Age 5 years or younger
Age 2 years and younger
Age 3 years through 5
Under 60 Years Old
At least one member who is
Undup Households
Assisted
Other Assisted Household Report
Other Assistance Total
Report run on 08312018 1107 AM Page 2 of 3 eheap_summaryrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Applicant Household Report
County of Applicant
Households Under 75 75 - 100 101 - 125 126 - 150 Over 150 Income data
unavailable
Total 0
Report run on 08312018 1107 AM Page 3 of 3 eheap_summaryrdf
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01
Enrollment Active Consumer Count by Program PSA ALL Provider ALL PROVIDERS
County Description Program Count of Clients
BREVARD
ADI
CCE
HCE
LSP
NDP
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
MLTC
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
31
57
44
5
62
123
141
26
9
7
5
40
5
50
67
129
2
19
42
29
1
233
79
63
8
2
14
3
37
14
47
3
3
33
127
10
02
03
04
ALACHUA
BAKER
BAY
BRADFORD
Report run on 08312018 1148 AM Page 1 of 18 actv_countrdf
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Enrollment Terminations with Reasons PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 Program All Programs Program Status ALL Program Status Worker ALL WORKERS
Last First Program Medicaid Provider Start End Name Name Client ID Status Description Worker Number Program Location Enrollment Enrollment
Count 0
Report run on 08312018 1150 AM Page 1 of 1 enroll_term_reasonrdf
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Enrollments with Care Plan Report
PSA ALL Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTIVE STATUS Care Plan Service ALL SERVICES Care Plan Start 01012017 Care Plan End 12312017
Care Plan Care Plan Care Plan Client Name
Unduplicated Client Count 0
Client ID Program Status Worker Start Date End Date Service
Report run on 08312018 1054 AM Page 1 of 1 enroll_careplrdf Report run by RSHQALL Dispose of this report so that it cannot be read or reconstructed
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PSA CLIENT_ID CLIENT_NAME OWNER PROVIDER_ID ASSESSMENT_DATE ASSESSOR_NAME MEDICAID_NUMBER CAREGIVER_CHANGE ENVIRONMENT_CHANGE HEALTH_CHANGE INCOME_CHANGE SITUATION_CHANGE INITIAL_ASSM ANNUAL_ASSM SSN REFERRAL_SOURCE 1114 N N N N Y N 771771777 SELFFAMILY 812017 JANE CASEWORKER 2 1001141633 TEST TEST N
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Fixed Service Costs List PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Provider Location County Program Service Reimbursement Unit Rate Provider Cost Per Unit Begin Valid End Valid
Count 0
Report run on 08312018 0233 PM Page 1 of 1 fixed_service_costrdf
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Civil Rights PSA ALL Provider ALL PROVIDERS Program AC Start Date 01012017 End Date 12312017 The Poverty Level for Single is The Poverty Level for Couple is Sort by County
County Unduplicated Count
Report run on 08312018 1055 AM Page 1 of 1 civil_rightsrdf
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Client Information Report Start Date 01012017 End Date 12312017
Client ID 1001141246
Emergency
Client Name Test Name
Telephone () - Address 78 TEST STREET TALLAHASSEE FL 32399
Most Recent Caregiver Information Date Updated
Doctor
Comments
Client Demographic Information
Birth Date 06041940 Race W
Owner ID Ethnicity O
Most Recent Income Information
Ind Mon Inc Cpl Mon Inc
Ind Assets Couple Assets
Most Recent Assessment Information
Asmt Date Ref Risk Lvl
Asmt Site Spec Shel
AsmtType Spec Reg
Ref Date Primary CG
Ref Source Living Sit
Enrollment Information
Sex
Marital Status
F
S
Medicaid Number
ADL Score
ADL Count
IADL Score
IADL Count
Memory Score
Priority Score
Env Score
Nutr Score
Risk Score
Social Score
Rank
Provider Location Program Program Status Worker Start Date End Date
Care Plan Service Needed
Date Service Units Type Frq End Date
Care Plan Service Planned
Program Service Units Type Frq Start Date End Date
Services Received between 01012017 and 12312017
Service Billed Provider Location Worker Program Service Date Units Unit Type Amount
Report run on 08312018 0159 PM Page 1 of 1 client_info_formrdf
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Provider N
Client Service Units Report PSA ALL Provider ALL PROVIDERS Location 0000
Program ALL PROGRAMS Service ALL SERVICES Worker ALL WORKERS
City ALL CITIES Include Zero Unit N Include Aggregate N Calculated Amount equals the number of Units Provided times Fixed Cost if it existsService Start Date 01012017 Service End Date 12312017 If Fixed Cost does not exist Calculated
Group by PSA Provider Location Client Name County Worker Amount equals Billed Amount
Unduplicated Client Count 0 Grand Total 000 $000
Report run on 08312018 0234 PM Page 1 of 1 clnt_serv_unitsrdf
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Clients In Common PSA All Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 County All Counties Worker All Workers
County JEFFERSON
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
MIAMI-DADE
0 0 0 0 0 0 0 0 0
4061539538 Test NameCounty Count
County
0 01
X
0 1
X
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
4061650856 Test Name X 4061486560 Test Name X 4062452921 Test Name X
Report run on 08312018 1148 AM clients_commonrdfPage 1 of 4 Report run by RSHQALL Dispose of this Report so that it can not be read or reconstructed
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Clients Served Not Enrolled PSA ALL Start Date 01012017 End Date 12312017 Locations 0000 Provider All Providers
Service Service Min Serv Max Serv Program Start End Enrollment PSA Provider Location Program Consumer Name Client ID Service Date Date Status Enrollment Enrollment Provider
Count 0
Report run on 08312018 0201 PM Page 1 of 1 clnts_serv_no_enrrdf
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
4061472791 04
09
1092
1291
0072
0042
LTCC
LTCC
APCL
APCL
4062714543 06
06
1514
1762
0072
5006
LTCC
LTCC
APCL
APPL
4061802246 11
06
1177
1514
0179
0072
LTCC
LTCC
APCL
APCL
4061563719 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062644312 06
08
1514
1771
0072
0896
LTCC
LTCC
APCL
APCL
1001141670 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
1001141671 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
4062375003 07
05
05
07
1263
1755
1638
1263
0368
0072
0072
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062155124 06
06
1762
1514
0072
0072
LTCC
LTCC
APPL
APCL
4061743886 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0369
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4061499927 06
06
1514
1762
0072
5005
LTCC
LTCC
APCL
APPL
4061583524 08
06
1144
1514
0896
0072
LTCC
LTCC
APCL
APCL
4062694843 06
03
1514
1922
0072
0179
LTCC
LTCC
APCL
APCL
4062744517 07
06
1263
1514
0369
0072
LTCC
LTCC
APCL
APCL
4062005488 10
11
10
11
1929
1177
1164
1177
0072
0073
0179
0179
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
Report run on 08312018 0200 PM Page 1 of 2 clnts_mult_enrollrdf
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
Total Count 15
Report run on 08312018 0200 PM Page 2 of 2 clnts_mult_enrollrdf
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CODE DESCRIPTIONS Category ALL STATE TABLES
Code Description Active Available To Code Category
0 UNKNOWN Y CARES SUBJECTIVE_HEALTH_EVALUATION
01 ALACHUA Y COMMON COUNTIES
02 BAKER Y COMMON COUNTIES
03 BAY Y COMMON COUNTIES
04 BRADFORD Y COMMON COUNTIES
05 BREVARD Y COMMON COUNTIES
06 BROWARD Y COMMON COUNTIES
07 CALHOUN Y COMMON COUNTIES
08 CHARLOTTE Y COMMON COUNTIES
09 CITRUS Y COMMON COUNTIES
1 EXCELLENT Y CARES SUBJECTIVE_HEALTH_EVALUATION
10 CLAY Y COMMON COUNTIES
11 COLLIER Y COMMON COUNTIES
12 COLUMBIA Y COMMON COUNTIES
13 MIAMI-DADE Y COMMON COUNTIES
14 DESOTO Y COMMON COUNTIES
15 DIXIE Y COMMON COUNTIES
16 DUVAL Y COMMON COUNTIES
17 ESCAMBIA Y COMMON COUNTIES
18 FLAGLER Y COMMON COUNTIES
19 FRANKLIN Y COMMON COUNTIES
2 GOOD Y CARES SUBJECTIVE_HEALTH_EVALUATION
20 GADSDEN Y COMMON COUNTIES
21 GILCHRIST Y COMMON COUNTIES
22 GLADES Y COMMON COUNTIES
23 GULF Y COMMON COUNTIES
24 HAMILTON Y COMMON COUNTIES
25 HARDEE Y COMMON COUNTIES
26 HENDRY Y COMMON COUNTIES
27 HERNANDO Y COMMON COUNTIES
28 HIGHLANDS Y COMMON COUNTIES
Report run on 08312018 0140 PM Page 1 of 45 state_codesrdf Report run by RSHQALL Dispose of this report so that it cannot be read or reconstructed
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CONSUMER AGE VERIFICATION REPORT PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Program AC
Age at Start
Enroll or Start Enroll Provider Program Description Consumer Name Client ID DOB Svc date or Svc Date
Report run on 08312018 0203 PM Page 1 of 1 age_verifyrdf
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Contract Budget Information PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Program Service Provider Location County Served Provider Contract
Projected Service
Units Unit Measure
Projected Unduplicated
State Federal Share Client Count Begin Date End Date
Row Count 0 Amount Total
Report run on 08312018 0233 PM Page 1 of 1 contract_budgetrdf
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Start Enroll Latest Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Date Asmt Date Worker
O3C1 1036 000 4061653427 Test CENTRAL 34982 W M 07091930 09102013 09102013 CIRTS20804 0 Name
Report run on 08312018 1133 AM Page 1 of 6 actv_by_progrdf
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Start Enroll Date
Latest Asmt Date Worker
4061593624 Test Name CENTRAL 34946 B F 11261940 12012011 12312013 CIRTS23407
Count 164
Unduplicated Client Count 163
Report run on 08312018 1133 AM Page 6 of 6 actv_by_progrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Assessments After DOD Report
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Owner 1025
The shaded records indicate clients who have different DOBs andor different names
Assemt Current PSA Owner Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Owner Assessor
Provider Assessor
Assemt Date
Assemt Type
Unduplicated Count Total 0
Report run on 08312018 0206 PM Page 1 of 1 vs_assmrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Open Enrollments
The Vital Statistics Data for 07192002 - 09112014PSA ALL Provider ALL Program Status ACTV Include MLTC ACTVS N
The shaded records indicate clients who have different DOBs andor different names
Enroll PSA
Enrollment Provider Loc Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Enroll Program Status
Enroll Program
Current Owner ID
02 1065 0072 4062244026 Test Name Test Name 10222004 03231917 03231917 ACTV CCE 1065
Count of enrollments for the Provider 1
Count of enrollments for the PSA 1
Count of enrollments for the Report 1
Unduplicated Count of Individuals with open enrollments and DOD PSA Total Clients Count
02 1
Total 1
Report run on 08312018 0205 PM Page 1 of 1 vs_open_enrollrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Report run on 08312018 0207 PM Page 1 of 3 vs_servicesrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Unduplicated count of individuals with Services after DOD
PSA Total Clients Count
Report Total
Report run on 08312018 0207 PM Page 2 of 3 vs_servicesrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
List of Clients with PSA table entry for SERVICES_AFTER_DOD
Unduplicated Count Total 0
Report run on 08312018 0207 PM Page 3 of 3 vs_servicesrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Age
Provider
Total
Age lt 60 Age 60 - 64 Age 65 - 74 Age 75 - 84 Age 85+ Total Clients Avg Age
Total
Avg Age
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 1 of 5 demo_all_prvrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Ethnicity
Provider Hispanic Other Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 2 of 5 demo_all_prvrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Race
American Indian Native Hawaiian Other Provider Asian Alaska Native Black Pacific Islander Minority White Multiple Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 3 of 5 demo_all_prvrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Gender
Provider Male Female Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 4 of 5 demo_all_prvrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Monthly Income
Provider 0 - - Higher than Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 5 of 5 demo_all_prvrdf
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None
Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Total Persons Served 0
Age lt 60 Years 0 0
Age 60 - 64 0 0
Age 65 - 74 0 0
Age 75 - 84 0 0
Age 85+ 0 0
Total Age 0 0
Average 000
Ethnicity Hispanic 0 0
Other Ethnicity 0 0
Unknown Ethnicity 0 0
Total 0 0
Race Asian 0 0
American Indian Alaska Native 0 0
Black 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority 0 0
White 0 0
Multiple 0 0
Unknown 0 0
Total 0 0
Sex Male 0 0
Female 0 0
Unknown Sex 0 0
Total 0 0
Monthly Income 0 - 0 0
- 0 0
Higher than 0 0
Unknown 0 0
Total 0 0
Report run on 08312018 1058 AM Page 1 of 2 demo_by_prov_detrdf Report run byRSHQALL Dispose of this report so that it can not be read or reconstructed
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Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Client ID Date Of Birth Ethnicity Race Sex Individual Monthly Income
Report run on 08312018 1058 AM Page 2 of 2 demo_by_prov_detrdf Report run byRSHQALL Dispose of this report so that it can not be read or reconstructed
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Demographics of Clients OAA Registered Served Only PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 City All Cities Program All Programs Service All Services County ALL COUNTIES Table OAA Registered Services Only Low Income Medium Income
Total Persons Served 0
Agelt 60 Years
Age 60 - 64
Age 65 - 74
Age 75 - 84
Age 85+
0
0
0
0
0
0
0
0
0
0
Monthly Income
0 -
-Higher than
Unknown
0
0
0
0
0
0
0
0
Total
Average
0
000
0 Total 0 0
Ethnicity Hispanic
Other
Unknown
0
0
0
0
0
0
Living Situation
Alone
Null
Policy Change
0
0
0
0
0
0
Total 0 0 Unknown
With Caregiver
0
0
0
0
Race Asian 0 0
With Other
With Other Caregiver
0
0
0
0
American Indian Alaska Native
Black
0
0
0
0Total Living Situation 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority
White
0
0
0
0 Limited English Proficiency
Multiple
Unknown
Total Race
0
0
0
0
0
0
Yes
No
Unknown
0
0
0
0
0
0
Total 0 0
Sex Male
Female
Unknown
0
0
0
0
0
0
Total 0 0
Report run on 08312018 1056 AM Page 1 of 1 demo_by_provrdf
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Disaster Assistance Clients for a Provider PSA ALL Provider All Providers Location 0000 Worker All Workers City All Cities Zip Code All Zip Codes Sort By ZIP
Provider 1036 Provider Name Location 0000 Worker CIRTS18634
Need Care Client Name Address City Zip County Phone Asst Reg Situation Relat Care phone Care Name
34946 N WO DA 000 SAINT JAMES DRIVE CENTRAL (025) 101-0620 Test NameTest Name SAINT LUCIE (005) 100-0369 Y
Client is active and no assessment information is available Special Shelter and Special Registry are unknown
Report run on 08312018 1102 AM Page 1 of 8 disaster_by_provrdf
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
Total by PSA 0
Report run on 08312018 1111 AM Page 1 of 5 eheap_exceptionsrdf
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
ALACH BAKER BAY BRADF BREVA BROWA CALHO CHARL CITRUS CLAY COLLIE COLUM DESOT DIXIE DUVAL ESCAM FLAGL FRANK GADSDAssisted Household Report UA ORD RD RD UN OTTE R BIA O BIA ER LIN EN
1 of Household Assisted 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Households AssistedWith Gross Income
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C 100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D 125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
3 Households with at leastOne member
A 60 Years or older 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B Disabled 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C Age 5 years or under 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D Under 60 Years Old 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Undup Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Assisted
Applicant Household Report
of Applicant Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
Report run on 08312018 1111 AM Page 2 of 5 eheap_exceptionsrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Energy Assisted Household Report
County of Assisted
Households
Households Assisted By Poverty Level
Under 75 75 - 100 101 - 125 126 - 150 Over 150 60 Years or older
At least one member who is
Age 5 years Age 2 years Age 3 years Disabled or younger and younger through 5
Under 60 Years Old
Undup Households
Assisted
Energy Assistance Total
Report run on 08312018 1107 AM Page 1 of 3 eheap_summaryrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Unduplicated Total 0 0
County of Assisted
Households Under 75 75 - 100
Households Assisted By Poverty Level
101 - 125 126 - 150 Over 150 60 Years or older Disabled
Age 5 years or younger
Age 2 years and younger
Age 3 years through 5
Under 60 Years Old
At least one member who is
Undup Households
Assisted
Other Assisted Household Report
Other Assistance Total
Report run on 08312018 1107 AM Page 2 of 3 eheap_summaryrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Applicant Household Report
County of Applicant
Households Under 75 75 - 100 101 - 125 126 - 150 Over 150 Income data
unavailable
Total 0
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01
Enrollment Active Consumer Count by Program PSA ALL Provider ALL PROVIDERS
County Description Program Count of Clients
BREVARD
ADI
CCE
HCE
LSP
NDP
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
MLTC
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
31
57
44
5
62
123
141
26
9
7
5
40
5
50
67
129
2
19
42
29
1
233
79
63
8
2
14
3
37
14
47
3
3
33
127
10
02
03
04
ALACHUA
BAKER
BAY
BRADFORD
Report run on 08312018 1148 AM Page 1 of 18 actv_countrdf
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05
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Enrollment Terminations with Reasons PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 Program All Programs Program Status ALL Program Status Worker ALL WORKERS
Last First Program Medicaid Provider Start End Name Name Client ID Status Description Worker Number Program Location Enrollment Enrollment
Count 0
Report run on 08312018 1150 AM Page 1 of 1 enroll_term_reasonrdf
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Enrollments with Care Plan Report
PSA ALL Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTIVE STATUS Care Plan Service ALL SERVICES Care Plan Start 01012017 Care Plan End 12312017
Care Plan Care Plan Care Plan Client Name
Unduplicated Client Count 0
Client ID Program Status Worker Start Date End Date Service
Report run on 08312018 1054 AM Page 1 of 1 enroll_careplrdf Report run by RSHQALL Dispose of this report so that it cannot be read or reconstructed
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PSA CLIENT_ID CLIENT_NAME OWNER PROVIDER_ID ASSESSMENT_DATE ASSESSOR_NAME MEDICAID_NUMBER CAREGIVER_CHANGE ENVIRONMENT_CHANGE HEALTH_CHANGE INCOME_CHANGE SITUATION_CHANGE INITIAL_ASSM ANNUAL_ASSM SSN REFERRAL_SOURCE 1114 N N N N Y N 771771777 SELFFAMILY 812017 JANE CASEWORKER 2 1001141633 TEST TEST N
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Fixed Service Costs List PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Provider Location County Program Service Reimbursement Unit Rate Provider Cost Per Unit Begin Valid End Valid
Count 0
Report run on 08312018 0233 PM Page 1 of 1 fixed_service_costrdf
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Client Information Report Start Date 01012017 End Date 12312017
Client ID 1001141246
Emergency
Client Name Test Name
Telephone () - Address 78 TEST STREET TALLAHASSEE FL 32399
Most Recent Caregiver Information Date Updated
Doctor
Comments
Client Demographic Information
Birth Date 06041940 Race W
Owner ID Ethnicity O
Most Recent Income Information
Ind Mon Inc Cpl Mon Inc
Ind Assets Couple Assets
Most Recent Assessment Information
Asmt Date Ref Risk Lvl
Asmt Site Spec Shel
AsmtType Spec Reg
Ref Date Primary CG
Ref Source Living Sit
Enrollment Information
Sex
Marital Status
F
S
Medicaid Number
ADL Score
ADL Count
IADL Score
IADL Count
Memory Score
Priority Score
Env Score
Nutr Score
Risk Score
Social Score
Rank
Provider Location Program Program Status Worker Start Date End Date
Care Plan Service Needed
Date Service Units Type Frq End Date
Care Plan Service Planned
Program Service Units Type Frq Start Date End Date
Services Received between 01012017 and 12312017
Service Billed Provider Location Worker Program Service Date Units Unit Type Amount
Report run on 08312018 0159 PM Page 1 of 1 client_info_formrdf
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Provider N
Client Service Units Report PSA ALL Provider ALL PROVIDERS Location 0000
Program ALL PROGRAMS Service ALL SERVICES Worker ALL WORKERS
City ALL CITIES Include Zero Unit N Include Aggregate N Calculated Amount equals the number of Units Provided times Fixed Cost if it existsService Start Date 01012017 Service End Date 12312017 If Fixed Cost does not exist Calculated
Group by PSA Provider Location Client Name County Worker Amount equals Billed Amount
Unduplicated Client Count 0 Grand Total 000 $000
Report run on 08312018 0234 PM Page 1 of 1 clnt_serv_unitsrdf
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Clients In Common PSA All Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 County All Counties Worker All Workers
County JEFFERSON
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
MIAMI-DADE
0 0 0 0 0 0 0 0 0
4061539538 Test NameCounty Count
County
0 01
X
0 1
X
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
4061650856 Test Name X 4061486560 Test Name X 4062452921 Test Name X
Report run on 08312018 1148 AM clients_commonrdfPage 1 of 4 Report run by RSHQALL Dispose of this Report so that it can not be read or reconstructed
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Clients Served Not Enrolled PSA ALL Start Date 01012017 End Date 12312017 Locations 0000 Provider All Providers
Service Service Min Serv Max Serv Program Start End Enrollment PSA Provider Location Program Consumer Name Client ID Service Date Date Status Enrollment Enrollment Provider
Count 0
Report run on 08312018 0201 PM Page 1 of 1 clnts_serv_no_enrrdf
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
4061472791 04
09
1092
1291
0072
0042
LTCC
LTCC
APCL
APCL
4062714543 06
06
1514
1762
0072
5006
LTCC
LTCC
APCL
APPL
4061802246 11
06
1177
1514
0179
0072
LTCC
LTCC
APCL
APCL
4061563719 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062644312 06
08
1514
1771
0072
0896
LTCC
LTCC
APCL
APCL
1001141670 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
1001141671 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
4062375003 07
05
05
07
1263
1755
1638
1263
0368
0072
0072
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062155124 06
06
1762
1514
0072
0072
LTCC
LTCC
APPL
APCL
4061743886 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0369
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4061499927 06
06
1514
1762
0072
5005
LTCC
LTCC
APCL
APPL
4061583524 08
06
1144
1514
0896
0072
LTCC
LTCC
APCL
APCL
4062694843 06
03
1514
1922
0072
0179
LTCC
LTCC
APCL
APCL
4062744517 07
06
1263
1514
0369
0072
LTCC
LTCC
APCL
APCL
4062005488 10
11
10
11
1929
1177
1164
1177
0072
0073
0179
0179
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
Report run on 08312018 0200 PM Page 1 of 2 clnts_mult_enrollrdf
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
Total Count 15
Report run on 08312018 0200 PM Page 2 of 2 clnts_mult_enrollrdf
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CODE DESCRIPTIONS Category ALL STATE TABLES
Code Description Active Available To Code Category
0 UNKNOWN Y CARES SUBJECTIVE_HEALTH_EVALUATION
01 ALACHUA Y COMMON COUNTIES
02 BAKER Y COMMON COUNTIES
03 BAY Y COMMON COUNTIES
04 BRADFORD Y COMMON COUNTIES
05 BREVARD Y COMMON COUNTIES
06 BROWARD Y COMMON COUNTIES
07 CALHOUN Y COMMON COUNTIES
08 CHARLOTTE Y COMMON COUNTIES
09 CITRUS Y COMMON COUNTIES
1 EXCELLENT Y CARES SUBJECTIVE_HEALTH_EVALUATION
10 CLAY Y COMMON COUNTIES
11 COLLIER Y COMMON COUNTIES
12 COLUMBIA Y COMMON COUNTIES
13 MIAMI-DADE Y COMMON COUNTIES
14 DESOTO Y COMMON COUNTIES
15 DIXIE Y COMMON COUNTIES
16 DUVAL Y COMMON COUNTIES
17 ESCAMBIA Y COMMON COUNTIES
18 FLAGLER Y COMMON COUNTIES
19 FRANKLIN Y COMMON COUNTIES
2 GOOD Y CARES SUBJECTIVE_HEALTH_EVALUATION
20 GADSDEN Y COMMON COUNTIES
21 GILCHRIST Y COMMON COUNTIES
22 GLADES Y COMMON COUNTIES
23 GULF Y COMMON COUNTIES
24 HAMILTON Y COMMON COUNTIES
25 HARDEE Y COMMON COUNTIES
26 HENDRY Y COMMON COUNTIES
27 HERNANDO Y COMMON COUNTIES
28 HIGHLANDS Y COMMON COUNTIES
Report run on 08312018 0140 PM Page 1 of 45 state_codesrdf Report run by RSHQALL Dispose of this report so that it cannot be read or reconstructed
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CONSUMER AGE VERIFICATION REPORT PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Program AC
Age at Start
Enroll or Start Enroll Provider Program Description Consumer Name Client ID DOB Svc date or Svc Date
Report run on 08312018 0203 PM Page 1 of 1 age_verifyrdf
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Contract Budget Information PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Program Service Provider Location County Served Provider Contract
Projected Service
Units Unit Measure
Projected Unduplicated
State Federal Share Client Count Begin Date End Date
Row Count 0 Amount Total
Report run on 08312018 0233 PM Page 1 of 1 contract_budgetrdf
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Start Enroll Latest Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Date Asmt Date Worker
O3C1 1036 000 4061653427 Test CENTRAL 34982 W M 07091930 09102013 09102013 CIRTS20804 0 Name
Report run on 08312018 1133 AM Page 1 of 6 actv_by_progrdf
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Start Enroll Date
Latest Asmt Date Worker
4061593624 Test Name CENTRAL 34946 B F 11261940 12012011 12312013 CIRTS23407
Count 164
Unduplicated Client Count 163
Report run on 08312018 1133 AM Page 6 of 6 actv_by_progrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Assessments After DOD Report
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Owner 1025
The shaded records indicate clients who have different DOBs andor different names
Assemt Current PSA Owner Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Owner Assessor
Provider Assessor
Assemt Date
Assemt Type
Unduplicated Count Total 0
Report run on 08312018 0206 PM Page 1 of 1 vs_assmrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Open Enrollments
The Vital Statistics Data for 07192002 - 09112014PSA ALL Provider ALL Program Status ACTV Include MLTC ACTVS N
The shaded records indicate clients who have different DOBs andor different names
Enroll PSA
Enrollment Provider Loc Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Enroll Program Status
Enroll Program
Current Owner ID
02 1065 0072 4062244026 Test Name Test Name 10222004 03231917 03231917 ACTV CCE 1065
Count of enrollments for the Provider 1
Count of enrollments for the PSA 1
Count of enrollments for the Report 1
Unduplicated Count of Individuals with open enrollments and DOD PSA Total Clients Count
02 1
Total 1
Report run on 08312018 0205 PM Page 1 of 1 vs_open_enrollrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Report run on 08312018 0207 PM Page 1 of 3 vs_servicesrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Unduplicated count of individuals with Services after DOD
PSA Total Clients Count
Report Total
Report run on 08312018 0207 PM Page 2 of 3 vs_servicesrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
List of Clients with PSA table entry for SERVICES_AFTER_DOD
Unduplicated Count Total 0
Report run on 08312018 0207 PM Page 3 of 3 vs_servicesrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Age
Provider
Total
Age lt 60 Age 60 - 64 Age 65 - 74 Age 75 - 84 Age 85+ Total Clients Avg Age
Total
Avg Age
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 1 of 5 demo_all_prvrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Ethnicity
Provider Hispanic Other Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 2 of 5 demo_all_prvrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Race
American Indian Native Hawaiian Other Provider Asian Alaska Native Black Pacific Islander Minority White Multiple Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Gender
Provider Male Female Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 4 of 5 demo_all_prvrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Monthly Income
Provider 0 - - Higher than Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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None
Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Total Persons Served 0
Age lt 60 Years 0 0
Age 60 - 64 0 0
Age 65 - 74 0 0
Age 75 - 84 0 0
Age 85+ 0 0
Total Age 0 0
Average 000
Ethnicity Hispanic 0 0
Other Ethnicity 0 0
Unknown Ethnicity 0 0
Total 0 0
Race Asian 0 0
American Indian Alaska Native 0 0
Black 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority 0 0
White 0 0
Multiple 0 0
Unknown 0 0
Total 0 0
Sex Male 0 0
Female 0 0
Unknown Sex 0 0
Total 0 0
Monthly Income 0 - 0 0
- 0 0
Higher than 0 0
Unknown 0 0
Total 0 0
Report run on 08312018 1058 AM Page 1 of 2 demo_by_prov_detrdf Report run byRSHQALL Dispose of this report so that it can not be read or reconstructed
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Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Client ID Date Of Birth Ethnicity Race Sex Individual Monthly Income
Report run on 08312018 1058 AM Page 2 of 2 demo_by_prov_detrdf Report run byRSHQALL Dispose of this report so that it can not be read or reconstructed
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Demographics of Clients OAA Registered Served Only PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 City All Cities Program All Programs Service All Services County ALL COUNTIES Table OAA Registered Services Only Low Income Medium Income
Total Persons Served 0
Agelt 60 Years
Age 60 - 64
Age 65 - 74
Age 75 - 84
Age 85+
0
0
0
0
0
0
0
0
0
0
Monthly Income
0 -
-Higher than
Unknown
0
0
0
0
0
0
0
0
Total
Average
0
000
0 Total 0 0
Ethnicity Hispanic
Other
Unknown
0
0
0
0
0
0
Living Situation
Alone
Null
Policy Change
0
0
0
0
0
0
Total 0 0 Unknown
With Caregiver
0
0
0
0
Race Asian 0 0
With Other
With Other Caregiver
0
0
0
0
American Indian Alaska Native
Black
0
0
0
0Total Living Situation 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority
White
0
0
0
0 Limited English Proficiency
Multiple
Unknown
Total Race
0
0
0
0
0
0
Yes
No
Unknown
0
0
0
0
0
0
Total 0 0
Sex Male
Female
Unknown
0
0
0
0
0
0
Total 0 0
Report run on 08312018 1056 AM Page 1 of 1 demo_by_provrdf
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Disaster Assistance Clients for a Provider PSA ALL Provider All Providers Location 0000 Worker All Workers City All Cities Zip Code All Zip Codes Sort By ZIP
Provider 1036 Provider Name Location 0000 Worker CIRTS18634
Need Care Client Name Address City Zip County Phone Asst Reg Situation Relat Care phone Care Name
34946 N WO DA 000 SAINT JAMES DRIVE CENTRAL (025) 101-0620 Test NameTest Name SAINT LUCIE (005) 100-0369 Y
Client is active and no assessment information is available Special Shelter and Special Registry are unknown
Report run on 08312018 1102 AM Page 1 of 8 disaster_by_provrdf
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
Total by PSA 0
Report run on 08312018 1111 AM Page 1 of 5 eheap_exceptionsrdf
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
ALACH BAKER BAY BRADF BREVA BROWA CALHO CHARL CITRUS CLAY COLLIE COLUM DESOT DIXIE DUVAL ESCAM FLAGL FRANK GADSDAssisted Household Report UA ORD RD RD UN OTTE R BIA O BIA ER LIN EN
1 of Household Assisted 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Households AssistedWith Gross Income
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C 100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D 125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
3 Households with at leastOne member
A 60 Years or older 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B Disabled 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C Age 5 years or under 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D Under 60 Years Old 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Undup Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Assisted
Applicant Household Report
of Applicant Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
Report run on 08312018 1111 AM Page 2 of 5 eheap_exceptionsrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Energy Assisted Household Report
County of Assisted
Households
Households Assisted By Poverty Level
Under 75 75 - 100 101 - 125 126 - 150 Over 150 60 Years or older
At least one member who is
Age 5 years Age 2 years Age 3 years Disabled or younger and younger through 5
Under 60 Years Old
Undup Households
Assisted
Energy Assistance Total
Report run on 08312018 1107 AM Page 1 of 3 eheap_summaryrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Unduplicated Total 0 0
County of Assisted
Households Under 75 75 - 100
Households Assisted By Poverty Level
101 - 125 126 - 150 Over 150 60 Years or older Disabled
Age 5 years or younger
Age 2 years and younger
Age 3 years through 5
Under 60 Years Old
At least one member who is
Undup Households
Assisted
Other Assisted Household Report
Other Assistance Total
Report run on 08312018 1107 AM Page 2 of 3 eheap_summaryrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Applicant Household Report
County of Applicant
Households Under 75 75 - 100 101 - 125 126 - 150 Over 150 Income data
unavailable
Total 0
Report run on 08312018 1107 AM Page 3 of 3 eheap_summaryrdf
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01
Enrollment Active Consumer Count by Program PSA ALL Provider ALL PROVIDERS
County Description Program Count of Clients
BREVARD
ADI
CCE
HCE
LSP
NDP
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
MLTC
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
31
57
44
5
62
123
141
26
9
7
5
40
5
50
67
129
2
19
42
29
1
233
79
63
8
2
14
3
37
14
47
3
3
33
127
10
02
03
04
ALACHUA
BAKER
BAY
BRADFORD
Report run on 08312018 1148 AM Page 1 of 18 actv_countrdf
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05
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Enrollment Terminations with Reasons PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 Program All Programs Program Status ALL Program Status Worker ALL WORKERS
Last First Program Medicaid Provider Start End Name Name Client ID Status Description Worker Number Program Location Enrollment Enrollment
Count 0
Report run on 08312018 1150 AM Page 1 of 1 enroll_term_reasonrdf
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Enrollments with Care Plan Report
PSA ALL Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTIVE STATUS Care Plan Service ALL SERVICES Care Plan Start 01012017 Care Plan End 12312017
Care Plan Care Plan Care Plan Client Name
Unduplicated Client Count 0
Client ID Program Status Worker Start Date End Date Service
Report run on 08312018 1054 AM Page 1 of 1 enroll_careplrdf Report run by RSHQALL Dispose of this report so that it cannot be read or reconstructed
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PSA CLIENT_ID CLIENT_NAME OWNER PROVIDER_ID ASSESSMENT_DATE ASSESSOR_NAME MEDICAID_NUMBER CAREGIVER_CHANGE ENVIRONMENT_CHANGE HEALTH_CHANGE INCOME_CHANGE SITUATION_CHANGE INITIAL_ASSM ANNUAL_ASSM SSN REFERRAL_SOURCE 1114 N N N N Y N 771771777 SELFFAMILY 812017 JANE CASEWORKER 2 1001141633 TEST TEST N
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Fixed Service Costs List PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Provider Location County Program Service Reimbursement Unit Rate Provider Cost Per Unit Begin Valid End Valid
Count 0
Report run on 08312018 0233 PM Page 1 of 1 fixed_service_costrdf
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Provider N
Client Service Units Report PSA ALL Provider ALL PROVIDERS Location 0000
Program ALL PROGRAMS Service ALL SERVICES Worker ALL WORKERS
City ALL CITIES Include Zero Unit N Include Aggregate N Calculated Amount equals the number of Units Provided times Fixed Cost if it existsService Start Date 01012017 Service End Date 12312017 If Fixed Cost does not exist Calculated
Group by PSA Provider Location Client Name County Worker Amount equals Billed Amount
Unduplicated Client Count 0 Grand Total 000 $000
Report run on 08312018 0234 PM Page 1 of 1 clnt_serv_unitsrdf
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Clients In Common PSA All Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 County All Counties Worker All Workers
County JEFFERSON
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
MIAMI-DADE
0 0 0 0 0 0 0 0 0
4061539538 Test NameCounty Count
County
0 01
X
0 1
X
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
4061650856 Test Name X 4061486560 Test Name X 4062452921 Test Name X
Report run on 08312018 1148 AM clients_commonrdfPage 1 of 4 Report run by RSHQALL Dispose of this Report so that it can not be read or reconstructed
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Clients Served Not Enrolled PSA ALL Start Date 01012017 End Date 12312017 Locations 0000 Provider All Providers
Service Service Min Serv Max Serv Program Start End Enrollment PSA Provider Location Program Consumer Name Client ID Service Date Date Status Enrollment Enrollment Provider
Count 0
Report run on 08312018 0201 PM Page 1 of 1 clnts_serv_no_enrrdf
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
4061472791 04
09
1092
1291
0072
0042
LTCC
LTCC
APCL
APCL
4062714543 06
06
1514
1762
0072
5006
LTCC
LTCC
APCL
APPL
4061802246 11
06
1177
1514
0179
0072
LTCC
LTCC
APCL
APCL
4061563719 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062644312 06
08
1514
1771
0072
0896
LTCC
LTCC
APCL
APCL
1001141670 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
1001141671 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
4062375003 07
05
05
07
1263
1755
1638
1263
0368
0072
0072
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062155124 06
06
1762
1514
0072
0072
LTCC
LTCC
APPL
APCL
4061743886 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0369
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4061499927 06
06
1514
1762
0072
5005
LTCC
LTCC
APCL
APPL
4061583524 08
06
1144
1514
0896
0072
LTCC
LTCC
APCL
APCL
4062694843 06
03
1514
1922
0072
0179
LTCC
LTCC
APCL
APCL
4062744517 07
06
1263
1514
0369
0072
LTCC
LTCC
APCL
APCL
4062005488 10
11
10
11
1929
1177
1164
1177
0072
0073
0179
0179
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
Report run on 08312018 0200 PM Page 1 of 2 clnts_mult_enrollrdf
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
Total Count 15
Report run on 08312018 0200 PM Page 2 of 2 clnts_mult_enrollrdf
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CODE DESCRIPTIONS Category ALL STATE TABLES
Code Description Active Available To Code Category
0 UNKNOWN Y CARES SUBJECTIVE_HEALTH_EVALUATION
01 ALACHUA Y COMMON COUNTIES
02 BAKER Y COMMON COUNTIES
03 BAY Y COMMON COUNTIES
04 BRADFORD Y COMMON COUNTIES
05 BREVARD Y COMMON COUNTIES
06 BROWARD Y COMMON COUNTIES
07 CALHOUN Y COMMON COUNTIES
08 CHARLOTTE Y COMMON COUNTIES
09 CITRUS Y COMMON COUNTIES
1 EXCELLENT Y CARES SUBJECTIVE_HEALTH_EVALUATION
10 CLAY Y COMMON COUNTIES
11 COLLIER Y COMMON COUNTIES
12 COLUMBIA Y COMMON COUNTIES
13 MIAMI-DADE Y COMMON COUNTIES
14 DESOTO Y COMMON COUNTIES
15 DIXIE Y COMMON COUNTIES
16 DUVAL Y COMMON COUNTIES
17 ESCAMBIA Y COMMON COUNTIES
18 FLAGLER Y COMMON COUNTIES
19 FRANKLIN Y COMMON COUNTIES
2 GOOD Y CARES SUBJECTIVE_HEALTH_EVALUATION
20 GADSDEN Y COMMON COUNTIES
21 GILCHRIST Y COMMON COUNTIES
22 GLADES Y COMMON COUNTIES
23 GULF Y COMMON COUNTIES
24 HAMILTON Y COMMON COUNTIES
25 HARDEE Y COMMON COUNTIES
26 HENDRY Y COMMON COUNTIES
27 HERNANDO Y COMMON COUNTIES
28 HIGHLANDS Y COMMON COUNTIES
Report run on 08312018 0140 PM Page 1 of 45 state_codesrdf Report run by RSHQALL Dispose of this report so that it cannot be read or reconstructed
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CONSUMER AGE VERIFICATION REPORT PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Program AC
Age at Start
Enroll or Start Enroll Provider Program Description Consumer Name Client ID DOB Svc date or Svc Date
Report run on 08312018 0203 PM Page 1 of 1 age_verifyrdf
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Contract Budget Information PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Program Service Provider Location County Served Provider Contract
Projected Service
Units Unit Measure
Projected Unduplicated
State Federal Share Client Count Begin Date End Date
Row Count 0 Amount Total
Report run on 08312018 0233 PM Page 1 of 1 contract_budgetrdf
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Start Enroll Latest Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Date Asmt Date Worker
O3C1 1036 000 4061653427 Test CENTRAL 34982 W M 07091930 09102013 09102013 CIRTS20804 0 Name
Report run on 08312018 1133 AM Page 1 of 6 actv_by_progrdf
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Start Enroll Date
Latest Asmt Date Worker
4061593624 Test Name CENTRAL 34946 B F 11261940 12012011 12312013 CIRTS23407
Count 164
Unduplicated Client Count 163
Report run on 08312018 1133 AM Page 6 of 6 actv_by_progrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Assessments After DOD Report
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Owner 1025
The shaded records indicate clients who have different DOBs andor different names
Assemt Current PSA Owner Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Owner Assessor
Provider Assessor
Assemt Date
Assemt Type
Unduplicated Count Total 0
Report run on 08312018 0206 PM Page 1 of 1 vs_assmrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Open Enrollments
The Vital Statistics Data for 07192002 - 09112014PSA ALL Provider ALL Program Status ACTV Include MLTC ACTVS N
The shaded records indicate clients who have different DOBs andor different names
Enroll PSA
Enrollment Provider Loc Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Enroll Program Status
Enroll Program
Current Owner ID
02 1065 0072 4062244026 Test Name Test Name 10222004 03231917 03231917 ACTV CCE 1065
Count of enrollments for the Provider 1
Count of enrollments for the PSA 1
Count of enrollments for the Report 1
Unduplicated Count of Individuals with open enrollments and DOD PSA Total Clients Count
02 1
Total 1
Report run on 08312018 0205 PM Page 1 of 1 vs_open_enrollrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Report run on 08312018 0207 PM Page 1 of 3 vs_servicesrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Unduplicated count of individuals with Services after DOD
PSA Total Clients Count
Report Total
Report run on 08312018 0207 PM Page 2 of 3 vs_servicesrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
List of Clients with PSA table entry for SERVICES_AFTER_DOD
Unduplicated Count Total 0
Report run on 08312018 0207 PM Page 3 of 3 vs_servicesrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Age
Provider
Total
Age lt 60 Age 60 - 64 Age 65 - 74 Age 75 - 84 Age 85+ Total Clients Avg Age
Total
Avg Age
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 1 of 5 demo_all_prvrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Ethnicity
Provider Hispanic Other Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 2 of 5 demo_all_prvrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Race
American Indian Native Hawaiian Other Provider Asian Alaska Native Black Pacific Islander Minority White Multiple Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 3 of 5 demo_all_prvrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Gender
Provider Male Female Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 4 of 5 demo_all_prvrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Monthly Income
Provider 0 - - Higher than Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 5 of 5 demo_all_prvrdf
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None
Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Total Persons Served 0
Age lt 60 Years 0 0
Age 60 - 64 0 0
Age 65 - 74 0 0
Age 75 - 84 0 0
Age 85+ 0 0
Total Age 0 0
Average 000
Ethnicity Hispanic 0 0
Other Ethnicity 0 0
Unknown Ethnicity 0 0
Total 0 0
Race Asian 0 0
American Indian Alaska Native 0 0
Black 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority 0 0
White 0 0
Multiple 0 0
Unknown 0 0
Total 0 0
Sex Male 0 0
Female 0 0
Unknown Sex 0 0
Total 0 0
Monthly Income 0 - 0 0
- 0 0
Higher than 0 0
Unknown 0 0
Total 0 0
Report run on 08312018 1058 AM Page 1 of 2 demo_by_prov_detrdf Report run byRSHQALL Dispose of this report so that it can not be read or reconstructed
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Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Client ID Date Of Birth Ethnicity Race Sex Individual Monthly Income
Report run on 08312018 1058 AM Page 2 of 2 demo_by_prov_detrdf Report run byRSHQALL Dispose of this report so that it can not be read or reconstructed
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Demographics of Clients OAA Registered Served Only PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 City All Cities Program All Programs Service All Services County ALL COUNTIES Table OAA Registered Services Only Low Income Medium Income
Total Persons Served 0
Agelt 60 Years
Age 60 - 64
Age 65 - 74
Age 75 - 84
Age 85+
0
0
0
0
0
0
0
0
0
0
Monthly Income
0 -
-Higher than
Unknown
0
0
0
0
0
0
0
0
Total
Average
0
000
0 Total 0 0
Ethnicity Hispanic
Other
Unknown
0
0
0
0
0
0
Living Situation
Alone
Null
Policy Change
0
0
0
0
0
0
Total 0 0 Unknown
With Caregiver
0
0
0
0
Race Asian 0 0
With Other
With Other Caregiver
0
0
0
0
American Indian Alaska Native
Black
0
0
0
0Total Living Situation 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority
White
0
0
0
0 Limited English Proficiency
Multiple
Unknown
Total Race
0
0
0
0
0
0
Yes
No
Unknown
0
0
0
0
0
0
Total 0 0
Sex Male
Female
Unknown
0
0
0
0
0
0
Total 0 0
Report run on 08312018 1056 AM Page 1 of 1 demo_by_provrdf
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Disaster Assistance Clients for a Provider PSA ALL Provider All Providers Location 0000 Worker All Workers City All Cities Zip Code All Zip Codes Sort By ZIP
Provider 1036 Provider Name Location 0000 Worker CIRTS18634
Need Care Client Name Address City Zip County Phone Asst Reg Situation Relat Care phone Care Name
34946 N WO DA 000 SAINT JAMES DRIVE CENTRAL (025) 101-0620 Test NameTest Name SAINT LUCIE (005) 100-0369 Y
Client is active and no assessment information is available Special Shelter and Special Registry are unknown
Report run on 08312018 1102 AM Page 1 of 8 disaster_by_provrdf
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
Total by PSA 0
Report run on 08312018 1111 AM Page 1 of 5 eheap_exceptionsrdf
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
ALACH BAKER BAY BRADF BREVA BROWA CALHO CHARL CITRUS CLAY COLLIE COLUM DESOT DIXIE DUVAL ESCAM FLAGL FRANK GADSDAssisted Household Report UA ORD RD RD UN OTTE R BIA O BIA ER LIN EN
1 of Household Assisted 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Households AssistedWith Gross Income
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C 100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D 125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
3 Households with at leastOne member
A 60 Years or older 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B Disabled 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C Age 5 years or under 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D Under 60 Years Old 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Undup Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Assisted
Applicant Household Report
of Applicant Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
Report run on 08312018 1111 AM Page 2 of 5 eheap_exceptionsrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Energy Assisted Household Report
County of Assisted
Households
Households Assisted By Poverty Level
Under 75 75 - 100 101 - 125 126 - 150 Over 150 60 Years or older
At least one member who is
Age 5 years Age 2 years Age 3 years Disabled or younger and younger through 5
Under 60 Years Old
Undup Households
Assisted
Energy Assistance Total
Report run on 08312018 1107 AM Page 1 of 3 eheap_summaryrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Unduplicated Total 0 0
County of Assisted
Households Under 75 75 - 100
Households Assisted By Poverty Level
101 - 125 126 - 150 Over 150 60 Years or older Disabled
Age 5 years or younger
Age 2 years and younger
Age 3 years through 5
Under 60 Years Old
At least one member who is
Undup Households
Assisted
Other Assisted Household Report
Other Assistance Total
Report run on 08312018 1107 AM Page 2 of 3 eheap_summaryrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Applicant Household Report
County of Applicant
Households Under 75 75 - 100 101 - 125 126 - 150 Over 150 Income data
unavailable
Total 0
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01
Enrollment Active Consumer Count by Program PSA ALL Provider ALL PROVIDERS
County Description Program Count of Clients
BREVARD
ADI
CCE
HCE
LSP
NDP
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
MLTC
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
31
57
44
5
62
123
141
26
9
7
5
40
5
50
67
129
2
19
42
29
1
233
79
63
8
2
14
3
37
14
47
3
3
33
127
10
02
03
04
ALACHUA
BAKER
BAY
BRADFORD
Report run on 08312018 1148 AM Page 1 of 18 actv_countrdf
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05
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Enrollment Terminations with Reasons PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 Program All Programs Program Status ALL Program Status Worker ALL WORKERS
Last First Program Medicaid Provider Start End Name Name Client ID Status Description Worker Number Program Location Enrollment Enrollment
Count 0
Report run on 08312018 1150 AM Page 1 of 1 enroll_term_reasonrdf
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Enrollments with Care Plan Report
PSA ALL Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTIVE STATUS Care Plan Service ALL SERVICES Care Plan Start 01012017 Care Plan End 12312017
Care Plan Care Plan Care Plan Client Name
Unduplicated Client Count 0
Client ID Program Status Worker Start Date End Date Service
Report run on 08312018 1054 AM Page 1 of 1 enroll_careplrdf Report run by RSHQALL Dispose of this report so that it cannot be read or reconstructed
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PSA CLIENT_ID CLIENT_NAME OWNER PROVIDER_ID ASSESSMENT_DATE ASSESSOR_NAME MEDICAID_NUMBER CAREGIVER_CHANGE ENVIRONMENT_CHANGE HEALTH_CHANGE INCOME_CHANGE SITUATION_CHANGE INITIAL_ASSM ANNUAL_ASSM SSN REFERRAL_SOURCE 1114 N N N N Y N 771771777 SELFFAMILY 812017 JANE CASEWORKER 2 1001141633 TEST TEST N
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Fixed Service Costs List PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Provider Location County Program Service Reimbursement Unit Rate Provider Cost Per Unit Begin Valid End Valid
Count 0
Report run on 08312018 0233 PM Page 1 of 1 fixed_service_costrdf
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Clients In Common PSA All Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 County All Counties Worker All Workers
County JEFFERSON
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
MIAMI-DADE
0 0 0 0 0 0 0 0 0
4061539538 Test NameCounty Count
County
0 01
X
0 1
X
Client ID Name ADI CCE HCE O3C1 O3C2 OA3B OA3D OA3E OA3EG OA3ES EHEAP EHEAC LSP MLTC
4061650856 Test Name X 4061486560 Test Name X 4062452921 Test Name X
Report run on 08312018 1148 AM clients_commonrdfPage 1 of 4 Report run by RSHQALL Dispose of this Report so that it can not be read or reconstructed
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Clients Served Not Enrolled PSA ALL Start Date 01012017 End Date 12312017 Locations 0000 Provider All Providers
Service Service Min Serv Max Serv Program Start End Enrollment PSA Provider Location Program Consumer Name Client ID Service Date Date Status Enrollment Enrollment Provider
Count 0
Report run on 08312018 0201 PM Page 1 of 1 clnts_serv_no_enrrdf
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
4061472791 04
09
1092
1291
0072
0042
LTCC
LTCC
APCL
APCL
4062714543 06
06
1514
1762
0072
5006
LTCC
LTCC
APCL
APPL
4061802246 11
06
1177
1514
0179
0072
LTCC
LTCC
APCL
APCL
4061563719 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062644312 06
08
1514
1771
0072
0896
LTCC
LTCC
APCL
APCL
1001141670 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
1001141671 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
4062375003 07
05
05
07
1263
1755
1638
1263
0368
0072
0072
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062155124 06
06
1762
1514
0072
0072
LTCC
LTCC
APPL
APCL
4061743886 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0369
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4061499927 06
06
1514
1762
0072
5005
LTCC
LTCC
APCL
APPL
4061583524 08
06
1144
1514
0896
0072
LTCC
LTCC
APCL
APCL
4062694843 06
03
1514
1922
0072
0179
LTCC
LTCC
APCL
APCL
4062744517 07
06
1263
1514
0369
0072
LTCC
LTCC
APCL
APCL
4062005488 10
11
10
11
1929
1177
1164
1177
0072
0073
0179
0179
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
Total Count 15
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CODE DESCRIPTIONS Category ALL STATE TABLES
Code Description Active Available To Code Category
0 UNKNOWN Y CARES SUBJECTIVE_HEALTH_EVALUATION
01 ALACHUA Y COMMON COUNTIES
02 BAKER Y COMMON COUNTIES
03 BAY Y COMMON COUNTIES
04 BRADFORD Y COMMON COUNTIES
05 BREVARD Y COMMON COUNTIES
06 BROWARD Y COMMON COUNTIES
07 CALHOUN Y COMMON COUNTIES
08 CHARLOTTE Y COMMON COUNTIES
09 CITRUS Y COMMON COUNTIES
1 EXCELLENT Y CARES SUBJECTIVE_HEALTH_EVALUATION
10 CLAY Y COMMON COUNTIES
11 COLLIER Y COMMON COUNTIES
12 COLUMBIA Y COMMON COUNTIES
13 MIAMI-DADE Y COMMON COUNTIES
14 DESOTO Y COMMON COUNTIES
15 DIXIE Y COMMON COUNTIES
16 DUVAL Y COMMON COUNTIES
17 ESCAMBIA Y COMMON COUNTIES
18 FLAGLER Y COMMON COUNTIES
19 FRANKLIN Y COMMON COUNTIES
2 GOOD Y CARES SUBJECTIVE_HEALTH_EVALUATION
20 GADSDEN Y COMMON COUNTIES
21 GILCHRIST Y COMMON COUNTIES
22 GLADES Y COMMON COUNTIES
23 GULF Y COMMON COUNTIES
24 HAMILTON Y COMMON COUNTIES
25 HARDEE Y COMMON COUNTIES
26 HENDRY Y COMMON COUNTIES
27 HERNANDO Y COMMON COUNTIES
28 HIGHLANDS Y COMMON COUNTIES
Report run on 08312018 0140 PM Page 1 of 45 state_codesrdf Report run by RSHQALL Dispose of this report so that it cannot be read or reconstructed
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CONSUMER AGE VERIFICATION REPORT PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Program AC
Age at Start
Enroll or Start Enroll Provider Program Description Consumer Name Client ID DOB Svc date or Svc Date
Report run on 08312018 0203 PM Page 1 of 1 age_verifyrdf
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Contract Budget Information PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Program Service Provider Location County Served Provider Contract
Projected Service
Units Unit Measure
Projected Unduplicated
State Federal Share Client Count Begin Date End Date
Row Count 0 Amount Total
Report run on 08312018 0233 PM Page 1 of 1 contract_budgetrdf
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Start Enroll Latest Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Date Asmt Date Worker
O3C1 1036 000 4061653427 Test CENTRAL 34982 W M 07091930 09102013 09102013 CIRTS20804 0 Name
Report run on 08312018 1133 AM Page 1 of 6 actv_by_progrdf
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Start Enroll Date
Latest Asmt Date Worker
4061593624 Test Name CENTRAL 34946 B F 11261940 12012011 12312013 CIRTS23407
Count 164
Unduplicated Client Count 163
Report run on 08312018 1133 AM Page 6 of 6 actv_by_progrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Assessments After DOD Report
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Owner 1025
The shaded records indicate clients who have different DOBs andor different names
Assemt Current PSA Owner Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Owner Assessor
Provider Assessor
Assemt Date
Assemt Type
Unduplicated Count Total 0
Report run on 08312018 0206 PM Page 1 of 1 vs_assmrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Open Enrollments
The Vital Statistics Data for 07192002 - 09112014PSA ALL Provider ALL Program Status ACTV Include MLTC ACTVS N
The shaded records indicate clients who have different DOBs andor different names
Enroll PSA
Enrollment Provider Loc Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Enroll Program Status
Enroll Program
Current Owner ID
02 1065 0072 4062244026 Test Name Test Name 10222004 03231917 03231917 ACTV CCE 1065
Count of enrollments for the Provider 1
Count of enrollments for the PSA 1
Count of enrollments for the Report 1
Unduplicated Count of Individuals with open enrollments and DOD PSA Total Clients Count
02 1
Total 1
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Report run on 08312018 0207 PM Page 1 of 3 vs_servicesrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Unduplicated count of individuals with Services after DOD
PSA Total Clients Count
Report Total
Report run on 08312018 0207 PM Page 2 of 3 vs_servicesrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
List of Clients with PSA table entry for SERVICES_AFTER_DOD
Unduplicated Count Total 0
Report run on 08312018 0207 PM Page 3 of 3 vs_servicesrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Age
Provider
Total
Age lt 60 Age 60 - 64 Age 65 - 74 Age 75 - 84 Age 85+ Total Clients Avg Age
Total
Avg Age
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 1 of 5 demo_all_prvrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Ethnicity
Provider Hispanic Other Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Race
American Indian Native Hawaiian Other Provider Asian Alaska Native Black Pacific Islander Minority White Multiple Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Gender
Provider Male Female Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Monthly Income
Provider 0 - - Higher than Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 5 of 5 demo_all_prvrdf
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None
Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Total Persons Served 0
Age lt 60 Years 0 0
Age 60 - 64 0 0
Age 65 - 74 0 0
Age 75 - 84 0 0
Age 85+ 0 0
Total Age 0 0
Average 000
Ethnicity Hispanic 0 0
Other Ethnicity 0 0
Unknown Ethnicity 0 0
Total 0 0
Race Asian 0 0
American Indian Alaska Native 0 0
Black 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority 0 0
White 0 0
Multiple 0 0
Unknown 0 0
Total 0 0
Sex Male 0 0
Female 0 0
Unknown Sex 0 0
Total 0 0
Monthly Income 0 - 0 0
- 0 0
Higher than 0 0
Unknown 0 0
Total 0 0
Report run on 08312018 1058 AM Page 1 of 2 demo_by_prov_detrdf Report run byRSHQALL Dispose of this report so that it can not be read or reconstructed
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Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Client ID Date Of Birth Ethnicity Race Sex Individual Monthly Income
Report run on 08312018 1058 AM Page 2 of 2 demo_by_prov_detrdf Report run byRSHQALL Dispose of this report so that it can not be read or reconstructed
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Demographics of Clients OAA Registered Served Only PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 City All Cities Program All Programs Service All Services County ALL COUNTIES Table OAA Registered Services Only Low Income Medium Income
Total Persons Served 0
Agelt 60 Years
Age 60 - 64
Age 65 - 74
Age 75 - 84
Age 85+
0
0
0
0
0
0
0
0
0
0
Monthly Income
0 -
-Higher than
Unknown
0
0
0
0
0
0
0
0
Total
Average
0
000
0 Total 0 0
Ethnicity Hispanic
Other
Unknown
0
0
0
0
0
0
Living Situation
Alone
Null
Policy Change
0
0
0
0
0
0
Total 0 0 Unknown
With Caregiver
0
0
0
0
Race Asian 0 0
With Other
With Other Caregiver
0
0
0
0
American Indian Alaska Native
Black
0
0
0
0Total Living Situation 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority
White
0
0
0
0 Limited English Proficiency
Multiple
Unknown
Total Race
0
0
0
0
0
0
Yes
No
Unknown
0
0
0
0
0
0
Total 0 0
Sex Male
Female
Unknown
0
0
0
0
0
0
Total 0 0
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Disaster Assistance Clients for a Provider PSA ALL Provider All Providers Location 0000 Worker All Workers City All Cities Zip Code All Zip Codes Sort By ZIP
Provider 1036 Provider Name Location 0000 Worker CIRTS18634
Need Care Client Name Address City Zip County Phone Asst Reg Situation Relat Care phone Care Name
34946 N WO DA 000 SAINT JAMES DRIVE CENTRAL (025) 101-0620 Test NameTest Name SAINT LUCIE (005) 100-0369 Y
Client is active and no assessment information is available Special Shelter and Special Registry are unknown
Report run on 08312018 1102 AM Page 1 of 8 disaster_by_provrdf
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
Total by PSA 0
Report run on 08312018 1111 AM Page 1 of 5 eheap_exceptionsrdf
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
ALACH BAKER BAY BRADF BREVA BROWA CALHO CHARL CITRUS CLAY COLLIE COLUM DESOT DIXIE DUVAL ESCAM FLAGL FRANK GADSDAssisted Household Report UA ORD RD RD UN OTTE R BIA O BIA ER LIN EN
1 of Household Assisted 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Households AssistedWith Gross Income
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C 100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D 125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
3 Households with at leastOne member
A 60 Years or older 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B Disabled 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C Age 5 years or under 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D Under 60 Years Old 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Undup Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Assisted
Applicant Household Report
of Applicant Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Energy Assisted Household Report
County of Assisted
Households
Households Assisted By Poverty Level
Under 75 75 - 100 101 - 125 126 - 150 Over 150 60 Years or older
At least one member who is
Age 5 years Age 2 years Age 3 years Disabled or younger and younger through 5
Under 60 Years Old
Undup Households
Assisted
Energy Assistance Total
Report run on 08312018 1107 AM Page 1 of 3 eheap_summaryrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Unduplicated Total 0 0
County of Assisted
Households Under 75 75 - 100
Households Assisted By Poverty Level
101 - 125 126 - 150 Over 150 60 Years or older Disabled
Age 5 years or younger
Age 2 years and younger
Age 3 years through 5
Under 60 Years Old
At least one member who is
Undup Households
Assisted
Other Assisted Household Report
Other Assistance Total
Report run on 08312018 1107 AM Page 2 of 3 eheap_summaryrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Applicant Household Report
County of Applicant
Households Under 75 75 - 100 101 - 125 126 - 150 Over 150 Income data
unavailable
Total 0
Report run on 08312018 1107 AM Page 3 of 3 eheap_summaryrdf
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01
Enrollment Active Consumer Count by Program PSA ALL Provider ALL PROVIDERS
County Description Program Count of Clients
BREVARD
ADI
CCE
HCE
LSP
NDP
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
MLTC
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
31
57
44
5
62
123
141
26
9
7
5
40
5
50
67
129
2
19
42
29
1
233
79
63
8
2
14
3
37
14
47
3
3
33
127
10
02
03
04
ALACHUA
BAKER
BAY
BRADFORD
Report run on 08312018 1148 AM Page 1 of 18 actv_countrdf
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05
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Enrollment Terminations with Reasons PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 Program All Programs Program Status ALL Program Status Worker ALL WORKERS
Last First Program Medicaid Provider Start End Name Name Client ID Status Description Worker Number Program Location Enrollment Enrollment
Count 0
Report run on 08312018 1150 AM Page 1 of 1 enroll_term_reasonrdf
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Enrollments with Care Plan Report
PSA ALL Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTIVE STATUS Care Plan Service ALL SERVICES Care Plan Start 01012017 Care Plan End 12312017
Care Plan Care Plan Care Plan Client Name
Unduplicated Client Count 0
Client ID Program Status Worker Start Date End Date Service
Report run on 08312018 1054 AM Page 1 of 1 enroll_careplrdf Report run by RSHQALL Dispose of this report so that it cannot be read or reconstructed
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PSA CLIENT_ID CLIENT_NAME OWNER PROVIDER_ID ASSESSMENT_DATE ASSESSOR_NAME MEDICAID_NUMBER CAREGIVER_CHANGE ENVIRONMENT_CHANGE HEALTH_CHANGE INCOME_CHANGE SITUATION_CHANGE INITIAL_ASSM ANNUAL_ASSM SSN REFERRAL_SOURCE 1114 N N N N Y N 771771777 SELFFAMILY 812017 JANE CASEWORKER 2 1001141633 TEST TEST N
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Fixed Service Costs List PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Provider Location County Program Service Reimbursement Unit Rate Provider Cost Per Unit Begin Valid End Valid
Count 0
Report run on 08312018 0233 PM Page 1 of 1 fixed_service_costrdf
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Clients Served Not Enrolled PSA ALL Start Date 01012017 End Date 12312017 Locations 0000 Provider All Providers
Service Service Min Serv Max Serv Program Start End Enrollment PSA Provider Location Program Consumer Name Client ID Service Date Date Status Enrollment Enrollment Provider
Count 0
Report run on 08312018 0201 PM Page 1 of 1 clnts_serv_no_enrrdf
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
4061472791 04
09
1092
1291
0072
0042
LTCC
LTCC
APCL
APCL
4062714543 06
06
1514
1762
0072
5006
LTCC
LTCC
APCL
APPL
4061802246 11
06
1177
1514
0179
0072
LTCC
LTCC
APCL
APCL
4061563719 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062644312 06
08
1514
1771
0072
0896
LTCC
LTCC
APCL
APCL
1001141670 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
1001141671 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
4062375003 07
05
05
07
1263
1755
1638
1263
0368
0072
0072
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062155124 06
06
1762
1514
0072
0072
LTCC
LTCC
APPL
APCL
4061743886 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0369
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4061499927 06
06
1514
1762
0072
5005
LTCC
LTCC
APCL
APPL
4061583524 08
06
1144
1514
0896
0072
LTCC
LTCC
APCL
APCL
4062694843 06
03
1514
1922
0072
0179
LTCC
LTCC
APCL
APCL
4062744517 07
06
1263
1514
0369
0072
LTCC
LTCC
APCL
APCL
4062005488 10
11
10
11
1929
1177
1164
1177
0072
0073
0179
0179
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
Report run on 08312018 0200 PM Page 1 of 2 clnts_mult_enrollrdf
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
Total Count 15
Report run on 08312018 0200 PM Page 2 of 2 clnts_mult_enrollrdf
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CODE DESCRIPTIONS Category ALL STATE TABLES
Code Description Active Available To Code Category
0 UNKNOWN Y CARES SUBJECTIVE_HEALTH_EVALUATION
01 ALACHUA Y COMMON COUNTIES
02 BAKER Y COMMON COUNTIES
03 BAY Y COMMON COUNTIES
04 BRADFORD Y COMMON COUNTIES
05 BREVARD Y COMMON COUNTIES
06 BROWARD Y COMMON COUNTIES
07 CALHOUN Y COMMON COUNTIES
08 CHARLOTTE Y COMMON COUNTIES
09 CITRUS Y COMMON COUNTIES
1 EXCELLENT Y CARES SUBJECTIVE_HEALTH_EVALUATION
10 CLAY Y COMMON COUNTIES
11 COLLIER Y COMMON COUNTIES
12 COLUMBIA Y COMMON COUNTIES
13 MIAMI-DADE Y COMMON COUNTIES
14 DESOTO Y COMMON COUNTIES
15 DIXIE Y COMMON COUNTIES
16 DUVAL Y COMMON COUNTIES
17 ESCAMBIA Y COMMON COUNTIES
18 FLAGLER Y COMMON COUNTIES
19 FRANKLIN Y COMMON COUNTIES
2 GOOD Y CARES SUBJECTIVE_HEALTH_EVALUATION
20 GADSDEN Y COMMON COUNTIES
21 GILCHRIST Y COMMON COUNTIES
22 GLADES Y COMMON COUNTIES
23 GULF Y COMMON COUNTIES
24 HAMILTON Y COMMON COUNTIES
25 HARDEE Y COMMON COUNTIES
26 HENDRY Y COMMON COUNTIES
27 HERNANDO Y COMMON COUNTIES
28 HIGHLANDS Y COMMON COUNTIES
Report run on 08312018 0140 PM Page 1 of 45 state_codesrdf Report run by RSHQALL Dispose of this report so that it cannot be read or reconstructed
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CONSUMER AGE VERIFICATION REPORT PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Program AC
Age at Start
Enroll or Start Enroll Provider Program Description Consumer Name Client ID DOB Svc date or Svc Date
Report run on 08312018 0203 PM Page 1 of 1 age_verifyrdf
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Contract Budget Information PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Program Service Provider Location County Served Provider Contract
Projected Service
Units Unit Measure
Projected Unduplicated
State Federal Share Client Count Begin Date End Date
Row Count 0 Amount Total
Report run on 08312018 0233 PM Page 1 of 1 contract_budgetrdf
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Start Enroll Latest Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Date Asmt Date Worker
O3C1 1036 000 4061653427 Test CENTRAL 34982 W M 07091930 09102013 09102013 CIRTS20804 0 Name
Report run on 08312018 1133 AM Page 1 of 6 actv_by_progrdf
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Start Enroll Date
Latest Asmt Date Worker
4061593624 Test Name CENTRAL 34946 B F 11261940 12012011 12312013 CIRTS23407
Count 164
Unduplicated Client Count 163
Report run on 08312018 1133 AM Page 6 of 6 actv_by_progrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Assessments After DOD Report
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Owner 1025
The shaded records indicate clients who have different DOBs andor different names
Assemt Current PSA Owner Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Owner Assessor
Provider Assessor
Assemt Date
Assemt Type
Unduplicated Count Total 0
Report run on 08312018 0206 PM Page 1 of 1 vs_assmrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Open Enrollments
The Vital Statistics Data for 07192002 - 09112014PSA ALL Provider ALL Program Status ACTV Include MLTC ACTVS N
The shaded records indicate clients who have different DOBs andor different names
Enroll PSA
Enrollment Provider Loc Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Enroll Program Status
Enroll Program
Current Owner ID
02 1065 0072 4062244026 Test Name Test Name 10222004 03231917 03231917 ACTV CCE 1065
Count of enrollments for the Provider 1
Count of enrollments for the PSA 1
Count of enrollments for the Report 1
Unduplicated Count of Individuals with open enrollments and DOD PSA Total Clients Count
02 1
Total 1
Report run on 08312018 0205 PM Page 1 of 1 vs_open_enrollrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Report run on 08312018 0207 PM Page 1 of 3 vs_servicesrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Unduplicated count of individuals with Services after DOD
PSA Total Clients Count
Report Total
Report run on 08312018 0207 PM Page 2 of 3 vs_servicesrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
List of Clients with PSA table entry for SERVICES_AFTER_DOD
Unduplicated Count Total 0
Report run on 08312018 0207 PM Page 3 of 3 vs_servicesrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Age
Provider
Total
Age lt 60 Age 60 - 64 Age 65 - 74 Age 75 - 84 Age 85+ Total Clients Avg Age
Total
Avg Age
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 1 of 5 demo_all_prvrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Ethnicity
Provider Hispanic Other Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 2 of 5 demo_all_prvrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Race
American Indian Native Hawaiian Other Provider Asian Alaska Native Black Pacific Islander Minority White Multiple Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 3 of 5 demo_all_prvrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Gender
Provider Male Female Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 4 of 5 demo_all_prvrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Monthly Income
Provider 0 - - Higher than Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 5 of 5 demo_all_prvrdf
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None
Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Total Persons Served 0
Age lt 60 Years 0 0
Age 60 - 64 0 0
Age 65 - 74 0 0
Age 75 - 84 0 0
Age 85+ 0 0
Total Age 0 0
Average 000
Ethnicity Hispanic 0 0
Other Ethnicity 0 0
Unknown Ethnicity 0 0
Total 0 0
Race Asian 0 0
American Indian Alaska Native 0 0
Black 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority 0 0
White 0 0
Multiple 0 0
Unknown 0 0
Total 0 0
Sex Male 0 0
Female 0 0
Unknown Sex 0 0
Total 0 0
Monthly Income 0 - 0 0
- 0 0
Higher than 0 0
Unknown 0 0
Total 0 0
Report run on 08312018 1058 AM Page 1 of 2 demo_by_prov_detrdf Report run byRSHQALL Dispose of this report so that it can not be read or reconstructed
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Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Client ID Date Of Birth Ethnicity Race Sex Individual Monthly Income
Report run on 08312018 1058 AM Page 2 of 2 demo_by_prov_detrdf Report run byRSHQALL Dispose of this report so that it can not be read or reconstructed
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Demographics of Clients OAA Registered Served Only PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 City All Cities Program All Programs Service All Services County ALL COUNTIES Table OAA Registered Services Only Low Income Medium Income
Total Persons Served 0
Agelt 60 Years
Age 60 - 64
Age 65 - 74
Age 75 - 84
Age 85+
0
0
0
0
0
0
0
0
0
0
Monthly Income
0 -
-Higher than
Unknown
0
0
0
0
0
0
0
0
Total
Average
0
000
0 Total 0 0
Ethnicity Hispanic
Other
Unknown
0
0
0
0
0
0
Living Situation
Alone
Null
Policy Change
0
0
0
0
0
0
Total 0 0 Unknown
With Caregiver
0
0
0
0
Race Asian 0 0
With Other
With Other Caregiver
0
0
0
0
American Indian Alaska Native
Black
0
0
0
0Total Living Situation 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority
White
0
0
0
0 Limited English Proficiency
Multiple
Unknown
Total Race
0
0
0
0
0
0
Yes
No
Unknown
0
0
0
0
0
0
Total 0 0
Sex Male
Female
Unknown
0
0
0
0
0
0
Total 0 0
Report run on 08312018 1056 AM Page 1 of 1 demo_by_provrdf
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Disaster Assistance Clients for a Provider PSA ALL Provider All Providers Location 0000 Worker All Workers City All Cities Zip Code All Zip Codes Sort By ZIP
Provider 1036 Provider Name Location 0000 Worker CIRTS18634
Need Care Client Name Address City Zip County Phone Asst Reg Situation Relat Care phone Care Name
34946 N WO DA 000 SAINT JAMES DRIVE CENTRAL (025) 101-0620 Test NameTest Name SAINT LUCIE (005) 100-0369 Y
Client is active and no assessment information is available Special Shelter and Special Registry are unknown
Report run on 08312018 1102 AM Page 1 of 8 disaster_by_provrdf
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
Total by PSA 0
Report run on 08312018 1111 AM Page 1 of 5 eheap_exceptionsrdf
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
ALACH BAKER BAY BRADF BREVA BROWA CALHO CHARL CITRUS CLAY COLLIE COLUM DESOT DIXIE DUVAL ESCAM FLAGL FRANK GADSDAssisted Household Report UA ORD RD RD UN OTTE R BIA O BIA ER LIN EN
1 of Household Assisted 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Households AssistedWith Gross Income
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C 100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D 125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
3 Households with at leastOne member
A 60 Years or older 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B Disabled 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C Age 5 years or under 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D Under 60 Years Old 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Undup Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Assisted
Applicant Household Report
of Applicant Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
Report run on 08312018 1111 AM Page 2 of 5 eheap_exceptionsrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Energy Assisted Household Report
County of Assisted
Households
Households Assisted By Poverty Level
Under 75 75 - 100 101 - 125 126 - 150 Over 150 60 Years or older
At least one member who is
Age 5 years Age 2 years Age 3 years Disabled or younger and younger through 5
Under 60 Years Old
Undup Households
Assisted
Energy Assistance Total
Report run on 08312018 1107 AM Page 1 of 3 eheap_summaryrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Unduplicated Total 0 0
County of Assisted
Households Under 75 75 - 100
Households Assisted By Poverty Level
101 - 125 126 - 150 Over 150 60 Years or older Disabled
Age 5 years or younger
Age 2 years and younger
Age 3 years through 5
Under 60 Years Old
At least one member who is
Undup Households
Assisted
Other Assisted Household Report
Other Assistance Total
Report run on 08312018 1107 AM Page 2 of 3 eheap_summaryrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Applicant Household Report
County of Applicant
Households Under 75 75 - 100 101 - 125 126 - 150 Over 150 Income data
unavailable
Total 0
Report run on 08312018 1107 AM Page 3 of 3 eheap_summaryrdf
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01
Enrollment Active Consumer Count by Program PSA ALL Provider ALL PROVIDERS
County Description Program Count of Clients
BREVARD
ADI
CCE
HCE
LSP
NDP
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
MLTC
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
31
57
44
5
62
123
141
26
9
7
5
40
5
50
67
129
2
19
42
29
1
233
79
63
8
2
14
3
37
14
47
3
3
33
127
10
02
03
04
ALACHUA
BAKER
BAY
BRADFORD
Report run on 08312018 1148 AM Page 1 of 18 actv_countrdf
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Enrollment Terminations with Reasons PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 Program All Programs Program Status ALL Program Status Worker ALL WORKERS
Last First Program Medicaid Provider Start End Name Name Client ID Status Description Worker Number Program Location Enrollment Enrollment
Count 0
Report run on 08312018 1150 AM Page 1 of 1 enroll_term_reasonrdf
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Enrollments with Care Plan Report
PSA ALL Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTIVE STATUS Care Plan Service ALL SERVICES Care Plan Start 01012017 Care Plan End 12312017
Care Plan Care Plan Care Plan Client Name
Unduplicated Client Count 0
Client ID Program Status Worker Start Date End Date Service
Report run on 08312018 1054 AM Page 1 of 1 enroll_careplrdf Report run by RSHQALL Dispose of this report so that it cannot be read or reconstructed
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PSA CLIENT_ID CLIENT_NAME OWNER PROVIDER_ID ASSESSMENT_DATE ASSESSOR_NAME MEDICAID_NUMBER CAREGIVER_CHANGE ENVIRONMENT_CHANGE HEALTH_CHANGE INCOME_CHANGE SITUATION_CHANGE INITIAL_ASSM ANNUAL_ASSM SSN REFERRAL_SOURCE 1114 N N N N Y N 771771777 SELFFAMILY 812017 JANE CASEWORKER 2 1001141633 TEST TEST N
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Fixed Service Costs List PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Provider Location County Program Service Reimbursement Unit Rate Provider Cost Per Unit Begin Valid End Valid
Count 0
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
4061472791 04
09
1092
1291
0072
0042
LTCC
LTCC
APCL
APCL
4062714543 06
06
1514
1762
0072
5006
LTCC
LTCC
APCL
APPL
4061802246 11
06
1177
1514
0179
0072
LTCC
LTCC
APCL
APCL
4061563719 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062644312 06
08
1514
1771
0072
0896
LTCC
LTCC
APCL
APCL
1001141670 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
1001141671 05
02
1114
1065
0073
0043
LTCC
LTCC
APCL
APCL
4062375003 07
05
05
07
1263
1755
1638
1263
0368
0072
0072
0181
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4062155124 06
06
1762
1514
0072
0072
LTCC
LTCC
APPL
APCL
4061743886 11
07
11
07
1177
1263
1177
1263
0073
0369
0179
0369
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
4061499927 06
06
1514
1762
0072
5005
LTCC
LTCC
APCL
APPL
4061583524 08
06
1144
1514
0896
0072
LTCC
LTCC
APCL
APCL
4062694843 06
03
1514
1922
0072
0179
LTCC
LTCC
APCL
APCL
4062744517 07
06
1263
1514
0369
0072
LTCC
LTCC
APCL
APCL
4062005488 10
11
10
11
1929
1177
1164
1177
0072
0073
0179
0179
CCE
CCE
LTCC
LTCC
APCL
APCL
APCL
APCL
Report run on 08312018 0200 PM Page 1 of 2 clnts_mult_enrollrdf
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
Total Count 15
Report run on 08312018 0200 PM Page 2 of 2 clnts_mult_enrollrdf
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CODE DESCRIPTIONS Category ALL STATE TABLES
Code Description Active Available To Code Category
0 UNKNOWN Y CARES SUBJECTIVE_HEALTH_EVALUATION
01 ALACHUA Y COMMON COUNTIES
02 BAKER Y COMMON COUNTIES
03 BAY Y COMMON COUNTIES
04 BRADFORD Y COMMON COUNTIES
05 BREVARD Y COMMON COUNTIES
06 BROWARD Y COMMON COUNTIES
07 CALHOUN Y COMMON COUNTIES
08 CHARLOTTE Y COMMON COUNTIES
09 CITRUS Y COMMON COUNTIES
1 EXCELLENT Y CARES SUBJECTIVE_HEALTH_EVALUATION
10 CLAY Y COMMON COUNTIES
11 COLLIER Y COMMON COUNTIES
12 COLUMBIA Y COMMON COUNTIES
13 MIAMI-DADE Y COMMON COUNTIES
14 DESOTO Y COMMON COUNTIES
15 DIXIE Y COMMON COUNTIES
16 DUVAL Y COMMON COUNTIES
17 ESCAMBIA Y COMMON COUNTIES
18 FLAGLER Y COMMON COUNTIES
19 FRANKLIN Y COMMON COUNTIES
2 GOOD Y CARES SUBJECTIVE_HEALTH_EVALUATION
20 GADSDEN Y COMMON COUNTIES
21 GILCHRIST Y COMMON COUNTIES
22 GLADES Y COMMON COUNTIES
23 GULF Y COMMON COUNTIES
24 HAMILTON Y COMMON COUNTIES
25 HARDEE Y COMMON COUNTIES
26 HENDRY Y COMMON COUNTIES
27 HERNANDO Y COMMON COUNTIES
28 HIGHLANDS Y COMMON COUNTIES
Report run on 08312018 0140 PM Page 1 of 45 state_codesrdf Report run by RSHQALL Dispose of this report so that it cannot be read or reconstructed
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CONSUMER AGE VERIFICATION REPORT PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Program AC
Age at Start
Enroll or Start Enroll Provider Program Description Consumer Name Client ID DOB Svc date or Svc Date
Report run on 08312018 0203 PM Page 1 of 1 age_verifyrdf
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Contract Budget Information PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Program Service Provider Location County Served Provider Contract
Projected Service
Units Unit Measure
Projected Unduplicated
State Federal Share Client Count Begin Date End Date
Row Count 0 Amount Total
Report run on 08312018 0233 PM Page 1 of 1 contract_budgetrdf
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Start Enroll Latest Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Date Asmt Date Worker
O3C1 1036 000 4061653427 Test CENTRAL 34982 W M 07091930 09102013 09102013 CIRTS20804 0 Name
Report run on 08312018 1133 AM Page 1 of 6 actv_by_progrdf
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Start Enroll Date
Latest Asmt Date Worker
4061593624 Test Name CENTRAL 34946 B F 11261940 12012011 12312013 CIRTS23407
Count 164
Unduplicated Client Count 163
Report run on 08312018 1133 AM Page 6 of 6 actv_by_progrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Assessments After DOD Report
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Owner 1025
The shaded records indicate clients who have different DOBs andor different names
Assemt Current PSA Owner Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Owner Assessor
Provider Assessor
Assemt Date
Assemt Type
Unduplicated Count Total 0
Report run on 08312018 0206 PM Page 1 of 1 vs_assmrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Open Enrollments
The Vital Statistics Data for 07192002 - 09112014PSA ALL Provider ALL Program Status ACTV Include MLTC ACTVS N
The shaded records indicate clients who have different DOBs andor different names
Enroll PSA
Enrollment Provider Loc Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Enroll Program Status
Enroll Program
Current Owner ID
02 1065 0072 4062244026 Test Name Test Name 10222004 03231917 03231917 ACTV CCE 1065
Count of enrollments for the Provider 1
Count of enrollments for the PSA 1
Count of enrollments for the Report 1
Unduplicated Count of Individuals with open enrollments and DOD PSA Total Clients Count
02 1
Total 1
Report run on 08312018 0205 PM Page 1 of 1 vs_open_enrollrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Report run on 08312018 0207 PM Page 1 of 3 vs_servicesrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Unduplicated count of individuals with Services after DOD
PSA Total Clients Count
Report Total
Report run on 08312018 0207 PM Page 2 of 3 vs_servicesrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
List of Clients with PSA table entry for SERVICES_AFTER_DOD
Unduplicated Count Total 0
Report run on 08312018 0207 PM Page 3 of 3 vs_servicesrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Age
Provider
Total
Age lt 60 Age 60 - 64 Age 65 - 74 Age 75 - 84 Age 85+ Total Clients Avg Age
Total
Avg Age
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 1 of 5 demo_all_prvrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Ethnicity
Provider Hispanic Other Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Race
American Indian Native Hawaiian Other Provider Asian Alaska Native Black Pacific Islander Minority White Multiple Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 3 of 5 demo_all_prvrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Gender
Provider Male Female Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 4 of 5 demo_all_prvrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Monthly Income
Provider 0 - - Higher than Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 5 of 5 demo_all_prvrdf
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None
Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Total Persons Served 0
Age lt 60 Years 0 0
Age 60 - 64 0 0
Age 65 - 74 0 0
Age 75 - 84 0 0
Age 85+ 0 0
Total Age 0 0
Average 000
Ethnicity Hispanic 0 0
Other Ethnicity 0 0
Unknown Ethnicity 0 0
Total 0 0
Race Asian 0 0
American Indian Alaska Native 0 0
Black 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority 0 0
White 0 0
Multiple 0 0
Unknown 0 0
Total 0 0
Sex Male 0 0
Female 0 0
Unknown Sex 0 0
Total 0 0
Monthly Income 0 - 0 0
- 0 0
Higher than 0 0
Unknown 0 0
Total 0 0
Report run on 08312018 1058 AM Page 1 of 2 demo_by_prov_detrdf Report run byRSHQALL Dispose of this report so that it can not be read or reconstructed
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Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Client ID Date Of Birth Ethnicity Race Sex Individual Monthly Income
Report run on 08312018 1058 AM Page 2 of 2 demo_by_prov_detrdf Report run byRSHQALL Dispose of this report so that it can not be read or reconstructed
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Demographics of Clients OAA Registered Served Only PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 City All Cities Program All Programs Service All Services County ALL COUNTIES Table OAA Registered Services Only Low Income Medium Income
Total Persons Served 0
Agelt 60 Years
Age 60 - 64
Age 65 - 74
Age 75 - 84
Age 85+
0
0
0
0
0
0
0
0
0
0
Monthly Income
0 -
-Higher than
Unknown
0
0
0
0
0
0
0
0
Total
Average
0
000
0 Total 0 0
Ethnicity Hispanic
Other
Unknown
0
0
0
0
0
0
Living Situation
Alone
Null
Policy Change
0
0
0
0
0
0
Total 0 0 Unknown
With Caregiver
0
0
0
0
Race Asian 0 0
With Other
With Other Caregiver
0
0
0
0
American Indian Alaska Native
Black
0
0
0
0Total Living Situation 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority
White
0
0
0
0 Limited English Proficiency
Multiple
Unknown
Total Race
0
0
0
0
0
0
Yes
No
Unknown
0
0
0
0
0
0
Total 0 0
Sex Male
Female
Unknown
0
0
0
0
0
0
Total 0 0
Report run on 08312018 1056 AM Page 1 of 1 demo_by_provrdf
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Disaster Assistance Clients for a Provider PSA ALL Provider All Providers Location 0000 Worker All Workers City All Cities Zip Code All Zip Codes Sort By ZIP
Provider 1036 Provider Name Location 0000 Worker CIRTS18634
Need Care Client Name Address City Zip County Phone Asst Reg Situation Relat Care phone Care Name
34946 N WO DA 000 SAINT JAMES DRIVE CENTRAL (025) 101-0620 Test NameTest Name SAINT LUCIE (005) 100-0369 Y
Client is active and no assessment information is available Special Shelter and Special Registry are unknown
Report run on 08312018 1102 AM Page 1 of 8 disaster_by_provrdf
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
Total by PSA 0
Report run on 08312018 1111 AM Page 1 of 5 eheap_exceptionsrdf
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
ALACH BAKER BAY BRADF BREVA BROWA CALHO CHARL CITRUS CLAY COLLIE COLUM DESOT DIXIE DUVAL ESCAM FLAGL FRANK GADSDAssisted Household Report UA ORD RD RD UN OTTE R BIA O BIA ER LIN EN
1 of Household Assisted 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Households AssistedWith Gross Income
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C 100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D 125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
3 Households with at leastOne member
A 60 Years or older 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B Disabled 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C Age 5 years or under 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D Under 60 Years Old 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Undup Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Assisted
Applicant Household Report
of Applicant Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
Report run on 08312018 1111 AM Page 2 of 5 eheap_exceptionsrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Energy Assisted Household Report
County of Assisted
Households
Households Assisted By Poverty Level
Under 75 75 - 100 101 - 125 126 - 150 Over 150 60 Years or older
At least one member who is
Age 5 years Age 2 years Age 3 years Disabled or younger and younger through 5
Under 60 Years Old
Undup Households
Assisted
Energy Assistance Total
Report run on 08312018 1107 AM Page 1 of 3 eheap_summaryrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Unduplicated Total 0 0
County of Assisted
Households Under 75 75 - 100
Households Assisted By Poverty Level
101 - 125 126 - 150 Over 150 60 Years or older Disabled
Age 5 years or younger
Age 2 years and younger
Age 3 years through 5
Under 60 Years Old
At least one member who is
Undup Households
Assisted
Other Assisted Household Report
Other Assistance Total
Report run on 08312018 1107 AM Page 2 of 3 eheap_summaryrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Applicant Household Report
County of Applicant
Households Under 75 75 - 100 101 - 125 126 - 150 Over 150 Income data
unavailable
Total 0
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01
Enrollment Active Consumer Count by Program PSA ALL Provider ALL PROVIDERS
County Description Program Count of Clients
BREVARD
ADI
CCE
HCE
LSP
NDP
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
MLTC
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
31
57
44
5
62
123
141
26
9
7
5
40
5
50
67
129
2
19
42
29
1
233
79
63
8
2
14
3
37
14
47
3
3
33
127
10
02
03
04
ALACHUA
BAKER
BAY
BRADFORD
Report run on 08312018 1148 AM Page 1 of 18 actv_countrdf
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Enrollment Terminations with Reasons PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 Program All Programs Program Status ALL Program Status Worker ALL WORKERS
Last First Program Medicaid Provider Start End Name Name Client ID Status Description Worker Number Program Location Enrollment Enrollment
Count 0
Report run on 08312018 1150 AM Page 1 of 1 enroll_term_reasonrdf
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Enrollments with Care Plan Report
PSA ALL Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTIVE STATUS Care Plan Service ALL SERVICES Care Plan Start 01012017 Care Plan End 12312017
Care Plan Care Plan Care Plan Client Name
Unduplicated Client Count 0
Client ID Program Status Worker Start Date End Date Service
Report run on 08312018 1054 AM Page 1 of 1 enroll_careplrdf Report run by RSHQALL Dispose of this report so that it cannot be read or reconstructed
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PSA CLIENT_ID CLIENT_NAME OWNER PROVIDER_ID ASSESSMENT_DATE ASSESSOR_NAME MEDICAID_NUMBER CAREGIVER_CHANGE ENVIRONMENT_CHANGE HEALTH_CHANGE INCOME_CHANGE SITUATION_CHANGE INITIAL_ASSM ANNUAL_ASSM SSN REFERRAL_SOURCE 1114 N N N N Y N 771771777 SELFFAMILY 812017 JANE CASEWORKER 2 1001141633 TEST TEST N
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Fixed Service Costs List PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Provider Location County Program Service Reimbursement Unit Rate Provider Cost Per Unit Begin Valid End Valid
Count 0
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Clients who are ACTV APCL or APPL in the same program multiple times
Client ID PSA Provider Location Program Program Status
Total Count 15
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CODE DESCRIPTIONS Category ALL STATE TABLES
Code Description Active Available To Code Category
0 UNKNOWN Y CARES SUBJECTIVE_HEALTH_EVALUATION
01 ALACHUA Y COMMON COUNTIES
02 BAKER Y COMMON COUNTIES
03 BAY Y COMMON COUNTIES
04 BRADFORD Y COMMON COUNTIES
05 BREVARD Y COMMON COUNTIES
06 BROWARD Y COMMON COUNTIES
07 CALHOUN Y COMMON COUNTIES
08 CHARLOTTE Y COMMON COUNTIES
09 CITRUS Y COMMON COUNTIES
1 EXCELLENT Y CARES SUBJECTIVE_HEALTH_EVALUATION
10 CLAY Y COMMON COUNTIES
11 COLLIER Y COMMON COUNTIES
12 COLUMBIA Y COMMON COUNTIES
13 MIAMI-DADE Y COMMON COUNTIES
14 DESOTO Y COMMON COUNTIES
15 DIXIE Y COMMON COUNTIES
16 DUVAL Y COMMON COUNTIES
17 ESCAMBIA Y COMMON COUNTIES
18 FLAGLER Y COMMON COUNTIES
19 FRANKLIN Y COMMON COUNTIES
2 GOOD Y CARES SUBJECTIVE_HEALTH_EVALUATION
20 GADSDEN Y COMMON COUNTIES
21 GILCHRIST Y COMMON COUNTIES
22 GLADES Y COMMON COUNTIES
23 GULF Y COMMON COUNTIES
24 HAMILTON Y COMMON COUNTIES
25 HARDEE Y COMMON COUNTIES
26 HENDRY Y COMMON COUNTIES
27 HERNANDO Y COMMON COUNTIES
28 HIGHLANDS Y COMMON COUNTIES
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CONSUMER AGE VERIFICATION REPORT PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Program AC
Age at Start
Enroll or Start Enroll Provider Program Description Consumer Name Client ID DOB Svc date or Svc Date
Report run on 08312018 0203 PM Page 1 of 1 age_verifyrdf
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Contract Budget Information PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Program Service Provider Location County Served Provider Contract
Projected Service
Units Unit Measure
Projected Unduplicated
State Federal Share Client Count Begin Date End Date
Row Count 0 Amount Total
Report run on 08312018 0233 PM Page 1 of 1 contract_budgetrdf
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Start Enroll Latest Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Date Asmt Date Worker
O3C1 1036 000 4061653427 Test CENTRAL 34982 W M 07091930 09102013 09102013 CIRTS20804 0 Name
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Start Enroll Date
Latest Asmt Date Worker
4061593624 Test Name CENTRAL 34946 B F 11261940 12012011 12312013 CIRTS23407
Count 164
Unduplicated Client Count 163
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Assessments After DOD Report
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Owner 1025
The shaded records indicate clients who have different DOBs andor different names
Assemt Current PSA Owner Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Owner Assessor
Provider Assessor
Assemt Date
Assemt Type
Unduplicated Count Total 0
Report run on 08312018 0206 PM Page 1 of 1 vs_assmrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Open Enrollments
The Vital Statistics Data for 07192002 - 09112014PSA ALL Provider ALL Program Status ACTV Include MLTC ACTVS N
The shaded records indicate clients who have different DOBs andor different names
Enroll PSA
Enrollment Provider Loc Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Enroll Program Status
Enroll Program
Current Owner ID
02 1065 0072 4062244026 Test Name Test Name 10222004 03231917 03231917 ACTV CCE 1065
Count of enrollments for the Provider 1
Count of enrollments for the PSA 1
Count of enrollments for the Report 1
Unduplicated Count of Individuals with open enrollments and DOD PSA Total Clients Count
02 1
Total 1
Report run on 08312018 0205 PM Page 1 of 1 vs_open_enrollrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Report run on 08312018 0207 PM Page 1 of 3 vs_servicesrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Unduplicated count of individuals with Services after DOD
PSA Total Clients Count
Report Total
Report run on 08312018 0207 PM Page 2 of 3 vs_servicesrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
List of Clients with PSA table entry for SERVICES_AFTER_DOD
Unduplicated Count Total 0
Report run on 08312018 0207 PM Page 3 of 3 vs_servicesrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Age
Provider
Total
Age lt 60 Age 60 - 64 Age 65 - 74 Age 75 - 84 Age 85+ Total Clients Avg Age
Total
Avg Age
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 1 of 5 demo_all_prvrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Ethnicity
Provider Hispanic Other Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 2 of 5 demo_all_prvrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Race
American Indian Native Hawaiian Other Provider Asian Alaska Native Black Pacific Islander Minority White Multiple Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Gender
Provider Male Female Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 4 of 5 demo_all_prvrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Monthly Income
Provider 0 - - Higher than Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 5 of 5 demo_all_prvrdf
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None
Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Total Persons Served 0
Age lt 60 Years 0 0
Age 60 - 64 0 0
Age 65 - 74 0 0
Age 75 - 84 0 0
Age 85+ 0 0
Total Age 0 0
Average 000
Ethnicity Hispanic 0 0
Other Ethnicity 0 0
Unknown Ethnicity 0 0
Total 0 0
Race Asian 0 0
American Indian Alaska Native 0 0
Black 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority 0 0
White 0 0
Multiple 0 0
Unknown 0 0
Total 0 0
Sex Male 0 0
Female 0 0
Unknown Sex 0 0
Total 0 0
Monthly Income 0 - 0 0
- 0 0
Higher than 0 0
Unknown 0 0
Total 0 0
Report run on 08312018 1058 AM Page 1 of 2 demo_by_prov_detrdf Report run byRSHQALL Dispose of this report so that it can not be read or reconstructed
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Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Client ID Date Of Birth Ethnicity Race Sex Individual Monthly Income
Report run on 08312018 1058 AM Page 2 of 2 demo_by_prov_detrdf Report run byRSHQALL Dispose of this report so that it can not be read or reconstructed
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Demographics of Clients OAA Registered Served Only PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 City All Cities Program All Programs Service All Services County ALL COUNTIES Table OAA Registered Services Only Low Income Medium Income
Total Persons Served 0
Agelt 60 Years
Age 60 - 64
Age 65 - 74
Age 75 - 84
Age 85+
0
0
0
0
0
0
0
0
0
0
Monthly Income
0 -
-Higher than
Unknown
0
0
0
0
0
0
0
0
Total
Average
0
000
0 Total 0 0
Ethnicity Hispanic
Other
Unknown
0
0
0
0
0
0
Living Situation
Alone
Null
Policy Change
0
0
0
0
0
0
Total 0 0 Unknown
With Caregiver
0
0
0
0
Race Asian 0 0
With Other
With Other Caregiver
0
0
0
0
American Indian Alaska Native
Black
0
0
0
0Total Living Situation 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority
White
0
0
0
0 Limited English Proficiency
Multiple
Unknown
Total Race
0
0
0
0
0
0
Yes
No
Unknown
0
0
0
0
0
0
Total 0 0
Sex Male
Female
Unknown
0
0
0
0
0
0
Total 0 0
Report run on 08312018 1056 AM Page 1 of 1 demo_by_provrdf
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Disaster Assistance Clients for a Provider PSA ALL Provider All Providers Location 0000 Worker All Workers City All Cities Zip Code All Zip Codes Sort By ZIP
Provider 1036 Provider Name Location 0000 Worker CIRTS18634
Need Care Client Name Address City Zip County Phone Asst Reg Situation Relat Care phone Care Name
34946 N WO DA 000 SAINT JAMES DRIVE CENTRAL (025) 101-0620 Test NameTest Name SAINT LUCIE (005) 100-0369 Y
Client is active and no assessment information is available Special Shelter and Special Registry are unknown
Report run on 08312018 1102 AM Page 1 of 8 disaster_by_provrdf
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
Total by PSA 0
Report run on 08312018 1111 AM Page 1 of 5 eheap_exceptionsrdf
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
ALACH BAKER BAY BRADF BREVA BROWA CALHO CHARL CITRUS CLAY COLLIE COLUM DESOT DIXIE DUVAL ESCAM FLAGL FRANK GADSDAssisted Household Report UA ORD RD RD UN OTTE R BIA O BIA ER LIN EN
1 of Household Assisted 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Households AssistedWith Gross Income
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C 100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D 125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
3 Households with at leastOne member
A 60 Years or older 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B Disabled 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C Age 5 years or under 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D Under 60 Years Old 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Undup Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Assisted
Applicant Household Report
of Applicant Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
Report run on 08312018 1111 AM Page 2 of 5 eheap_exceptionsrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Energy Assisted Household Report
County of Assisted
Households
Households Assisted By Poverty Level
Under 75 75 - 100 101 - 125 126 - 150 Over 150 60 Years or older
At least one member who is
Age 5 years Age 2 years Age 3 years Disabled or younger and younger through 5
Under 60 Years Old
Undup Households
Assisted
Energy Assistance Total
Report run on 08312018 1107 AM Page 1 of 3 eheap_summaryrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Unduplicated Total 0 0
County of Assisted
Households Under 75 75 - 100
Households Assisted By Poverty Level
101 - 125 126 - 150 Over 150 60 Years or older Disabled
Age 5 years or younger
Age 2 years and younger
Age 3 years through 5
Under 60 Years Old
At least one member who is
Undup Households
Assisted
Other Assisted Household Report
Other Assistance Total
Report run on 08312018 1107 AM Page 2 of 3 eheap_summaryrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Applicant Household Report
County of Applicant
Households Under 75 75 - 100 101 - 125 126 - 150 Over 150 Income data
unavailable
Total 0
Report run on 08312018 1107 AM Page 3 of 3 eheap_summaryrdf
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01
Enrollment Active Consumer Count by Program PSA ALL Provider ALL PROVIDERS
County Description Program Count of Clients
BREVARD
ADI
CCE
HCE
LSP
NDP
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
MLTC
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
31
57
44
5
62
123
141
26
9
7
5
40
5
50
67
129
2
19
42
29
1
233
79
63
8
2
14
3
37
14
47
3
3
33
127
10
02
03
04
ALACHUA
BAKER
BAY
BRADFORD
Report run on 08312018 1148 AM Page 1 of 18 actv_countrdf
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05
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Enrollment Terminations with Reasons PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 Program All Programs Program Status ALL Program Status Worker ALL WORKERS
Last First Program Medicaid Provider Start End Name Name Client ID Status Description Worker Number Program Location Enrollment Enrollment
Count 0
Report run on 08312018 1150 AM Page 1 of 1 enroll_term_reasonrdf
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Enrollments with Care Plan Report
PSA ALL Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTIVE STATUS Care Plan Service ALL SERVICES Care Plan Start 01012017 Care Plan End 12312017
Care Plan Care Plan Care Plan Client Name
Unduplicated Client Count 0
Client ID Program Status Worker Start Date End Date Service
Report run on 08312018 1054 AM Page 1 of 1 enroll_careplrdf Report run by RSHQALL Dispose of this report so that it cannot be read or reconstructed
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PSA CLIENT_ID CLIENT_NAME OWNER PROVIDER_ID ASSESSMENT_DATE ASSESSOR_NAME MEDICAID_NUMBER CAREGIVER_CHANGE ENVIRONMENT_CHANGE HEALTH_CHANGE INCOME_CHANGE SITUATION_CHANGE INITIAL_ASSM ANNUAL_ASSM SSN REFERRAL_SOURCE 1114 N N N N Y N 771771777 SELFFAMILY 812017 JANE CASEWORKER 2 1001141633 TEST TEST N
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Fixed Service Costs List PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Provider Location County Program Service Reimbursement Unit Rate Provider Cost Per Unit Begin Valid End Valid
Count 0
Report run on 08312018 0233 PM Page 1 of 1 fixed_service_costrdf
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CODE DESCRIPTIONS Category ALL STATE TABLES
Code Description Active Available To Code Category
0 UNKNOWN Y CARES SUBJECTIVE_HEALTH_EVALUATION
01 ALACHUA Y COMMON COUNTIES
02 BAKER Y COMMON COUNTIES
03 BAY Y COMMON COUNTIES
04 BRADFORD Y COMMON COUNTIES
05 BREVARD Y COMMON COUNTIES
06 BROWARD Y COMMON COUNTIES
07 CALHOUN Y COMMON COUNTIES
08 CHARLOTTE Y COMMON COUNTIES
09 CITRUS Y COMMON COUNTIES
1 EXCELLENT Y CARES SUBJECTIVE_HEALTH_EVALUATION
10 CLAY Y COMMON COUNTIES
11 COLLIER Y COMMON COUNTIES
12 COLUMBIA Y COMMON COUNTIES
13 MIAMI-DADE Y COMMON COUNTIES
14 DESOTO Y COMMON COUNTIES
15 DIXIE Y COMMON COUNTIES
16 DUVAL Y COMMON COUNTIES
17 ESCAMBIA Y COMMON COUNTIES
18 FLAGLER Y COMMON COUNTIES
19 FRANKLIN Y COMMON COUNTIES
2 GOOD Y CARES SUBJECTIVE_HEALTH_EVALUATION
20 GADSDEN Y COMMON COUNTIES
21 GILCHRIST Y COMMON COUNTIES
22 GLADES Y COMMON COUNTIES
23 GULF Y COMMON COUNTIES
24 HAMILTON Y COMMON COUNTIES
25 HARDEE Y COMMON COUNTIES
26 HENDRY Y COMMON COUNTIES
27 HERNANDO Y COMMON COUNTIES
28 HIGHLANDS Y COMMON COUNTIES
Report run on 08312018 0140 PM Page 1 of 45 state_codesrdf Report run by RSHQALL Dispose of this report so that it cannot be read or reconstructed
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CONSUMER AGE VERIFICATION REPORT PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Program AC
Age at Start
Enroll or Start Enroll Provider Program Description Consumer Name Client ID DOB Svc date or Svc Date
Report run on 08312018 0203 PM Page 1 of 1 age_verifyrdf
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Contract Budget Information PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Program Service Provider Location County Served Provider Contract
Projected Service
Units Unit Measure
Projected Unduplicated
State Federal Share Client Count Begin Date End Date
Row Count 0 Amount Total
Report run on 08312018 0233 PM Page 1 of 1 contract_budgetrdf
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Start Enroll Latest Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Date Asmt Date Worker
O3C1 1036 000 4061653427 Test CENTRAL 34982 W M 07091930 09102013 09102013 CIRTS20804 0 Name
Report run on 08312018 1133 AM Page 1 of 6 actv_by_progrdf
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Start Enroll Date
Latest Asmt Date Worker
4061593624 Test Name CENTRAL 34946 B F 11261940 12012011 12312013 CIRTS23407
Count 164
Unduplicated Client Count 163
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Assessments After DOD Report
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Owner 1025
The shaded records indicate clients who have different DOBs andor different names
Assemt Current PSA Owner Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Owner Assessor
Provider Assessor
Assemt Date
Assemt Type
Unduplicated Count Total 0
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Open Enrollments
The Vital Statistics Data for 07192002 - 09112014PSA ALL Provider ALL Program Status ACTV Include MLTC ACTVS N
The shaded records indicate clients who have different DOBs andor different names
Enroll PSA
Enrollment Provider Loc Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Enroll Program Status
Enroll Program
Current Owner ID
02 1065 0072 4062244026 Test Name Test Name 10222004 03231917 03231917 ACTV CCE 1065
Count of enrollments for the Provider 1
Count of enrollments for the PSA 1
Count of enrollments for the Report 1
Unduplicated Count of Individuals with open enrollments and DOD PSA Total Clients Count
02 1
Total 1
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Report run on 08312018 0207 PM Page 1 of 3 vs_servicesrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Unduplicated count of individuals with Services after DOD
PSA Total Clients Count
Report Total
Report run on 08312018 0207 PM Page 2 of 3 vs_servicesrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
List of Clients with PSA table entry for SERVICES_AFTER_DOD
Unduplicated Count Total 0
Report run on 08312018 0207 PM Page 3 of 3 vs_servicesrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Age
Provider
Total
Age lt 60 Age 60 - 64 Age 65 - 74 Age 75 - 84 Age 85+ Total Clients Avg Age
Total
Avg Age
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Ethnicity
Provider Hispanic Other Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Race
American Indian Native Hawaiian Other Provider Asian Alaska Native Black Pacific Islander Minority White Multiple Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Gender
Provider Male Female Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Monthly Income
Provider 0 - - Higher than Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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None
Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Total Persons Served 0
Age lt 60 Years 0 0
Age 60 - 64 0 0
Age 65 - 74 0 0
Age 75 - 84 0 0
Age 85+ 0 0
Total Age 0 0
Average 000
Ethnicity Hispanic 0 0
Other Ethnicity 0 0
Unknown Ethnicity 0 0
Total 0 0
Race Asian 0 0
American Indian Alaska Native 0 0
Black 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority 0 0
White 0 0
Multiple 0 0
Unknown 0 0
Total 0 0
Sex Male 0 0
Female 0 0
Unknown Sex 0 0
Total 0 0
Monthly Income 0 - 0 0
- 0 0
Higher than 0 0
Unknown 0 0
Total 0 0
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Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Client ID Date Of Birth Ethnicity Race Sex Individual Monthly Income
Report run on 08312018 1058 AM Page 2 of 2 demo_by_prov_detrdf Report run byRSHQALL Dispose of this report so that it can not be read or reconstructed
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Demographics of Clients OAA Registered Served Only PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 City All Cities Program All Programs Service All Services County ALL COUNTIES Table OAA Registered Services Only Low Income Medium Income
Total Persons Served 0
Agelt 60 Years
Age 60 - 64
Age 65 - 74
Age 75 - 84
Age 85+
0
0
0
0
0
0
0
0
0
0
Monthly Income
0 -
-Higher than
Unknown
0
0
0
0
0
0
0
0
Total
Average
0
000
0 Total 0 0
Ethnicity Hispanic
Other
Unknown
0
0
0
0
0
0
Living Situation
Alone
Null
Policy Change
0
0
0
0
0
0
Total 0 0 Unknown
With Caregiver
0
0
0
0
Race Asian 0 0
With Other
With Other Caregiver
0
0
0
0
American Indian Alaska Native
Black
0
0
0
0Total Living Situation 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority
White
0
0
0
0 Limited English Proficiency
Multiple
Unknown
Total Race
0
0
0
0
0
0
Yes
No
Unknown
0
0
0
0
0
0
Total 0 0
Sex Male
Female
Unknown
0
0
0
0
0
0
Total 0 0
Report run on 08312018 1056 AM Page 1 of 1 demo_by_provrdf
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Disaster Assistance Clients for a Provider PSA ALL Provider All Providers Location 0000 Worker All Workers City All Cities Zip Code All Zip Codes Sort By ZIP
Provider 1036 Provider Name Location 0000 Worker CIRTS18634
Need Care Client Name Address City Zip County Phone Asst Reg Situation Relat Care phone Care Name
34946 N WO DA 000 SAINT JAMES DRIVE CENTRAL (025) 101-0620 Test NameTest Name SAINT LUCIE (005) 100-0369 Y
Client is active and no assessment information is available Special Shelter and Special Registry are unknown
Report run on 08312018 1102 AM Page 1 of 8 disaster_by_provrdf
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
Total by PSA 0
Report run on 08312018 1111 AM Page 1 of 5 eheap_exceptionsrdf
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
ALACH BAKER BAY BRADF BREVA BROWA CALHO CHARL CITRUS CLAY COLLIE COLUM DESOT DIXIE DUVAL ESCAM FLAGL FRANK GADSDAssisted Household Report UA ORD RD RD UN OTTE R BIA O BIA ER LIN EN
1 of Household Assisted 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Households AssistedWith Gross Income
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C 100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D 125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
3 Households with at leastOne member
A 60 Years or older 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B Disabled 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C Age 5 years or under 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D Under 60 Years Old 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Undup Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Assisted
Applicant Household Report
of Applicant Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
Report run on 08312018 1111 AM Page 2 of 5 eheap_exceptionsrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Energy Assisted Household Report
County of Assisted
Households
Households Assisted By Poverty Level
Under 75 75 - 100 101 - 125 126 - 150 Over 150 60 Years or older
At least one member who is
Age 5 years Age 2 years Age 3 years Disabled or younger and younger through 5
Under 60 Years Old
Undup Households
Assisted
Energy Assistance Total
Report run on 08312018 1107 AM Page 1 of 3 eheap_summaryrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Unduplicated Total 0 0
County of Assisted
Households Under 75 75 - 100
Households Assisted By Poverty Level
101 - 125 126 - 150 Over 150 60 Years or older Disabled
Age 5 years or younger
Age 2 years and younger
Age 3 years through 5
Under 60 Years Old
At least one member who is
Undup Households
Assisted
Other Assisted Household Report
Other Assistance Total
Report run on 08312018 1107 AM Page 2 of 3 eheap_summaryrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Applicant Household Report
County of Applicant
Households Under 75 75 - 100 101 - 125 126 - 150 Over 150 Income data
unavailable
Total 0
Report run on 08312018 1107 AM Page 3 of 3 eheap_summaryrdf
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01
Enrollment Active Consumer Count by Program PSA ALL Provider ALL PROVIDERS
County Description Program Count of Clients
BREVARD
ADI
CCE
HCE
LSP
NDP
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
MLTC
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
31
57
44
5
62
123
141
26
9
7
5
40
5
50
67
129
2
19
42
29
1
233
79
63
8
2
14
3
37
14
47
3
3
33
127
10
02
03
04
ALACHUA
BAKER
BAY
BRADFORD
Report run on 08312018 1148 AM Page 1 of 18 actv_countrdf
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Enrollment Terminations with Reasons PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 Program All Programs Program Status ALL Program Status Worker ALL WORKERS
Last First Program Medicaid Provider Start End Name Name Client ID Status Description Worker Number Program Location Enrollment Enrollment
Count 0
Report run on 08312018 1150 AM Page 1 of 1 enroll_term_reasonrdf
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Enrollments with Care Plan Report
PSA ALL Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTIVE STATUS Care Plan Service ALL SERVICES Care Plan Start 01012017 Care Plan End 12312017
Care Plan Care Plan Care Plan Client Name
Unduplicated Client Count 0
Client ID Program Status Worker Start Date End Date Service
Report run on 08312018 1054 AM Page 1 of 1 enroll_careplrdf Report run by RSHQALL Dispose of this report so that it cannot be read or reconstructed
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PSA CLIENT_ID CLIENT_NAME OWNER PROVIDER_ID ASSESSMENT_DATE ASSESSOR_NAME MEDICAID_NUMBER CAREGIVER_CHANGE ENVIRONMENT_CHANGE HEALTH_CHANGE INCOME_CHANGE SITUATION_CHANGE INITIAL_ASSM ANNUAL_ASSM SSN REFERRAL_SOURCE 1114 N N N N Y N 771771777 SELFFAMILY 812017 JANE CASEWORKER 2 1001141633 TEST TEST N
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Fixed Service Costs List PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Provider Location County Program Service Reimbursement Unit Rate Provider Cost Per Unit Begin Valid End Valid
Count 0
Report run on 08312018 0233 PM Page 1 of 1 fixed_service_costrdf
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CONSUMER AGE VERIFICATION REPORT PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Program AC
Age at Start
Enroll or Start Enroll Provider Program Description Consumer Name Client ID DOB Svc date or Svc Date
Report run on 08312018 0203 PM Page 1 of 1 age_verifyrdf
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Contract Budget Information PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Program Service Provider Location County Served Provider Contract
Projected Service
Units Unit Measure
Projected Unduplicated
State Federal Share Client Count Begin Date End Date
Row Count 0 Amount Total
Report run on 08312018 0233 PM Page 1 of 1 contract_budgetrdf
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Start Enroll Latest Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Date Asmt Date Worker
O3C1 1036 000 4061653427 Test CENTRAL 34982 W M 07091930 09102013 09102013 CIRTS20804 0 Name
Report run on 08312018 1133 AM Page 1 of 6 actv_by_progrdf
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Start Enroll Date
Latest Asmt Date Worker
4061593624 Test Name CENTRAL 34946 B F 11261940 12012011 12312013 CIRTS23407
Count 164
Unduplicated Client Count 163
Report run on 08312018 1133 AM Page 6 of 6 actv_by_progrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Assessments After DOD Report
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Owner 1025
The shaded records indicate clients who have different DOBs andor different names
Assemt Current PSA Owner Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Owner Assessor
Provider Assessor
Assemt Date
Assemt Type
Unduplicated Count Total 0
Report run on 08312018 0206 PM Page 1 of 1 vs_assmrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Open Enrollments
The Vital Statistics Data for 07192002 - 09112014PSA ALL Provider ALL Program Status ACTV Include MLTC ACTVS N
The shaded records indicate clients who have different DOBs andor different names
Enroll PSA
Enrollment Provider Loc Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Enroll Program Status
Enroll Program
Current Owner ID
02 1065 0072 4062244026 Test Name Test Name 10222004 03231917 03231917 ACTV CCE 1065
Count of enrollments for the Provider 1
Count of enrollments for the PSA 1
Count of enrollments for the Report 1
Unduplicated Count of Individuals with open enrollments and DOD PSA Total Clients Count
02 1
Total 1
Report run on 08312018 0205 PM Page 1 of 1 vs_open_enrollrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Report run on 08312018 0207 PM Page 1 of 3 vs_servicesrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Unduplicated count of individuals with Services after DOD
PSA Total Clients Count
Report Total
Report run on 08312018 0207 PM Page 2 of 3 vs_servicesrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
List of Clients with PSA table entry for SERVICES_AFTER_DOD
Unduplicated Count Total 0
Report run on 08312018 0207 PM Page 3 of 3 vs_servicesrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Age
Provider
Total
Age lt 60 Age 60 - 64 Age 65 - 74 Age 75 - 84 Age 85+ Total Clients Avg Age
Total
Avg Age
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 1 of 5 demo_all_prvrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Ethnicity
Provider Hispanic Other Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 2 of 5 demo_all_prvrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Race
American Indian Native Hawaiian Other Provider Asian Alaska Native Black Pacific Islander Minority White Multiple Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 3 of 5 demo_all_prvrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Gender
Provider Male Female Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 4 of 5 demo_all_prvrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Monthly Income
Provider 0 - - Higher than Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 5 of 5 demo_all_prvrdf
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None
Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Total Persons Served 0
Age lt 60 Years 0 0
Age 60 - 64 0 0
Age 65 - 74 0 0
Age 75 - 84 0 0
Age 85+ 0 0
Total Age 0 0
Average 000
Ethnicity Hispanic 0 0
Other Ethnicity 0 0
Unknown Ethnicity 0 0
Total 0 0
Race Asian 0 0
American Indian Alaska Native 0 0
Black 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority 0 0
White 0 0
Multiple 0 0
Unknown 0 0
Total 0 0
Sex Male 0 0
Female 0 0
Unknown Sex 0 0
Total 0 0
Monthly Income 0 - 0 0
- 0 0
Higher than 0 0
Unknown 0 0
Total 0 0
Report run on 08312018 1058 AM Page 1 of 2 demo_by_prov_detrdf Report run byRSHQALL Dispose of this report so that it can not be read or reconstructed
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Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Client ID Date Of Birth Ethnicity Race Sex Individual Monthly Income
Report run on 08312018 1058 AM Page 2 of 2 demo_by_prov_detrdf Report run byRSHQALL Dispose of this report so that it can not be read or reconstructed
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Demographics of Clients OAA Registered Served Only PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 City All Cities Program All Programs Service All Services County ALL COUNTIES Table OAA Registered Services Only Low Income Medium Income
Total Persons Served 0
Agelt 60 Years
Age 60 - 64
Age 65 - 74
Age 75 - 84
Age 85+
0
0
0
0
0
0
0
0
0
0
Monthly Income
0 -
-Higher than
Unknown
0
0
0
0
0
0
0
0
Total
Average
0
000
0 Total 0 0
Ethnicity Hispanic
Other
Unknown
0
0
0
0
0
0
Living Situation
Alone
Null
Policy Change
0
0
0
0
0
0
Total 0 0 Unknown
With Caregiver
0
0
0
0
Race Asian 0 0
With Other
With Other Caregiver
0
0
0
0
American Indian Alaska Native
Black
0
0
0
0Total Living Situation 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority
White
0
0
0
0 Limited English Proficiency
Multiple
Unknown
Total Race
0
0
0
0
0
0
Yes
No
Unknown
0
0
0
0
0
0
Total 0 0
Sex Male
Female
Unknown
0
0
0
0
0
0
Total 0 0
Report run on 08312018 1056 AM Page 1 of 1 demo_by_provrdf
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Disaster Assistance Clients for a Provider PSA ALL Provider All Providers Location 0000 Worker All Workers City All Cities Zip Code All Zip Codes Sort By ZIP
Provider 1036 Provider Name Location 0000 Worker CIRTS18634
Need Care Client Name Address City Zip County Phone Asst Reg Situation Relat Care phone Care Name
34946 N WO DA 000 SAINT JAMES DRIVE CENTRAL (025) 101-0620 Test NameTest Name SAINT LUCIE (005) 100-0369 Y
Client is active and no assessment information is available Special Shelter and Special Registry are unknown
Report run on 08312018 1102 AM Page 1 of 8 disaster_by_provrdf
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
Total by PSA 0
Report run on 08312018 1111 AM Page 1 of 5 eheap_exceptionsrdf
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
ALACH BAKER BAY BRADF BREVA BROWA CALHO CHARL CITRUS CLAY COLLIE COLUM DESOT DIXIE DUVAL ESCAM FLAGL FRANK GADSDAssisted Household Report UA ORD RD RD UN OTTE R BIA O BIA ER LIN EN
1 of Household Assisted 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Households AssistedWith Gross Income
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C 100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D 125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
3 Households with at leastOne member
A 60 Years or older 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B Disabled 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C Age 5 years or under 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D Under 60 Years Old 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Undup Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Assisted
Applicant Household Report
of Applicant Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
Report run on 08312018 1111 AM Page 2 of 5 eheap_exceptionsrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Energy Assisted Household Report
County of Assisted
Households
Households Assisted By Poverty Level
Under 75 75 - 100 101 - 125 126 - 150 Over 150 60 Years or older
At least one member who is
Age 5 years Age 2 years Age 3 years Disabled or younger and younger through 5
Under 60 Years Old
Undup Households
Assisted
Energy Assistance Total
Report run on 08312018 1107 AM Page 1 of 3 eheap_summaryrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Unduplicated Total 0 0
County of Assisted
Households Under 75 75 - 100
Households Assisted By Poverty Level
101 - 125 126 - 150 Over 150 60 Years or older Disabled
Age 5 years or younger
Age 2 years and younger
Age 3 years through 5
Under 60 Years Old
At least one member who is
Undup Households
Assisted
Other Assisted Household Report
Other Assistance Total
Report run on 08312018 1107 AM Page 2 of 3 eheap_summaryrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Applicant Household Report
County of Applicant
Households Under 75 75 - 100 101 - 125 126 - 150 Over 150 Income data
unavailable
Total 0
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01
Enrollment Active Consumer Count by Program PSA ALL Provider ALL PROVIDERS
County Description Program Count of Clients
BREVARD
ADI
CCE
HCE
LSP
NDP
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
MLTC
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
31
57
44
5
62
123
141
26
9
7
5
40
5
50
67
129
2
19
42
29
1
233
79
63
8
2
14
3
37
14
47
3
3
33
127
10
02
03
04
ALACHUA
BAKER
BAY
BRADFORD
Report run on 08312018 1148 AM Page 1 of 18 actv_countrdf
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Enrollment Terminations with Reasons PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 Program All Programs Program Status ALL Program Status Worker ALL WORKERS
Last First Program Medicaid Provider Start End Name Name Client ID Status Description Worker Number Program Location Enrollment Enrollment
Count 0
Report run on 08312018 1150 AM Page 1 of 1 enroll_term_reasonrdf
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Enrollments with Care Plan Report
PSA ALL Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTIVE STATUS Care Plan Service ALL SERVICES Care Plan Start 01012017 Care Plan End 12312017
Care Plan Care Plan Care Plan Client Name
Unduplicated Client Count 0
Client ID Program Status Worker Start Date End Date Service
Report run on 08312018 1054 AM Page 1 of 1 enroll_careplrdf Report run by RSHQALL Dispose of this report so that it cannot be read or reconstructed
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PSA CLIENT_ID CLIENT_NAME OWNER PROVIDER_ID ASSESSMENT_DATE ASSESSOR_NAME MEDICAID_NUMBER CAREGIVER_CHANGE ENVIRONMENT_CHANGE HEALTH_CHANGE INCOME_CHANGE SITUATION_CHANGE INITIAL_ASSM ANNUAL_ASSM SSN REFERRAL_SOURCE 1114 N N N N Y N 771771777 SELFFAMILY 812017 JANE CASEWORKER 2 1001141633 TEST TEST N
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Fixed Service Costs List PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Provider Location County Program Service Reimbursement Unit Rate Provider Cost Per Unit Begin Valid End Valid
Count 0
Report run on 08312018 0233 PM Page 1 of 1 fixed_service_costrdf
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Contract Budget Information PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Program Service Provider Location County Served Provider Contract
Projected Service
Units Unit Measure
Projected Unduplicated
State Federal Share Client Count Begin Date End Date
Row Count 0 Amount Total
Report run on 08312018 0233 PM Page 1 of 1 contract_budgetrdf
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Start Enroll Latest Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Date Asmt Date Worker
O3C1 1036 000 4061653427 Test CENTRAL 34982 W M 07091930 09102013 09102013 CIRTS20804 0 Name
Report run on 08312018 1133 AM Page 1 of 6 actv_by_progrdf
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Start Enroll Date
Latest Asmt Date Worker
4061593624 Test Name CENTRAL 34946 B F 11261940 12012011 12312013 CIRTS23407
Count 164
Unduplicated Client Count 163
Report run on 08312018 1133 AM Page 6 of 6 actv_by_progrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Assessments After DOD Report
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Owner 1025
The shaded records indicate clients who have different DOBs andor different names
Assemt Current PSA Owner Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Owner Assessor
Provider Assessor
Assemt Date
Assemt Type
Unduplicated Count Total 0
Report run on 08312018 0206 PM Page 1 of 1 vs_assmrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Open Enrollments
The Vital Statistics Data for 07192002 - 09112014PSA ALL Provider ALL Program Status ACTV Include MLTC ACTVS N
The shaded records indicate clients who have different DOBs andor different names
Enroll PSA
Enrollment Provider Loc Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Enroll Program Status
Enroll Program
Current Owner ID
02 1065 0072 4062244026 Test Name Test Name 10222004 03231917 03231917 ACTV CCE 1065
Count of enrollments for the Provider 1
Count of enrollments for the PSA 1
Count of enrollments for the Report 1
Unduplicated Count of Individuals with open enrollments and DOD PSA Total Clients Count
02 1
Total 1
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Report run on 08312018 0207 PM Page 1 of 3 vs_servicesrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Unduplicated count of individuals with Services after DOD
PSA Total Clients Count
Report Total
Report run on 08312018 0207 PM Page 2 of 3 vs_servicesrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
List of Clients with PSA table entry for SERVICES_AFTER_DOD
Unduplicated Count Total 0
Report run on 08312018 0207 PM Page 3 of 3 vs_servicesrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Age
Provider
Total
Age lt 60 Age 60 - 64 Age 65 - 74 Age 75 - 84 Age 85+ Total Clients Avg Age
Total
Avg Age
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Ethnicity
Provider Hispanic Other Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Race
American Indian Native Hawaiian Other Provider Asian Alaska Native Black Pacific Islander Minority White Multiple Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Gender
Provider Male Female Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 4 of 5 demo_all_prvrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Monthly Income
Provider 0 - - Higher than Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 5 of 5 demo_all_prvrdf
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None
Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Total Persons Served 0
Age lt 60 Years 0 0
Age 60 - 64 0 0
Age 65 - 74 0 0
Age 75 - 84 0 0
Age 85+ 0 0
Total Age 0 0
Average 000
Ethnicity Hispanic 0 0
Other Ethnicity 0 0
Unknown Ethnicity 0 0
Total 0 0
Race Asian 0 0
American Indian Alaska Native 0 0
Black 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority 0 0
White 0 0
Multiple 0 0
Unknown 0 0
Total 0 0
Sex Male 0 0
Female 0 0
Unknown Sex 0 0
Total 0 0
Monthly Income 0 - 0 0
- 0 0
Higher than 0 0
Unknown 0 0
Total 0 0
Report run on 08312018 1058 AM Page 1 of 2 demo_by_prov_detrdf Report run byRSHQALL Dispose of this report so that it can not be read or reconstructed
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Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Client ID Date Of Birth Ethnicity Race Sex Individual Monthly Income
Report run on 08312018 1058 AM Page 2 of 2 demo_by_prov_detrdf Report run byRSHQALL Dispose of this report so that it can not be read or reconstructed
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Demographics of Clients OAA Registered Served Only PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 City All Cities Program All Programs Service All Services County ALL COUNTIES Table OAA Registered Services Only Low Income Medium Income
Total Persons Served 0
Agelt 60 Years
Age 60 - 64
Age 65 - 74
Age 75 - 84
Age 85+
0
0
0
0
0
0
0
0
0
0
Monthly Income
0 -
-Higher than
Unknown
0
0
0
0
0
0
0
0
Total
Average
0
000
0 Total 0 0
Ethnicity Hispanic
Other
Unknown
0
0
0
0
0
0
Living Situation
Alone
Null
Policy Change
0
0
0
0
0
0
Total 0 0 Unknown
With Caregiver
0
0
0
0
Race Asian 0 0
With Other
With Other Caregiver
0
0
0
0
American Indian Alaska Native
Black
0
0
0
0Total Living Situation 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority
White
0
0
0
0 Limited English Proficiency
Multiple
Unknown
Total Race
0
0
0
0
0
0
Yes
No
Unknown
0
0
0
0
0
0
Total 0 0
Sex Male
Female
Unknown
0
0
0
0
0
0
Total 0 0
Report run on 08312018 1056 AM Page 1 of 1 demo_by_provrdf
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Disaster Assistance Clients for a Provider PSA ALL Provider All Providers Location 0000 Worker All Workers City All Cities Zip Code All Zip Codes Sort By ZIP
Provider 1036 Provider Name Location 0000 Worker CIRTS18634
Need Care Client Name Address City Zip County Phone Asst Reg Situation Relat Care phone Care Name
34946 N WO DA 000 SAINT JAMES DRIVE CENTRAL (025) 101-0620 Test NameTest Name SAINT LUCIE (005) 100-0369 Y
Client is active and no assessment information is available Special Shelter and Special Registry are unknown
Report run on 08312018 1102 AM Page 1 of 8 disaster_by_provrdf
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
Total by PSA 0
Report run on 08312018 1111 AM Page 1 of 5 eheap_exceptionsrdf
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
ALACH BAKER BAY BRADF BREVA BROWA CALHO CHARL CITRUS CLAY COLLIE COLUM DESOT DIXIE DUVAL ESCAM FLAGL FRANK GADSDAssisted Household Report UA ORD RD RD UN OTTE R BIA O BIA ER LIN EN
1 of Household Assisted 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Households AssistedWith Gross Income
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C 100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D 125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
3 Households with at leastOne member
A 60 Years or older 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B Disabled 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C Age 5 years or under 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D Under 60 Years Old 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Undup Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Assisted
Applicant Household Report
of Applicant Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
Report run on 08312018 1111 AM Page 2 of 5 eheap_exceptionsrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Energy Assisted Household Report
County of Assisted
Households
Households Assisted By Poverty Level
Under 75 75 - 100 101 - 125 126 - 150 Over 150 60 Years or older
At least one member who is
Age 5 years Age 2 years Age 3 years Disabled or younger and younger through 5
Under 60 Years Old
Undup Households
Assisted
Energy Assistance Total
Report run on 08312018 1107 AM Page 1 of 3 eheap_summaryrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Unduplicated Total 0 0
County of Assisted
Households Under 75 75 - 100
Households Assisted By Poverty Level
101 - 125 126 - 150 Over 150 60 Years or older Disabled
Age 5 years or younger
Age 2 years and younger
Age 3 years through 5
Under 60 Years Old
At least one member who is
Undup Households
Assisted
Other Assisted Household Report
Other Assistance Total
Report run on 08312018 1107 AM Page 2 of 3 eheap_summaryrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Applicant Household Report
County of Applicant
Households Under 75 75 - 100 101 - 125 126 - 150 Over 150 Income data
unavailable
Total 0
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01
Enrollment Active Consumer Count by Program PSA ALL Provider ALL PROVIDERS
County Description Program Count of Clients
BREVARD
ADI
CCE
HCE
LSP
NDP
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
MLTC
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
31
57
44
5
62
123
141
26
9
7
5
40
5
50
67
129
2
19
42
29
1
233
79
63
8
2
14
3
37
14
47
3
3
33
127
10
02
03
04
ALACHUA
BAKER
BAY
BRADFORD
Report run on 08312018 1148 AM Page 1 of 18 actv_countrdf
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05
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Enrollment Terminations with Reasons PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 Program All Programs Program Status ALL Program Status Worker ALL WORKERS
Last First Program Medicaid Provider Start End Name Name Client ID Status Description Worker Number Program Location Enrollment Enrollment
Count 0
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Enrollments with Care Plan Report
PSA ALL Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTIVE STATUS Care Plan Service ALL SERVICES Care Plan Start 01012017 Care Plan End 12312017
Care Plan Care Plan Care Plan Client Name
Unduplicated Client Count 0
Client ID Program Status Worker Start Date End Date Service
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PSA CLIENT_ID CLIENT_NAME OWNER PROVIDER_ID ASSESSMENT_DATE ASSESSOR_NAME MEDICAID_NUMBER CAREGIVER_CHANGE ENVIRONMENT_CHANGE HEALTH_CHANGE INCOME_CHANGE SITUATION_CHANGE INITIAL_ASSM ANNUAL_ASSM SSN REFERRAL_SOURCE 1114 N N N N Y N 771771777 SELFFAMILY 812017 JANE CASEWORKER 2 1001141633 TEST TEST N
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Fixed Service Costs List PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Provider Location County Program Service Reimbursement Unit Rate Provider Cost Per Unit Begin Valid End Valid
Count 0
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Start Enroll Latest Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Date Asmt Date Worker
O3C1 1036 000 4061653427 Test CENTRAL 34982 W M 07091930 09102013 09102013 CIRTS20804 0 Name
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Start Enroll Date
Latest Asmt Date Worker
4061593624 Test Name CENTRAL 34946 B F 11261940 12012011 12312013 CIRTS23407
Count 164
Unduplicated Client Count 163
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Assessments After DOD Report
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Owner 1025
The shaded records indicate clients who have different DOBs andor different names
Assemt Current PSA Owner Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Owner Assessor
Provider Assessor
Assemt Date
Assemt Type
Unduplicated Count Total 0
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Open Enrollments
The Vital Statistics Data for 07192002 - 09112014PSA ALL Provider ALL Program Status ACTV Include MLTC ACTVS N
The shaded records indicate clients who have different DOBs andor different names
Enroll PSA
Enrollment Provider Loc Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Enroll Program Status
Enroll Program
Current Owner ID
02 1065 0072 4062244026 Test Name Test Name 10222004 03231917 03231917 ACTV CCE 1065
Count of enrollments for the Provider 1
Count of enrollments for the PSA 1
Count of enrollments for the Report 1
Unduplicated Count of Individuals with open enrollments and DOD PSA Total Clients Count
02 1
Total 1
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Report run on 08312018 0207 PM Page 1 of 3 vs_servicesrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Unduplicated count of individuals with Services after DOD
PSA Total Clients Count
Report Total
Report run on 08312018 0207 PM Page 2 of 3 vs_servicesrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
List of Clients with PSA table entry for SERVICES_AFTER_DOD
Unduplicated Count Total 0
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Age
Provider
Total
Age lt 60 Age 60 - 64 Age 65 - 74 Age 75 - 84 Age 85+ Total Clients Avg Age
Total
Avg Age
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Ethnicity
Provider Hispanic Other Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Race
American Indian Native Hawaiian Other Provider Asian Alaska Native Black Pacific Islander Minority White Multiple Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Gender
Provider Male Female Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Monthly Income
Provider 0 - - Higher than Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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None
Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Total Persons Served 0
Age lt 60 Years 0 0
Age 60 - 64 0 0
Age 65 - 74 0 0
Age 75 - 84 0 0
Age 85+ 0 0
Total Age 0 0
Average 000
Ethnicity Hispanic 0 0
Other Ethnicity 0 0
Unknown Ethnicity 0 0
Total 0 0
Race Asian 0 0
American Indian Alaska Native 0 0
Black 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority 0 0
White 0 0
Multiple 0 0
Unknown 0 0
Total 0 0
Sex Male 0 0
Female 0 0
Unknown Sex 0 0
Total 0 0
Monthly Income 0 - 0 0
- 0 0
Higher than 0 0
Unknown 0 0
Total 0 0
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Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Client ID Date Of Birth Ethnicity Race Sex Individual Monthly Income
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Demographics of Clients OAA Registered Served Only PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 City All Cities Program All Programs Service All Services County ALL COUNTIES Table OAA Registered Services Only Low Income Medium Income
Total Persons Served 0
Agelt 60 Years
Age 60 - 64
Age 65 - 74
Age 75 - 84
Age 85+
0
0
0
0
0
0
0
0
0
0
Monthly Income
0 -
-Higher than
Unknown
0
0
0
0
0
0
0
0
Total
Average
0
000
0 Total 0 0
Ethnicity Hispanic
Other
Unknown
0
0
0
0
0
0
Living Situation
Alone
Null
Policy Change
0
0
0
0
0
0
Total 0 0 Unknown
With Caregiver
0
0
0
0
Race Asian 0 0
With Other
With Other Caregiver
0
0
0
0
American Indian Alaska Native
Black
0
0
0
0Total Living Situation 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority
White
0
0
0
0 Limited English Proficiency
Multiple
Unknown
Total Race
0
0
0
0
0
0
Yes
No
Unknown
0
0
0
0
0
0
Total 0 0
Sex Male
Female
Unknown
0
0
0
0
0
0
Total 0 0
Report run on 08312018 1056 AM Page 1 of 1 demo_by_provrdf
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Disaster Assistance Clients for a Provider PSA ALL Provider All Providers Location 0000 Worker All Workers City All Cities Zip Code All Zip Codes Sort By ZIP
Provider 1036 Provider Name Location 0000 Worker CIRTS18634
Need Care Client Name Address City Zip County Phone Asst Reg Situation Relat Care phone Care Name
34946 N WO DA 000 SAINT JAMES DRIVE CENTRAL (025) 101-0620 Test NameTest Name SAINT LUCIE (005) 100-0369 Y
Client is active and no assessment information is available Special Shelter and Special Registry are unknown
Report run on 08312018 1102 AM Page 1 of 8 disaster_by_provrdf
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
Total by PSA 0
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
ALACH BAKER BAY BRADF BREVA BROWA CALHO CHARL CITRUS CLAY COLLIE COLUM DESOT DIXIE DUVAL ESCAM FLAGL FRANK GADSDAssisted Household Report UA ORD RD RD UN OTTE R BIA O BIA ER LIN EN
1 of Household Assisted 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Households AssistedWith Gross Income
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C 100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D 125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
3 Households with at leastOne member
A 60 Years or older 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B Disabled 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C Age 5 years or under 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D Under 60 Years Old 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Undup Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Assisted
Applicant Household Report
of Applicant Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
Report run on 08312018 1111 AM Page 2 of 5 eheap_exceptionsrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Energy Assisted Household Report
County of Assisted
Households
Households Assisted By Poverty Level
Under 75 75 - 100 101 - 125 126 - 150 Over 150 60 Years or older
At least one member who is
Age 5 years Age 2 years Age 3 years Disabled or younger and younger through 5
Under 60 Years Old
Undup Households
Assisted
Energy Assistance Total
Report run on 08312018 1107 AM Page 1 of 3 eheap_summaryrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Unduplicated Total 0 0
County of Assisted
Households Under 75 75 - 100
Households Assisted By Poverty Level
101 - 125 126 - 150 Over 150 60 Years or older Disabled
Age 5 years or younger
Age 2 years and younger
Age 3 years through 5
Under 60 Years Old
At least one member who is
Undup Households
Assisted
Other Assisted Household Report
Other Assistance Total
Report run on 08312018 1107 AM Page 2 of 3 eheap_summaryrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Applicant Household Report
County of Applicant
Households Under 75 75 - 100 101 - 125 126 - 150 Over 150 Income data
unavailable
Total 0
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01
Enrollment Active Consumer Count by Program PSA ALL Provider ALL PROVIDERS
County Description Program Count of Clients
BREVARD
ADI
CCE
HCE
LSP
NDP
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
MLTC
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
31
57
44
5
62
123
141
26
9
7
5
40
5
50
67
129
2
19
42
29
1
233
79
63
8
2
14
3
37
14
47
3
3
33
127
10
02
03
04
ALACHUA
BAKER
BAY
BRADFORD
Report run on 08312018 1148 AM Page 1 of 18 actv_countrdf
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Enrollment Terminations with Reasons PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 Program All Programs Program Status ALL Program Status Worker ALL WORKERS
Last First Program Medicaid Provider Start End Name Name Client ID Status Description Worker Number Program Location Enrollment Enrollment
Count 0
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Enrollments with Care Plan Report
PSA ALL Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTIVE STATUS Care Plan Service ALL SERVICES Care Plan Start 01012017 Care Plan End 12312017
Care Plan Care Plan Care Plan Client Name
Unduplicated Client Count 0
Client ID Program Status Worker Start Date End Date Service
Report run on 08312018 1054 AM Page 1 of 1 enroll_careplrdf Report run by RSHQALL Dispose of this report so that it cannot be read or reconstructed
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PSA CLIENT_ID CLIENT_NAME OWNER PROVIDER_ID ASSESSMENT_DATE ASSESSOR_NAME MEDICAID_NUMBER CAREGIVER_CHANGE ENVIRONMENT_CHANGE HEALTH_CHANGE INCOME_CHANGE SITUATION_CHANGE INITIAL_ASSM ANNUAL_ASSM SSN REFERRAL_SOURCE 1114 N N N N Y N 771771777 SELFFAMILY 812017 JANE CASEWORKER 2 1001141633 TEST TEST N
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Fixed Service Costs List PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Provider Location County Program Service Reimbursement Unit Rate Provider Cost Per Unit Begin Valid End Valid
Count 0
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Current Active Clients by Program or Provider PSA ALL Provider ALL PROVIDERS Location 0000 County ALL COUNTIES Zip Code All ZipCodes
Worker All Workers
Program Provider Loc Provider Name Client ID Client Name City Zip Race Sex Birth Date Start Enroll Date
Latest Asmt Date Worker
4061593624 Test Name CENTRAL 34946 B F 11261940 12012011 12312013 CIRTS23407
Count 164
Unduplicated Client Count 163
Report run on 08312018 1133 AM Page 6 of 6 actv_by_progrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Assessments After DOD Report
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Owner 1025
The shaded records indicate clients who have different DOBs andor different names
Assemt Current PSA Owner Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Owner Assessor
Provider Assessor
Assemt Date
Assemt Type
Unduplicated Count Total 0
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Open Enrollments
The Vital Statistics Data for 07192002 - 09112014PSA ALL Provider ALL Program Status ACTV Include MLTC ACTVS N
The shaded records indicate clients who have different DOBs andor different names
Enroll PSA
Enrollment Provider Loc Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Enroll Program Status
Enroll Program
Current Owner ID
02 1065 0072 4062244026 Test Name Test Name 10222004 03231917 03231917 ACTV CCE 1065
Count of enrollments for the Provider 1
Count of enrollments for the PSA 1
Count of enrollments for the Report 1
Unduplicated Count of Individuals with open enrollments and DOD PSA Total Clients Count
02 1
Total 1
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Report run on 08312018 0207 PM Page 1 of 3 vs_servicesrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Unduplicated count of individuals with Services after DOD
PSA Total Clients Count
Report Total
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
List of Clients with PSA table entry for SERVICES_AFTER_DOD
Unduplicated Count Total 0
Report run on 08312018 0207 PM Page 3 of 3 vs_servicesrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Age
Provider
Total
Age lt 60 Age 60 - 64 Age 65 - 74 Age 75 - 84 Age 85+ Total Clients Avg Age
Total
Avg Age
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Ethnicity
Provider Hispanic Other Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Race
American Indian Native Hawaiian Other Provider Asian Alaska Native Black Pacific Islander Minority White Multiple Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Gender
Provider Male Female Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Monthly Income
Provider 0 - - Higher than Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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None
Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Total Persons Served 0
Age lt 60 Years 0 0
Age 60 - 64 0 0
Age 65 - 74 0 0
Age 75 - 84 0 0
Age 85+ 0 0
Total Age 0 0
Average 000
Ethnicity Hispanic 0 0
Other Ethnicity 0 0
Unknown Ethnicity 0 0
Total 0 0
Race Asian 0 0
American Indian Alaska Native 0 0
Black 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority 0 0
White 0 0
Multiple 0 0
Unknown 0 0
Total 0 0
Sex Male 0 0
Female 0 0
Unknown Sex 0 0
Total 0 0
Monthly Income 0 - 0 0
- 0 0
Higher than 0 0
Unknown 0 0
Total 0 0
Report run on 08312018 1058 AM Page 1 of 2 demo_by_prov_detrdf Report run byRSHQALL Dispose of this report so that it can not be read or reconstructed
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Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Client ID Date Of Birth Ethnicity Race Sex Individual Monthly Income
Report run on 08312018 1058 AM Page 2 of 2 demo_by_prov_detrdf Report run byRSHQALL Dispose of this report so that it can not be read or reconstructed
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Demographics of Clients OAA Registered Served Only PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 City All Cities Program All Programs Service All Services County ALL COUNTIES Table OAA Registered Services Only Low Income Medium Income
Total Persons Served 0
Agelt 60 Years
Age 60 - 64
Age 65 - 74
Age 75 - 84
Age 85+
0
0
0
0
0
0
0
0
0
0
Monthly Income
0 -
-Higher than
Unknown
0
0
0
0
0
0
0
0
Total
Average
0
000
0 Total 0 0
Ethnicity Hispanic
Other
Unknown
0
0
0
0
0
0
Living Situation
Alone
Null
Policy Change
0
0
0
0
0
0
Total 0 0 Unknown
With Caregiver
0
0
0
0
Race Asian 0 0
With Other
With Other Caregiver
0
0
0
0
American Indian Alaska Native
Black
0
0
0
0Total Living Situation 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority
White
0
0
0
0 Limited English Proficiency
Multiple
Unknown
Total Race
0
0
0
0
0
0
Yes
No
Unknown
0
0
0
0
0
0
Total 0 0
Sex Male
Female
Unknown
0
0
0
0
0
0
Total 0 0
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Disaster Assistance Clients for a Provider PSA ALL Provider All Providers Location 0000 Worker All Workers City All Cities Zip Code All Zip Codes Sort By ZIP
Provider 1036 Provider Name Location 0000 Worker CIRTS18634
Need Care Client Name Address City Zip County Phone Asst Reg Situation Relat Care phone Care Name
34946 N WO DA 000 SAINT JAMES DRIVE CENTRAL (025) 101-0620 Test NameTest Name SAINT LUCIE (005) 100-0369 Y
Client is active and no assessment information is available Special Shelter and Special Registry are unknown
Report run on 08312018 1102 AM Page 1 of 8 disaster_by_provrdf
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
Total by PSA 0
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
ALACH BAKER BAY BRADF BREVA BROWA CALHO CHARL CITRUS CLAY COLLIE COLUM DESOT DIXIE DUVAL ESCAM FLAGL FRANK GADSDAssisted Household Report UA ORD RD RD UN OTTE R BIA O BIA ER LIN EN
1 of Household Assisted 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Households AssistedWith Gross Income
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C 100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D 125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
3 Households with at leastOne member
A 60 Years or older 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B Disabled 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C Age 5 years or under 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D Under 60 Years Old 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Undup Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Assisted
Applicant Household Report
of Applicant Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Energy Assisted Household Report
County of Assisted
Households
Households Assisted By Poverty Level
Under 75 75 - 100 101 - 125 126 - 150 Over 150 60 Years or older
At least one member who is
Age 5 years Age 2 years Age 3 years Disabled or younger and younger through 5
Under 60 Years Old
Undup Households
Assisted
Energy Assistance Total
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Unduplicated Total 0 0
County of Assisted
Households Under 75 75 - 100
Households Assisted By Poverty Level
101 - 125 126 - 150 Over 150 60 Years or older Disabled
Age 5 years or younger
Age 2 years and younger
Age 3 years through 5
Under 60 Years Old
At least one member who is
Undup Households
Assisted
Other Assisted Household Report
Other Assistance Total
Report run on 08312018 1107 AM Page 2 of 3 eheap_summaryrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Applicant Household Report
County of Applicant
Households Under 75 75 - 100 101 - 125 126 - 150 Over 150 Income data
unavailable
Total 0
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01
Enrollment Active Consumer Count by Program PSA ALL Provider ALL PROVIDERS
County Description Program Count of Clients
BREVARD
ADI
CCE
HCE
LSP
NDP
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
MLTC
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
31
57
44
5
62
123
141
26
9
7
5
40
5
50
67
129
2
19
42
29
1
233
79
63
8
2
14
3
37
14
47
3
3
33
127
10
02
03
04
ALACHUA
BAKER
BAY
BRADFORD
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Enrollment Terminations with Reasons PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 Program All Programs Program Status ALL Program Status Worker ALL WORKERS
Last First Program Medicaid Provider Start End Name Name Client ID Status Description Worker Number Program Location Enrollment Enrollment
Count 0
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Enrollments with Care Plan Report
PSA ALL Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTIVE STATUS Care Plan Service ALL SERVICES Care Plan Start 01012017 Care Plan End 12312017
Care Plan Care Plan Care Plan Client Name
Unduplicated Client Count 0
Client ID Program Status Worker Start Date End Date Service
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PSA CLIENT_ID CLIENT_NAME OWNER PROVIDER_ID ASSESSMENT_DATE ASSESSOR_NAME MEDICAID_NUMBER CAREGIVER_CHANGE ENVIRONMENT_CHANGE HEALTH_CHANGE INCOME_CHANGE SITUATION_CHANGE INITIAL_ASSM ANNUAL_ASSM SSN REFERRAL_SOURCE 1114 N N N N Y N 771771777 SELFFAMILY 812017 JANE CASEWORKER 2 1001141633 TEST TEST N
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Fixed Service Costs List PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Provider Location County Program Service Reimbursement Unit Rate Provider Cost Per Unit Begin Valid End Valid
Count 0
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Assessments After DOD Report
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Owner 1025
The shaded records indicate clients who have different DOBs andor different names
Assemt Current PSA Owner Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Owner Assessor
Provider Assessor
Assemt Date
Assemt Type
Unduplicated Count Total 0
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Open Enrollments
The Vital Statistics Data for 07192002 - 09112014PSA ALL Provider ALL Program Status ACTV Include MLTC ACTVS N
The shaded records indicate clients who have different DOBs andor different names
Enroll PSA
Enrollment Provider Loc Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Enroll Program Status
Enroll Program
Current Owner ID
02 1065 0072 4062244026 Test Name Test Name 10222004 03231917 03231917 ACTV CCE 1065
Count of enrollments for the Provider 1
Count of enrollments for the PSA 1
Count of enrollments for the Report 1
Unduplicated Count of Individuals with open enrollments and DOD PSA Total Clients Count
02 1
Total 1
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Report run on 08312018 0207 PM Page 1 of 3 vs_servicesrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Unduplicated count of individuals with Services after DOD
PSA Total Clients Count
Report Total
Report run on 08312018 0207 PM Page 2 of 3 vs_servicesrdf
Report run by RSHQALL Dispose of this report so that it can not be read or reconstructed
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
List of Clients with PSA table entry for SERVICES_AFTER_DOD
Unduplicated Count Total 0
Report run on 08312018 0207 PM Page 3 of 3 vs_servicesrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Age
Provider
Total
Age lt 60 Age 60 - 64 Age 65 - 74 Age 75 - 84 Age 85+ Total Clients Avg Age
Total
Avg Age
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 1 of 5 demo_all_prvrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Ethnicity
Provider Hispanic Other Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 2 of 5 demo_all_prvrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Race
American Indian Native Hawaiian Other Provider Asian Alaska Native Black Pacific Islander Minority White Multiple Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 3 of 5 demo_all_prvrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Gender
Provider Male Female Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 4 of 5 demo_all_prvrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Monthly Income
Provider 0 - - Higher than Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 5 of 5 demo_all_prvrdf
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None
Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Total Persons Served 0
Age lt 60 Years 0 0
Age 60 - 64 0 0
Age 65 - 74 0 0
Age 75 - 84 0 0
Age 85+ 0 0
Total Age 0 0
Average 000
Ethnicity Hispanic 0 0
Other Ethnicity 0 0
Unknown Ethnicity 0 0
Total 0 0
Race Asian 0 0
American Indian Alaska Native 0 0
Black 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority 0 0
White 0 0
Multiple 0 0
Unknown 0 0
Total 0 0
Sex Male 0 0
Female 0 0
Unknown Sex 0 0
Total 0 0
Monthly Income 0 - 0 0
- 0 0
Higher than 0 0
Unknown 0 0
Total 0 0
Report run on 08312018 1058 AM Page 1 of 2 demo_by_prov_detrdf Report run byRSHQALL Dispose of this report so that it can not be read or reconstructed
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Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Client ID Date Of Birth Ethnicity Race Sex Individual Monthly Income
Report run on 08312018 1058 AM Page 2 of 2 demo_by_prov_detrdf Report run byRSHQALL Dispose of this report so that it can not be read or reconstructed
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Demographics of Clients OAA Registered Served Only PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 City All Cities Program All Programs Service All Services County ALL COUNTIES Table OAA Registered Services Only Low Income Medium Income
Total Persons Served 0
Agelt 60 Years
Age 60 - 64
Age 65 - 74
Age 75 - 84
Age 85+
0
0
0
0
0
0
0
0
0
0
Monthly Income
0 -
-Higher than
Unknown
0
0
0
0
0
0
0
0
Total
Average
0
000
0 Total 0 0
Ethnicity Hispanic
Other
Unknown
0
0
0
0
0
0
Living Situation
Alone
Null
Policy Change
0
0
0
0
0
0
Total 0 0 Unknown
With Caregiver
0
0
0
0
Race Asian 0 0
With Other
With Other Caregiver
0
0
0
0
American Indian Alaska Native
Black
0
0
0
0Total Living Situation 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority
White
0
0
0
0 Limited English Proficiency
Multiple
Unknown
Total Race
0
0
0
0
0
0
Yes
No
Unknown
0
0
0
0
0
0
Total 0 0
Sex Male
Female
Unknown
0
0
0
0
0
0
Total 0 0
Report run on 08312018 1056 AM Page 1 of 1 demo_by_provrdf
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Disaster Assistance Clients for a Provider PSA ALL Provider All Providers Location 0000 Worker All Workers City All Cities Zip Code All Zip Codes Sort By ZIP
Provider 1036 Provider Name Location 0000 Worker CIRTS18634
Need Care Client Name Address City Zip County Phone Asst Reg Situation Relat Care phone Care Name
34946 N WO DA 000 SAINT JAMES DRIVE CENTRAL (025) 101-0620 Test NameTest Name SAINT LUCIE (005) 100-0369 Y
Client is active and no assessment information is available Special Shelter and Special Registry are unknown
Report run on 08312018 1102 AM Page 1 of 8 disaster_by_provrdf
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
Total by PSA 0
Report run on 08312018 1111 AM Page 1 of 5 eheap_exceptionsrdf
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
ALACH BAKER BAY BRADF BREVA BROWA CALHO CHARL CITRUS CLAY COLLIE COLUM DESOT DIXIE DUVAL ESCAM FLAGL FRANK GADSDAssisted Household Report UA ORD RD RD UN OTTE R BIA O BIA ER LIN EN
1 of Household Assisted 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Households AssistedWith Gross Income
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C 100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D 125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
3 Households with at leastOne member
A 60 Years or older 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B Disabled 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C Age 5 years or under 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D Under 60 Years Old 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Undup Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Assisted
Applicant Household Report
of Applicant Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
Report run on 08312018 1111 AM Page 2 of 5 eheap_exceptionsrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Energy Assisted Household Report
County of Assisted
Households
Households Assisted By Poverty Level
Under 75 75 - 100 101 - 125 126 - 150 Over 150 60 Years or older
At least one member who is
Age 5 years Age 2 years Age 3 years Disabled or younger and younger through 5
Under 60 Years Old
Undup Households
Assisted
Energy Assistance Total
Report run on 08312018 1107 AM Page 1 of 3 eheap_summaryrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Unduplicated Total 0 0
County of Assisted
Households Under 75 75 - 100
Households Assisted By Poverty Level
101 - 125 126 - 150 Over 150 60 Years or older Disabled
Age 5 years or younger
Age 2 years and younger
Age 3 years through 5
Under 60 Years Old
At least one member who is
Undup Households
Assisted
Other Assisted Household Report
Other Assistance Total
Report run on 08312018 1107 AM Page 2 of 3 eheap_summaryrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Applicant Household Report
County of Applicant
Households Under 75 75 - 100 101 - 125 126 - 150 Over 150 Income data
unavailable
Total 0
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01
Enrollment Active Consumer Count by Program PSA ALL Provider ALL PROVIDERS
County Description Program Count of Clients
BREVARD
ADI
CCE
HCE
LSP
NDP
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
MLTC
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
31
57
44
5
62
123
141
26
9
7
5
40
5
50
67
129
2
19
42
29
1
233
79
63
8
2
14
3
37
14
47
3
3
33
127
10
02
03
04
ALACHUA
BAKER
BAY
BRADFORD
Report run on 08312018 1148 AM Page 1 of 18 actv_countrdf
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05
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Enrollment Terminations with Reasons PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 Program All Programs Program Status ALL Program Status Worker ALL WORKERS
Last First Program Medicaid Provider Start End Name Name Client ID Status Description Worker Number Program Location Enrollment Enrollment
Count 0
Report run on 08312018 1150 AM Page 1 of 1 enroll_term_reasonrdf
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Enrollments with Care Plan Report
PSA ALL Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTIVE STATUS Care Plan Service ALL SERVICES Care Plan Start 01012017 Care Plan End 12312017
Care Plan Care Plan Care Plan Client Name
Unduplicated Client Count 0
Client ID Program Status Worker Start Date End Date Service
Report run on 08312018 1054 AM Page 1 of 1 enroll_careplrdf Report run by RSHQALL Dispose of this report so that it cannot be read or reconstructed
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PSA CLIENT_ID CLIENT_NAME OWNER PROVIDER_ID ASSESSMENT_DATE ASSESSOR_NAME MEDICAID_NUMBER CAREGIVER_CHANGE ENVIRONMENT_CHANGE HEALTH_CHANGE INCOME_CHANGE SITUATION_CHANGE INITIAL_ASSM ANNUAL_ASSM SSN REFERRAL_SOURCE 1114 N N N N Y N 771771777 SELFFAMILY 812017 JANE CASEWORKER 2 1001141633 TEST TEST N
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Fixed Service Costs List PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Provider Location County Program Service Reimbursement Unit Rate Provider Cost Per Unit Begin Valid End Valid
Count 0
Report run on 08312018 0233 PM Page 1 of 1 fixed_service_costrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Open Enrollments
The Vital Statistics Data for 07192002 - 09112014PSA ALL Provider ALL Program Status ACTV Include MLTC ACTVS N
The shaded records indicate clients who have different DOBs andor different names
Enroll PSA
Enrollment Provider Loc Client ID CIRTS Name Vital Statistics Name
Vital Stat DOD
CIRTS DOB
Vital Stat DOB
Enroll Program Status
Enroll Program
Current Owner ID
02 1065 0072 4062244026 Test Name Test Name 10222004 03231917 03231917 ACTV CCE 1065
Count of enrollments for the Provider 1
Count of enrollments for the PSA 1
Count of enrollments for the Report 1
Unduplicated Count of Individuals with open enrollments and DOD PSA Total Clients Count
02 1
Total 1
Report run on 08312018 0205 PM Page 1 of 1 vs_open_enrollrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Report run on 08312018 0207 PM Page 1 of 3 vs_servicesrdf
Report run by RSHQALL Dispose of this report so that it can not be read or reconstructed
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Unduplicated count of individuals with Services after DOD
PSA Total Clients Count
Report Total
Report run on 08312018 0207 PM Page 2 of 3 vs_servicesrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
List of Clients with PSA table entry for SERVICES_AFTER_DOD
Unduplicated Count Total 0
Report run on 08312018 0207 PM Page 3 of 3 vs_servicesrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Age
Provider
Total
Age lt 60 Age 60 - 64 Age 65 - 74 Age 75 - 84 Age 85+ Total Clients Avg Age
Total
Avg Age
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 1 of 5 demo_all_prvrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Ethnicity
Provider Hispanic Other Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Race
American Indian Native Hawaiian Other Provider Asian Alaska Native Black Pacific Islander Minority White Multiple Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Gender
Provider Male Female Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 4 of 5 demo_all_prvrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Monthly Income
Provider 0 - - Higher than Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 5 of 5 demo_all_prvrdf
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None
Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Total Persons Served 0
Age lt 60 Years 0 0
Age 60 - 64 0 0
Age 65 - 74 0 0
Age 75 - 84 0 0
Age 85+ 0 0
Total Age 0 0
Average 000
Ethnicity Hispanic 0 0
Other Ethnicity 0 0
Unknown Ethnicity 0 0
Total 0 0
Race Asian 0 0
American Indian Alaska Native 0 0
Black 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority 0 0
White 0 0
Multiple 0 0
Unknown 0 0
Total 0 0
Sex Male 0 0
Female 0 0
Unknown Sex 0 0
Total 0 0
Monthly Income 0 - 0 0
- 0 0
Higher than 0 0
Unknown 0 0
Total 0 0
Report run on 08312018 1058 AM Page 1 of 2 demo_by_prov_detrdf Report run byRSHQALL Dispose of this report so that it can not be read or reconstructed
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Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Client ID Date Of Birth Ethnicity Race Sex Individual Monthly Income
Report run on 08312018 1058 AM Page 2 of 2 demo_by_prov_detrdf Report run byRSHQALL Dispose of this report so that it can not be read or reconstructed
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Demographics of Clients OAA Registered Served Only PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 City All Cities Program All Programs Service All Services County ALL COUNTIES Table OAA Registered Services Only Low Income Medium Income
Total Persons Served 0
Agelt 60 Years
Age 60 - 64
Age 65 - 74
Age 75 - 84
Age 85+
0
0
0
0
0
0
0
0
0
0
Monthly Income
0 -
-Higher than
Unknown
0
0
0
0
0
0
0
0
Total
Average
0
000
0 Total 0 0
Ethnicity Hispanic
Other
Unknown
0
0
0
0
0
0
Living Situation
Alone
Null
Policy Change
0
0
0
0
0
0
Total 0 0 Unknown
With Caregiver
0
0
0
0
Race Asian 0 0
With Other
With Other Caregiver
0
0
0
0
American Indian Alaska Native
Black
0
0
0
0Total Living Situation 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority
White
0
0
0
0 Limited English Proficiency
Multiple
Unknown
Total Race
0
0
0
0
0
0
Yes
No
Unknown
0
0
0
0
0
0
Total 0 0
Sex Male
Female
Unknown
0
0
0
0
0
0
Total 0 0
Report run on 08312018 1056 AM Page 1 of 1 demo_by_provrdf
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Disaster Assistance Clients for a Provider PSA ALL Provider All Providers Location 0000 Worker All Workers City All Cities Zip Code All Zip Codes Sort By ZIP
Provider 1036 Provider Name Location 0000 Worker CIRTS18634
Need Care Client Name Address City Zip County Phone Asst Reg Situation Relat Care phone Care Name
34946 N WO DA 000 SAINT JAMES DRIVE CENTRAL (025) 101-0620 Test NameTest Name SAINT LUCIE (005) 100-0369 Y
Client is active and no assessment information is available Special Shelter and Special Registry are unknown
Report run on 08312018 1102 AM Page 1 of 8 disaster_by_provrdf
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
Total by PSA 0
Report run on 08312018 1111 AM Page 1 of 5 eheap_exceptionsrdf
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
ALACH BAKER BAY BRADF BREVA BROWA CALHO CHARL CITRUS CLAY COLLIE COLUM DESOT DIXIE DUVAL ESCAM FLAGL FRANK GADSDAssisted Household Report UA ORD RD RD UN OTTE R BIA O BIA ER LIN EN
1 of Household Assisted 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Households AssistedWith Gross Income
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C 100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D 125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
3 Households with at leastOne member
A 60 Years or older 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B Disabled 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C Age 5 years or under 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D Under 60 Years Old 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Undup Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Assisted
Applicant Household Report
of Applicant Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Energy Assisted Household Report
County of Assisted
Households
Households Assisted By Poverty Level
Under 75 75 - 100 101 - 125 126 - 150 Over 150 60 Years or older
At least one member who is
Age 5 years Age 2 years Age 3 years Disabled or younger and younger through 5
Under 60 Years Old
Undup Households
Assisted
Energy Assistance Total
Report run on 08312018 1107 AM Page 1 of 3 eheap_summaryrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Unduplicated Total 0 0
County of Assisted
Households Under 75 75 - 100
Households Assisted By Poverty Level
101 - 125 126 - 150 Over 150 60 Years or older Disabled
Age 5 years or younger
Age 2 years and younger
Age 3 years through 5
Under 60 Years Old
At least one member who is
Undup Households
Assisted
Other Assisted Household Report
Other Assistance Total
Report run on 08312018 1107 AM Page 2 of 3 eheap_summaryrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Applicant Household Report
County of Applicant
Households Under 75 75 - 100 101 - 125 126 - 150 Over 150 Income data
unavailable
Total 0
Report run on 08312018 1107 AM Page 3 of 3 eheap_summaryrdf
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01
Enrollment Active Consumer Count by Program PSA ALL Provider ALL PROVIDERS
County Description Program Count of Clients
BREVARD
ADI
CCE
HCE
LSP
NDP
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
MLTC
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
31
57
44
5
62
123
141
26
9
7
5
40
5
50
67
129
2
19
42
29
1
233
79
63
8
2
14
3
37
14
47
3
3
33
127
10
02
03
04
ALACHUA
BAKER
BAY
BRADFORD
Report run on 08312018 1148 AM Page 1 of 18 actv_countrdf
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05
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Enrollment Terminations with Reasons PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 Program All Programs Program Status ALL Program Status Worker ALL WORKERS
Last First Program Medicaid Provider Start End Name Name Client ID Status Description Worker Number Program Location Enrollment Enrollment
Count 0
Report run on 08312018 1150 AM Page 1 of 1 enroll_term_reasonrdf
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Enrollments with Care Plan Report
PSA ALL Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTIVE STATUS Care Plan Service ALL SERVICES Care Plan Start 01012017 Care Plan End 12312017
Care Plan Care Plan Care Plan Client Name
Unduplicated Client Count 0
Client ID Program Status Worker Start Date End Date Service
Report run on 08312018 1054 AM Page 1 of 1 enroll_careplrdf Report run by RSHQALL Dispose of this report so that it cannot be read or reconstructed
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PSA CLIENT_ID CLIENT_NAME OWNER PROVIDER_ID ASSESSMENT_DATE ASSESSOR_NAME MEDICAID_NUMBER CAREGIVER_CHANGE ENVIRONMENT_CHANGE HEALTH_CHANGE INCOME_CHANGE SITUATION_CHANGE INITIAL_ASSM ANNUAL_ASSM SSN REFERRAL_SOURCE 1114 N N N N Y N 771771777 SELFFAMILY 812017 JANE CASEWORKER 2 1001141633 TEST TEST N
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Fixed Service Costs List PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Provider Location County Program Service Reimbursement Unit Rate Provider Cost Per Unit Begin Valid End Valid
Count 0
Report run on 08312018 0233 PM Page 1 of 1 fixed_service_costrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Report run on 08312018 0207 PM Page 1 of 3 vs_servicesrdf
Report run by RSHQALL Dispose of this report so that it can not be read or reconstructed
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Unduplicated count of individuals with Services after DOD
PSA Total Clients Count
Report Total
Report run on 08312018 0207 PM Page 2 of 3 vs_servicesrdf
Report run by RSHQALL Dispose of this report so that it can not be read or reconstructed
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
List of Clients with PSA table entry for SERVICES_AFTER_DOD
Unduplicated Count Total 0
Report run on 08312018 0207 PM Page 3 of 3 vs_servicesrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Age
Provider
Total
Age lt 60 Age 60 - 64 Age 65 - 74 Age 75 - 84 Age 85+ Total Clients Avg Age
Total
Avg Age
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 1 of 5 demo_all_prvrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Ethnicity
Provider Hispanic Other Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 2 of 5 demo_all_prvrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Race
American Indian Native Hawaiian Other Provider Asian Alaska Native Black Pacific Islander Minority White Multiple Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 3 of 5 demo_all_prvrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Gender
Provider Male Female Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 4 of 5 demo_all_prvrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Monthly Income
Provider 0 - - Higher than Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 5 of 5 demo_all_prvrdf
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None
Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Total Persons Served 0
Age lt 60 Years 0 0
Age 60 - 64 0 0
Age 65 - 74 0 0
Age 75 - 84 0 0
Age 85+ 0 0
Total Age 0 0
Average 000
Ethnicity Hispanic 0 0
Other Ethnicity 0 0
Unknown Ethnicity 0 0
Total 0 0
Race Asian 0 0
American Indian Alaska Native 0 0
Black 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority 0 0
White 0 0
Multiple 0 0
Unknown 0 0
Total 0 0
Sex Male 0 0
Female 0 0
Unknown Sex 0 0
Total 0 0
Monthly Income 0 - 0 0
- 0 0
Higher than 0 0
Unknown 0 0
Total 0 0
Report run on 08312018 1058 AM Page 1 of 2 demo_by_prov_detrdf Report run byRSHQALL Dispose of this report so that it can not be read or reconstructed
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Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Client ID Date Of Birth Ethnicity Race Sex Individual Monthly Income
Report run on 08312018 1058 AM Page 2 of 2 demo_by_prov_detrdf Report run byRSHQALL Dispose of this report so that it can not be read or reconstructed
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Demographics of Clients OAA Registered Served Only PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 City All Cities Program All Programs Service All Services County ALL COUNTIES Table OAA Registered Services Only Low Income Medium Income
Total Persons Served 0
Agelt 60 Years
Age 60 - 64
Age 65 - 74
Age 75 - 84
Age 85+
0
0
0
0
0
0
0
0
0
0
Monthly Income
0 -
-Higher than
Unknown
0
0
0
0
0
0
0
0
Total
Average
0
000
0 Total 0 0
Ethnicity Hispanic
Other
Unknown
0
0
0
0
0
0
Living Situation
Alone
Null
Policy Change
0
0
0
0
0
0
Total 0 0 Unknown
With Caregiver
0
0
0
0
Race Asian 0 0
With Other
With Other Caregiver
0
0
0
0
American Indian Alaska Native
Black
0
0
0
0Total Living Situation 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority
White
0
0
0
0 Limited English Proficiency
Multiple
Unknown
Total Race
0
0
0
0
0
0
Yes
No
Unknown
0
0
0
0
0
0
Total 0 0
Sex Male
Female
Unknown
0
0
0
0
0
0
Total 0 0
Report run on 08312018 1056 AM Page 1 of 1 demo_by_provrdf
Report run by RSHQALL Dispose of this report so that it cannot be read or reconstructed
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Disaster Assistance Clients for a Provider PSA ALL Provider All Providers Location 0000 Worker All Workers City All Cities Zip Code All Zip Codes Sort By ZIP
Provider 1036 Provider Name Location 0000 Worker CIRTS18634
Need Care Client Name Address City Zip County Phone Asst Reg Situation Relat Care phone Care Name
34946 N WO DA 000 SAINT JAMES DRIVE CENTRAL (025) 101-0620 Test NameTest Name SAINT LUCIE (005) 100-0369 Y
Client is active and no assessment information is available Special Shelter and Special Registry are unknown
Report run on 08312018 1102 AM Page 1 of 8 disaster_by_provrdf
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
Total by PSA 0
Report run on 08312018 1111 AM Page 1 of 5 eheap_exceptionsrdf
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
ALACH BAKER BAY BRADF BREVA BROWA CALHO CHARL CITRUS CLAY COLLIE COLUM DESOT DIXIE DUVAL ESCAM FLAGL FRANK GADSDAssisted Household Report UA ORD RD RD UN OTTE R BIA O BIA ER LIN EN
1 of Household Assisted 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Households AssistedWith Gross Income
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C 100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D 125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
3 Households with at leastOne member
A 60 Years or older 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B Disabled 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C Age 5 years or under 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D Under 60 Years Old 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Undup Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Assisted
Applicant Household Report
of Applicant Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
Report run on 08312018 1111 AM Page 2 of 5 eheap_exceptionsrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Energy Assisted Household Report
County of Assisted
Households
Households Assisted By Poverty Level
Under 75 75 - 100 101 - 125 126 - 150 Over 150 60 Years or older
At least one member who is
Age 5 years Age 2 years Age 3 years Disabled or younger and younger through 5
Under 60 Years Old
Undup Households
Assisted
Energy Assistance Total
Report run on 08312018 1107 AM Page 1 of 3 eheap_summaryrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Unduplicated Total 0 0
County of Assisted
Households Under 75 75 - 100
Households Assisted By Poverty Level
101 - 125 126 - 150 Over 150 60 Years or older Disabled
Age 5 years or younger
Age 2 years and younger
Age 3 years through 5
Under 60 Years Old
At least one member who is
Undup Households
Assisted
Other Assisted Household Report
Other Assistance Total
Report run on 08312018 1107 AM Page 2 of 3 eheap_summaryrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Applicant Household Report
County of Applicant
Households Under 75 75 - 100 101 - 125 126 - 150 Over 150 Income data
unavailable
Total 0
Report run on 08312018 1107 AM Page 3 of 3 eheap_summaryrdf
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01
Enrollment Active Consumer Count by Program PSA ALL Provider ALL PROVIDERS
County Description Program Count of Clients
BREVARD
ADI
CCE
HCE
LSP
NDP
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
MLTC
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
31
57
44
5
62
123
141
26
9
7
5
40
5
50
67
129
2
19
42
29
1
233
79
63
8
2
14
3
37
14
47
3
3
33
127
10
02
03
04
ALACHUA
BAKER
BAY
BRADFORD
Report run on 08312018 1148 AM Page 1 of 18 actv_countrdf
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05
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Enrollment Terminations with Reasons PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 Program All Programs Program Status ALL Program Status Worker ALL WORKERS
Last First Program Medicaid Provider Start End Name Name Client ID Status Description Worker Number Program Location Enrollment Enrollment
Count 0
Report run on 08312018 1150 AM Page 1 of 1 enroll_term_reasonrdf
Report run by RSHQALL Dispose of this report so that it can not be read or reconstructed
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Enrollments with Care Plan Report
PSA ALL Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTIVE STATUS Care Plan Service ALL SERVICES Care Plan Start 01012017 Care Plan End 12312017
Care Plan Care Plan Care Plan Client Name
Unduplicated Client Count 0
Client ID Program Status Worker Start Date End Date Service
Report run on 08312018 1054 AM Page 1 of 1 enroll_careplrdf Report run by RSHQALL Dispose of this report so that it cannot be read or reconstructed
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PSA CLIENT_ID CLIENT_NAME OWNER PROVIDER_ID ASSESSMENT_DATE ASSESSOR_NAME MEDICAID_NUMBER CAREGIVER_CHANGE ENVIRONMENT_CHANGE HEALTH_CHANGE INCOME_CHANGE SITUATION_CHANGE INITIAL_ASSM ANNUAL_ASSM SSN REFERRAL_SOURCE 1114 N N N N Y N 771771777 SELFFAMILY 812017 JANE CASEWORKER 2 1001141633 TEST TEST N
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Fixed Service Costs List PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Provider Location County Program Service Reimbursement Unit Rate Provider Cost Per Unit Begin Valid End Valid
Count 0
Report run on 08312018 0233 PM Page 1 of 1 fixed_service_costrdf
Report run by RSHQALL Dispose of this report so that it can not be read or reconstruced
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
Unduplicated count of individuals with Services after DOD
PSA Total Clients Count
Report Total
Report run on 08312018 0207 PM Page 2 of 3 vs_servicesrdf
Report run by RSHQALL Dispose of this report so that it can not be read or reconstructed
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
List of Clients with PSA table entry for SERVICES_AFTER_DOD
Unduplicated Count Total 0
Report run on 08312018 0207 PM Page 3 of 3 vs_servicesrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Age
Provider
Total
Age lt 60 Age 60 - 64 Age 65 - 74 Age 75 - 84 Age 85+ Total Clients Avg Age
Total
Avg Age
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 1 of 5 demo_all_prvrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Ethnicity
Provider Hispanic Other Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 2 of 5 demo_all_prvrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Race
American Indian Native Hawaiian Other Provider Asian Alaska Native Black Pacific Islander Minority White Multiple Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 3 of 5 demo_all_prvrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Gender
Provider Male Female Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 4 of 5 demo_all_prvrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Monthly Income
Provider 0 - - Higher than Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 5 of 5 demo_all_prvrdf
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None
Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Total Persons Served 0
Age lt 60 Years 0 0
Age 60 - 64 0 0
Age 65 - 74 0 0
Age 75 - 84 0 0
Age 85+ 0 0
Total Age 0 0
Average 000
Ethnicity Hispanic 0 0
Other Ethnicity 0 0
Unknown Ethnicity 0 0
Total 0 0
Race Asian 0 0
American Indian Alaska Native 0 0
Black 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority 0 0
White 0 0
Multiple 0 0
Unknown 0 0
Total 0 0
Sex Male 0 0
Female 0 0
Unknown Sex 0 0
Total 0 0
Monthly Income 0 - 0 0
- 0 0
Higher than 0 0
Unknown 0 0
Total 0 0
Report run on 08312018 1058 AM Page 1 of 2 demo_by_prov_detrdf Report run byRSHQALL Dispose of this report so that it can not be read or reconstructed
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Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Client ID Date Of Birth Ethnicity Race Sex Individual Monthly Income
Report run on 08312018 1058 AM Page 2 of 2 demo_by_prov_detrdf Report run byRSHQALL Dispose of this report so that it can not be read or reconstructed
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Demographics of Clients OAA Registered Served Only PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 City All Cities Program All Programs Service All Services County ALL COUNTIES Table OAA Registered Services Only Low Income Medium Income
Total Persons Served 0
Agelt 60 Years
Age 60 - 64
Age 65 - 74
Age 75 - 84
Age 85+
0
0
0
0
0
0
0
0
0
0
Monthly Income
0 -
-Higher than
Unknown
0
0
0
0
0
0
0
0
Total
Average
0
000
0 Total 0 0
Ethnicity Hispanic
Other
Unknown
0
0
0
0
0
0
Living Situation
Alone
Null
Policy Change
0
0
0
0
0
0
Total 0 0 Unknown
With Caregiver
0
0
0
0
Race Asian 0 0
With Other
With Other Caregiver
0
0
0
0
American Indian Alaska Native
Black
0
0
0
0Total Living Situation 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority
White
0
0
0
0 Limited English Proficiency
Multiple
Unknown
Total Race
0
0
0
0
0
0
Yes
No
Unknown
0
0
0
0
0
0
Total 0 0
Sex Male
Female
Unknown
0
0
0
0
0
0
Total 0 0
Report run on 08312018 1056 AM Page 1 of 1 demo_by_provrdf
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Disaster Assistance Clients for a Provider PSA ALL Provider All Providers Location 0000 Worker All Workers City All Cities Zip Code All Zip Codes Sort By ZIP
Provider 1036 Provider Name Location 0000 Worker CIRTS18634
Need Care Client Name Address City Zip County Phone Asst Reg Situation Relat Care phone Care Name
34946 N WO DA 000 SAINT JAMES DRIVE CENTRAL (025) 101-0620 Test NameTest Name SAINT LUCIE (005) 100-0369 Y
Client is active and no assessment information is available Special Shelter and Special Registry are unknown
Report run on 08312018 1102 AM Page 1 of 8 disaster_by_provrdf
Report run by RSHQALL Dispose of this report so that it can not be read or reconstructed
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
Total by PSA 0
Report run on 08312018 1111 AM Page 1 of 5 eheap_exceptionsrdf
Report run by RSHQALL Dispose of this report so that it can not be read or reconstructed
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
ALACH BAKER BAY BRADF BREVA BROWA CALHO CHARL CITRUS CLAY COLLIE COLUM DESOT DIXIE DUVAL ESCAM FLAGL FRANK GADSDAssisted Household Report UA ORD RD RD UN OTTE R BIA O BIA ER LIN EN
1 of Household Assisted 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Households AssistedWith Gross Income
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C 100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D 125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
3 Households with at leastOne member
A 60 Years or older 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B Disabled 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C Age 5 years or under 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D Under 60 Years Old 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Undup Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Assisted
Applicant Household Report
of Applicant Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
Report run on 08312018 1111 AM Page 2 of 5 eheap_exceptionsrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Energy Assisted Household Report
County of Assisted
Households
Households Assisted By Poverty Level
Under 75 75 - 100 101 - 125 126 - 150 Over 150 60 Years or older
At least one member who is
Age 5 years Age 2 years Age 3 years Disabled or younger and younger through 5
Under 60 Years Old
Undup Households
Assisted
Energy Assistance Total
Report run on 08312018 1107 AM Page 1 of 3 eheap_summaryrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Unduplicated Total 0 0
County of Assisted
Households Under 75 75 - 100
Households Assisted By Poverty Level
101 - 125 126 - 150 Over 150 60 Years or older Disabled
Age 5 years or younger
Age 2 years and younger
Age 3 years through 5
Under 60 Years Old
At least one member who is
Undup Households
Assisted
Other Assisted Household Report
Other Assistance Total
Report run on 08312018 1107 AM Page 2 of 3 eheap_summaryrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Applicant Household Report
County of Applicant
Households Under 75 75 - 100 101 - 125 126 - 150 Over 150 Income data
unavailable
Total 0
Report run on 08312018 1107 AM Page 3 of 3 eheap_summaryrdf
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01
Enrollment Active Consumer Count by Program PSA ALL Provider ALL PROVIDERS
County Description Program Count of Clients
BREVARD
ADI
CCE
HCE
LSP
NDP
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
MLTC
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
31
57
44
5
62
123
141
26
9
7
5
40
5
50
67
129
2
19
42
29
1
233
79
63
8
2
14
3
37
14
47
3
3
33
127
10
02
03
04
ALACHUA
BAKER
BAY
BRADFORD
Report run on 08312018 1148 AM Page 1 of 18 actv_countrdf
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Enrollment Terminations with Reasons PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 Program All Programs Program Status ALL Program Status Worker ALL WORKERS
Last First Program Medicaid Provider Start End Name Name Client ID Status Description Worker Number Program Location Enrollment Enrollment
Count 0
Report run on 08312018 1150 AM Page 1 of 1 enroll_term_reasonrdf
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Enrollments with Care Plan Report
PSA ALL Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTIVE STATUS Care Plan Service ALL SERVICES Care Plan Start 01012017 Care Plan End 12312017
Care Plan Care Plan Care Plan Client Name
Unduplicated Client Count 0
Client ID Program Status Worker Start Date End Date Service
Report run on 08312018 1054 AM Page 1 of 1 enroll_careplrdf Report run by RSHQALL Dispose of this report so that it cannot be read or reconstructed
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PSA CLIENT_ID CLIENT_NAME OWNER PROVIDER_ID ASSESSMENT_DATE ASSESSOR_NAME MEDICAID_NUMBER CAREGIVER_CHANGE ENVIRONMENT_CHANGE HEALTH_CHANGE INCOME_CHANGE SITUATION_CHANGE INITIAL_ASSM ANNUAL_ASSM SSN REFERRAL_SOURCE 1114 N N N N Y N 771771777 SELFFAMILY 812017 JANE CASEWORKER 2 1001141633 TEST TEST N
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Fixed Service Costs List PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Provider Location County Program Service Reimbursement Unit Rate Provider Cost Per Unit Begin Valid End Valid
Count 0
Report run on 08312018 0233 PM Page 1 of 1 fixed_service_costrdf
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Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS -- Services More Than 2 Months After DOD
The Vital Statistics Data for 07192002 - 09112014
PSA ALL Provider ALL
The shaded records indicate clients who have different DOBs andor different names
List of Clients with PSA table entry for SERVICES_AFTER_DOD
Unduplicated Count Total 0
Report run on 08312018 0207 PM Page 3 of 3 vs_servicesrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Age
Provider
Total
Age lt 60 Age 60 - 64 Age 65 - 74 Age 75 - 84 Age 85+ Total Clients Avg Age
Total
Avg Age
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 1 of 5 demo_all_prvrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Ethnicity
Provider Hispanic Other Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Race
American Indian Native Hawaiian Other Provider Asian Alaska Native Black Pacific Islander Minority White Multiple Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 3 of 5 demo_all_prvrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Gender
Provider Male Female Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 4 of 5 demo_all_prvrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Monthly Income
Provider 0 - - Higher than Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 5 of 5 demo_all_prvrdf
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None
Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Total Persons Served 0
Age lt 60 Years 0 0
Age 60 - 64 0 0
Age 65 - 74 0 0
Age 75 - 84 0 0
Age 85+ 0 0
Total Age 0 0
Average 000
Ethnicity Hispanic 0 0
Other Ethnicity 0 0
Unknown Ethnicity 0 0
Total 0 0
Race Asian 0 0
American Indian Alaska Native 0 0
Black 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority 0 0
White 0 0
Multiple 0 0
Unknown 0 0
Total 0 0
Sex Male 0 0
Female 0 0
Unknown Sex 0 0
Total 0 0
Monthly Income 0 - 0 0
- 0 0
Higher than 0 0
Unknown 0 0
Total 0 0
Report run on 08312018 1058 AM Page 1 of 2 demo_by_prov_detrdf Report run byRSHQALL Dispose of this report so that it can not be read or reconstructed
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Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Client ID Date Of Birth Ethnicity Race Sex Individual Monthly Income
Report run on 08312018 1058 AM Page 2 of 2 demo_by_prov_detrdf Report run byRSHQALL Dispose of this report so that it can not be read or reconstructed
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Demographics of Clients OAA Registered Served Only PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 City All Cities Program All Programs Service All Services County ALL COUNTIES Table OAA Registered Services Only Low Income Medium Income
Total Persons Served 0
Agelt 60 Years
Age 60 - 64
Age 65 - 74
Age 75 - 84
Age 85+
0
0
0
0
0
0
0
0
0
0
Monthly Income
0 -
-Higher than
Unknown
0
0
0
0
0
0
0
0
Total
Average
0
000
0 Total 0 0
Ethnicity Hispanic
Other
Unknown
0
0
0
0
0
0
Living Situation
Alone
Null
Policy Change
0
0
0
0
0
0
Total 0 0 Unknown
With Caregiver
0
0
0
0
Race Asian 0 0
With Other
With Other Caregiver
0
0
0
0
American Indian Alaska Native
Black
0
0
0
0Total Living Situation 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority
White
0
0
0
0 Limited English Proficiency
Multiple
Unknown
Total Race
0
0
0
0
0
0
Yes
No
Unknown
0
0
0
0
0
0
Total 0 0
Sex Male
Female
Unknown
0
0
0
0
0
0
Total 0 0
Report run on 08312018 1056 AM Page 1 of 1 demo_by_provrdf
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Disaster Assistance Clients for a Provider PSA ALL Provider All Providers Location 0000 Worker All Workers City All Cities Zip Code All Zip Codes Sort By ZIP
Provider 1036 Provider Name Location 0000 Worker CIRTS18634
Need Care Client Name Address City Zip County Phone Asst Reg Situation Relat Care phone Care Name
34946 N WO DA 000 SAINT JAMES DRIVE CENTRAL (025) 101-0620 Test NameTest Name SAINT LUCIE (005) 100-0369 Y
Client is active and no assessment information is available Special Shelter and Special Registry are unknown
Report run on 08312018 1102 AM Page 1 of 8 disaster_by_provrdf
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
Total by PSA 0
Report run on 08312018 1111 AM Page 1 of 5 eheap_exceptionsrdf
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
ALACH BAKER BAY BRADF BREVA BROWA CALHO CHARL CITRUS CLAY COLLIE COLUM DESOT DIXIE DUVAL ESCAM FLAGL FRANK GADSDAssisted Household Report UA ORD RD RD UN OTTE R BIA O BIA ER LIN EN
1 of Household Assisted 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Households AssistedWith Gross Income
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C 100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D 125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
3 Households with at leastOne member
A 60 Years or older 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B Disabled 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C Age 5 years or under 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D Under 60 Years Old 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Undup Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Assisted
Applicant Household Report
of Applicant Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
Report run on 08312018 1111 AM Page 2 of 5 eheap_exceptionsrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Energy Assisted Household Report
County of Assisted
Households
Households Assisted By Poverty Level
Under 75 75 - 100 101 - 125 126 - 150 Over 150 60 Years or older
At least one member who is
Age 5 years Age 2 years Age 3 years Disabled or younger and younger through 5
Under 60 Years Old
Undup Households
Assisted
Energy Assistance Total
Report run on 08312018 1107 AM Page 1 of 3 eheap_summaryrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Unduplicated Total 0 0
County of Assisted
Households Under 75 75 - 100
Households Assisted By Poverty Level
101 - 125 126 - 150 Over 150 60 Years or older Disabled
Age 5 years or younger
Age 2 years and younger
Age 3 years through 5
Under 60 Years Old
At least one member who is
Undup Households
Assisted
Other Assisted Household Report
Other Assistance Total
Report run on 08312018 1107 AM Page 2 of 3 eheap_summaryrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Applicant Household Report
County of Applicant
Households Under 75 75 - 100 101 - 125 126 - 150 Over 150 Income data
unavailable
Total 0
Report run on 08312018 1107 AM Page 3 of 3 eheap_summaryrdf
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01
Enrollment Active Consumer Count by Program PSA ALL Provider ALL PROVIDERS
County Description Program Count of Clients
BREVARD
ADI
CCE
HCE
LSP
NDP
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
MLTC
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
31
57
44
5
62
123
141
26
9
7
5
40
5
50
67
129
2
19
42
29
1
233
79
63
8
2
14
3
37
14
47
3
3
33
127
10
02
03
04
ALACHUA
BAKER
BAY
BRADFORD
Report run on 08312018 1148 AM Page 1 of 18 actv_countrdf
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05
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Enrollment Terminations with Reasons PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 Program All Programs Program Status ALL Program Status Worker ALL WORKERS
Last First Program Medicaid Provider Start End Name Name Client ID Status Description Worker Number Program Location Enrollment Enrollment
Count 0
Report run on 08312018 1150 AM Page 1 of 1 enroll_term_reasonrdf
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Enrollments with Care Plan Report
PSA ALL Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTIVE STATUS Care Plan Service ALL SERVICES Care Plan Start 01012017 Care Plan End 12312017
Care Plan Care Plan Care Plan Client Name
Unduplicated Client Count 0
Client ID Program Status Worker Start Date End Date Service
Report run on 08312018 1054 AM Page 1 of 1 enroll_careplrdf Report run by RSHQALL Dispose of this report so that it cannot be read or reconstructed
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PSA CLIENT_ID CLIENT_NAME OWNER PROVIDER_ID ASSESSMENT_DATE ASSESSOR_NAME MEDICAID_NUMBER CAREGIVER_CHANGE ENVIRONMENT_CHANGE HEALTH_CHANGE INCOME_CHANGE SITUATION_CHANGE INITIAL_ASSM ANNUAL_ASSM SSN REFERRAL_SOURCE 1114 N N N N Y N 771771777 SELFFAMILY 812017 JANE CASEWORKER 2 1001141633 TEST TEST N
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Fixed Service Costs List PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Provider Location County Program Service Reimbursement Unit Rate Provider Cost Per Unit Begin Valid End Valid
Count 0
Report run on 08312018 0233 PM Page 1 of 1 fixed_service_costrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Age
Provider
Total
Age lt 60 Age 60 - 64 Age 65 - 74 Age 75 - 84 Age 85+ Total Clients Avg Age
Total
Avg Age
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 1 of 5 demo_all_prvrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Ethnicity
Provider Hispanic Other Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 2 of 5 demo_all_prvrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Race
American Indian Native Hawaiian Other Provider Asian Alaska Native Black Pacific Islander Minority White Multiple Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 3 of 5 demo_all_prvrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Gender
Provider Male Female Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 4 of 5 demo_all_prvrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Monthly Income
Provider 0 - - Higher than Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 5 of 5 demo_all_prvrdf
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None
Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Total Persons Served 0
Age lt 60 Years 0 0
Age 60 - 64 0 0
Age 65 - 74 0 0
Age 75 - 84 0 0
Age 85+ 0 0
Total Age 0 0
Average 000
Ethnicity Hispanic 0 0
Other Ethnicity 0 0
Unknown Ethnicity 0 0
Total 0 0
Race Asian 0 0
American Indian Alaska Native 0 0
Black 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority 0 0
White 0 0
Multiple 0 0
Unknown 0 0
Total 0 0
Sex Male 0 0
Female 0 0
Unknown Sex 0 0
Total 0 0
Monthly Income 0 - 0 0
- 0 0
Higher than 0 0
Unknown 0 0
Total 0 0
Report run on 08312018 1058 AM Page 1 of 2 demo_by_prov_detrdf Report run byRSHQALL Dispose of this report so that it can not be read or reconstructed
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Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Client ID Date Of Birth Ethnicity Race Sex Individual Monthly Income
Report run on 08312018 1058 AM Page 2 of 2 demo_by_prov_detrdf Report run byRSHQALL Dispose of this report so that it can not be read or reconstructed
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Demographics of Clients OAA Registered Served Only PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 City All Cities Program All Programs Service All Services County ALL COUNTIES Table OAA Registered Services Only Low Income Medium Income
Total Persons Served 0
Agelt 60 Years
Age 60 - 64
Age 65 - 74
Age 75 - 84
Age 85+
0
0
0
0
0
0
0
0
0
0
Monthly Income
0 -
-Higher than
Unknown
0
0
0
0
0
0
0
0
Total
Average
0
000
0 Total 0 0
Ethnicity Hispanic
Other
Unknown
0
0
0
0
0
0
Living Situation
Alone
Null
Policy Change
0
0
0
0
0
0
Total 0 0 Unknown
With Caregiver
0
0
0
0
Race Asian 0 0
With Other
With Other Caregiver
0
0
0
0
American Indian Alaska Native
Black
0
0
0
0Total Living Situation 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority
White
0
0
0
0 Limited English Proficiency
Multiple
Unknown
Total Race
0
0
0
0
0
0
Yes
No
Unknown
0
0
0
0
0
0
Total 0 0
Sex Male
Female
Unknown
0
0
0
0
0
0
Total 0 0
Report run on 08312018 1056 AM Page 1 of 1 demo_by_provrdf
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Disaster Assistance Clients for a Provider PSA ALL Provider All Providers Location 0000 Worker All Workers City All Cities Zip Code All Zip Codes Sort By ZIP
Provider 1036 Provider Name Location 0000 Worker CIRTS18634
Need Care Client Name Address City Zip County Phone Asst Reg Situation Relat Care phone Care Name
34946 N WO DA 000 SAINT JAMES DRIVE CENTRAL (025) 101-0620 Test NameTest Name SAINT LUCIE (005) 100-0369 Y
Client is active and no assessment information is available Special Shelter and Special Registry are unknown
Report run on 08312018 1102 AM Page 1 of 8 disaster_by_provrdf
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
Total by PSA 0
Report run on 08312018 1111 AM Page 1 of 5 eheap_exceptionsrdf
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ata
EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
ALACH BAKER BAY BRADF BREVA BROWA CALHO CHARL CITRUS CLAY COLLIE COLUM DESOT DIXIE DUVAL ESCAM FLAGL FRANK GADSDAssisted Household Report UA ORD RD RD UN OTTE R BIA O BIA ER LIN EN
1 of Household Assisted 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Households AssistedWith Gross Income
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C 100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D 125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
3 Households with at leastOne member
A 60 Years or older 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B Disabled 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C Age 5 years or under 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D Under 60 Years Old 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Undup Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Assisted
Applicant Household Report
of Applicant Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
Report run on 08312018 1111 AM Page 2 of 5 eheap_exceptionsrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Energy Assisted Household Report
County of Assisted
Households
Households Assisted By Poverty Level
Under 75 75 - 100 101 - 125 126 - 150 Over 150 60 Years or older
At least one member who is
Age 5 years Age 2 years Age 3 years Disabled or younger and younger through 5
Under 60 Years Old
Undup Households
Assisted
Energy Assistance Total
Report run on 08312018 1107 AM Page 1 of 3 eheap_summaryrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Unduplicated Total 0 0
County of Assisted
Households Under 75 75 - 100
Households Assisted By Poverty Level
101 - 125 126 - 150 Over 150 60 Years or older Disabled
Age 5 years or younger
Age 2 years and younger
Age 3 years through 5
Under 60 Years Old
At least one member who is
Undup Households
Assisted
Other Assisted Household Report
Other Assistance Total
Report run on 08312018 1107 AM Page 2 of 3 eheap_summaryrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Applicant Household Report
County of Applicant
Households Under 75 75 - 100 101 - 125 126 - 150 Over 150 Income data
unavailable
Total 0
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01
Enrollment Active Consumer Count by Program PSA ALL Provider ALL PROVIDERS
County Description Program Count of Clients
BREVARD
ADI
CCE
HCE
LSP
NDP
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
MLTC
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
31
57
44
5
62
123
141
26
9
7
5
40
5
50
67
129
2
19
42
29
1
233
79
63
8
2
14
3
37
14
47
3
3
33
127
10
02
03
04
ALACHUA
BAKER
BAY
BRADFORD
Report run on 08312018 1148 AM Page 1 of 18 actv_countrdf
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Enrollment Terminations with Reasons PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 Program All Programs Program Status ALL Program Status Worker ALL WORKERS
Last First Program Medicaid Provider Start End Name Name Client ID Status Description Worker Number Program Location Enrollment Enrollment
Count 0
Report run on 08312018 1150 AM Page 1 of 1 enroll_term_reasonrdf
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Enrollments with Care Plan Report
PSA ALL Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTIVE STATUS Care Plan Service ALL SERVICES Care Plan Start 01012017 Care Plan End 12312017
Care Plan Care Plan Care Plan Client Name
Unduplicated Client Count 0
Client ID Program Status Worker Start Date End Date Service
Report run on 08312018 1054 AM Page 1 of 1 enroll_careplrdf Report run by RSHQALL Dispose of this report so that it cannot be read or reconstructed
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PSA CLIENT_ID CLIENT_NAME OWNER PROVIDER_ID ASSESSMENT_DATE ASSESSOR_NAME MEDICAID_NUMBER CAREGIVER_CHANGE ENVIRONMENT_CHANGE HEALTH_CHANGE INCOME_CHANGE SITUATION_CHANGE INITIAL_ASSM ANNUAL_ASSM SSN REFERRAL_SOURCE 1114 N N N N Y N 771771777 SELFFAMILY 812017 JANE CASEWORKER 2 1001141633 TEST TEST N
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Fixed Service Costs List PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Provider Location County Program Service Reimbursement Unit Rate Provider Cost Per Unit Begin Valid End Valid
Count 0
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Ethnicity
Provider Hispanic Other Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Race
American Indian Native Hawaiian Other Provider Asian Alaska Native Black Pacific Islander Minority White Multiple Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Gender
Provider Male Female Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 4 of 5 demo_all_prvrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Monthly Income
Provider 0 - - Higher than Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 5 of 5 demo_all_prvrdf
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None
Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Total Persons Served 0
Age lt 60 Years 0 0
Age 60 - 64 0 0
Age 65 - 74 0 0
Age 75 - 84 0 0
Age 85+ 0 0
Total Age 0 0
Average 000
Ethnicity Hispanic 0 0
Other Ethnicity 0 0
Unknown Ethnicity 0 0
Total 0 0
Race Asian 0 0
American Indian Alaska Native 0 0
Black 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority 0 0
White 0 0
Multiple 0 0
Unknown 0 0
Total 0 0
Sex Male 0 0
Female 0 0
Unknown Sex 0 0
Total 0 0
Monthly Income 0 - 0 0
- 0 0
Higher than 0 0
Unknown 0 0
Total 0 0
Report run on 08312018 1058 AM Page 1 of 2 demo_by_prov_detrdf Report run byRSHQALL Dispose of this report so that it can not be read or reconstructed
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Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Client ID Date Of Birth Ethnicity Race Sex Individual Monthly Income
Report run on 08312018 1058 AM Page 2 of 2 demo_by_prov_detrdf Report run byRSHQALL Dispose of this report so that it can not be read or reconstructed
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Demographics of Clients OAA Registered Served Only PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 City All Cities Program All Programs Service All Services County ALL COUNTIES Table OAA Registered Services Only Low Income Medium Income
Total Persons Served 0
Agelt 60 Years
Age 60 - 64
Age 65 - 74
Age 75 - 84
Age 85+
0
0
0
0
0
0
0
0
0
0
Monthly Income
0 -
-Higher than
Unknown
0
0
0
0
0
0
0
0
Total
Average
0
000
0 Total 0 0
Ethnicity Hispanic
Other
Unknown
0
0
0
0
0
0
Living Situation
Alone
Null
Policy Change
0
0
0
0
0
0
Total 0 0 Unknown
With Caregiver
0
0
0
0
Race Asian 0 0
With Other
With Other Caregiver
0
0
0
0
American Indian Alaska Native
Black
0
0
0
0Total Living Situation 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority
White
0
0
0
0 Limited English Proficiency
Multiple
Unknown
Total Race
0
0
0
0
0
0
Yes
No
Unknown
0
0
0
0
0
0
Total 0 0
Sex Male
Female
Unknown
0
0
0
0
0
0
Total 0 0
Report run on 08312018 1056 AM Page 1 of 1 demo_by_provrdf
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Disaster Assistance Clients for a Provider PSA ALL Provider All Providers Location 0000 Worker All Workers City All Cities Zip Code All Zip Codes Sort By ZIP
Provider 1036 Provider Name Location 0000 Worker CIRTS18634
Need Care Client Name Address City Zip County Phone Asst Reg Situation Relat Care phone Care Name
34946 N WO DA 000 SAINT JAMES DRIVE CENTRAL (025) 101-0620 Test NameTest Name SAINT LUCIE (005) 100-0369 Y
Client is active and no assessment information is available Special Shelter and Special Registry are unknown
Report run on 08312018 1102 AM Page 1 of 8 disaster_by_provrdf
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
Total by PSA 0
Report run on 08312018 1111 AM Page 1 of 5 eheap_exceptionsrdf
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
ALACH BAKER BAY BRADF BREVA BROWA CALHO CHARL CITRUS CLAY COLLIE COLUM DESOT DIXIE DUVAL ESCAM FLAGL FRANK GADSDAssisted Household Report UA ORD RD RD UN OTTE R BIA O BIA ER LIN EN
1 of Household Assisted 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Households AssistedWith Gross Income
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C 100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D 125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
3 Households with at leastOne member
A 60 Years or older 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B Disabled 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C Age 5 years or under 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D Under 60 Years Old 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Undup Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Assisted
Applicant Household Report
of Applicant Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
Report run on 08312018 1111 AM Page 2 of 5 eheap_exceptionsrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Energy Assisted Household Report
County of Assisted
Households
Households Assisted By Poverty Level
Under 75 75 - 100 101 - 125 126 - 150 Over 150 60 Years or older
At least one member who is
Age 5 years Age 2 years Age 3 years Disabled or younger and younger through 5
Under 60 Years Old
Undup Households
Assisted
Energy Assistance Total
Report run on 08312018 1107 AM Page 1 of 3 eheap_summaryrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Unduplicated Total 0 0
County of Assisted
Households Under 75 75 - 100
Households Assisted By Poverty Level
101 - 125 126 - 150 Over 150 60 Years or older Disabled
Age 5 years or younger
Age 2 years and younger
Age 3 years through 5
Under 60 Years Old
At least one member who is
Undup Households
Assisted
Other Assisted Household Report
Other Assistance Total
Report run on 08312018 1107 AM Page 2 of 3 eheap_summaryrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Applicant Household Report
County of Applicant
Households Under 75 75 - 100 101 - 125 126 - 150 Over 150 Income data
unavailable
Total 0
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01
Enrollment Active Consumer Count by Program PSA ALL Provider ALL PROVIDERS
County Description Program Count of Clients
BREVARD
ADI
CCE
HCE
LSP
NDP
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
MLTC
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
31
57
44
5
62
123
141
26
9
7
5
40
5
50
67
129
2
19
42
29
1
233
79
63
8
2
14
3
37
14
47
3
3
33
127
10
02
03
04
ALACHUA
BAKER
BAY
BRADFORD
Report run on 08312018 1148 AM Page 1 of 18 actv_countrdf
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Enrollment Terminations with Reasons PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 Program All Programs Program Status ALL Program Status Worker ALL WORKERS
Last First Program Medicaid Provider Start End Name Name Client ID Status Description Worker Number Program Location Enrollment Enrollment
Count 0
Report run on 08312018 1150 AM Page 1 of 1 enroll_term_reasonrdf
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Enrollments with Care Plan Report
PSA ALL Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTIVE STATUS Care Plan Service ALL SERVICES Care Plan Start 01012017 Care Plan End 12312017
Care Plan Care Plan Care Plan Client Name
Unduplicated Client Count 0
Client ID Program Status Worker Start Date End Date Service
Report run on 08312018 1054 AM Page 1 of 1 enroll_careplrdf Report run by RSHQALL Dispose of this report so that it cannot be read or reconstructed
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PSA CLIENT_ID CLIENT_NAME OWNER PROVIDER_ID ASSESSMENT_DATE ASSESSOR_NAME MEDICAID_NUMBER CAREGIVER_CHANGE ENVIRONMENT_CHANGE HEALTH_CHANGE INCOME_CHANGE SITUATION_CHANGE INITIAL_ASSM ANNUAL_ASSM SSN REFERRAL_SOURCE 1114 N N N N Y N 771771777 SELFFAMILY 812017 JANE CASEWORKER 2 1001141633 TEST TEST N
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Fixed Service Costs List PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Provider Location County Program Service Reimbursement Unit Rate Provider Cost Per Unit Begin Valid End Valid
Count 0
Report run on 08312018 0233 PM Page 1 of 1 fixed_service_costrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Race
American Indian Native Hawaiian Other Provider Asian Alaska Native Black Pacific Islander Minority White Multiple Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Gender
Provider Male Female Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Monthly Income
Provider 0 - - Higher than Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
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None
Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Total Persons Served 0
Age lt 60 Years 0 0
Age 60 - 64 0 0
Age 65 - 74 0 0
Age 75 - 84 0 0
Age 85+ 0 0
Total Age 0 0
Average 000
Ethnicity Hispanic 0 0
Other Ethnicity 0 0
Unknown Ethnicity 0 0
Total 0 0
Race Asian 0 0
American Indian Alaska Native 0 0
Black 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority 0 0
White 0 0
Multiple 0 0
Unknown 0 0
Total 0 0
Sex Male 0 0
Female 0 0
Unknown Sex 0 0
Total 0 0
Monthly Income 0 - 0 0
- 0 0
Higher than 0 0
Unknown 0 0
Total 0 0
Report run on 08312018 1058 AM Page 1 of 2 demo_by_prov_detrdf Report run byRSHQALL Dispose of this report so that it can not be read or reconstructed
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Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Client ID Date Of Birth Ethnicity Race Sex Individual Monthly Income
Report run on 08312018 1058 AM Page 2 of 2 demo_by_prov_detrdf Report run byRSHQALL Dispose of this report so that it can not be read or reconstructed
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Demographics of Clients OAA Registered Served Only PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 City All Cities Program All Programs Service All Services County ALL COUNTIES Table OAA Registered Services Only Low Income Medium Income
Total Persons Served 0
Agelt 60 Years
Age 60 - 64
Age 65 - 74
Age 75 - 84
Age 85+
0
0
0
0
0
0
0
0
0
0
Monthly Income
0 -
-Higher than
Unknown
0
0
0
0
0
0
0
0
Total
Average
0
000
0 Total 0 0
Ethnicity Hispanic
Other
Unknown
0
0
0
0
0
0
Living Situation
Alone
Null
Policy Change
0
0
0
0
0
0
Total 0 0 Unknown
With Caregiver
0
0
0
0
Race Asian 0 0
With Other
With Other Caregiver
0
0
0
0
American Indian Alaska Native
Black
0
0
0
0Total Living Situation 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority
White
0
0
0
0 Limited English Proficiency
Multiple
Unknown
Total Race
0
0
0
0
0
0
Yes
No
Unknown
0
0
0
0
0
0
Total 0 0
Sex Male
Female
Unknown
0
0
0
0
0
0
Total 0 0
Report run on 08312018 1056 AM Page 1 of 1 demo_by_provrdf
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Disaster Assistance Clients for a Provider PSA ALL Provider All Providers Location 0000 Worker All Workers City All Cities Zip Code All Zip Codes Sort By ZIP
Provider 1036 Provider Name Location 0000 Worker CIRTS18634
Need Care Client Name Address City Zip County Phone Asst Reg Situation Relat Care phone Care Name
34946 N WO DA 000 SAINT JAMES DRIVE CENTRAL (025) 101-0620 Test NameTest Name SAINT LUCIE (005) 100-0369 Y
Client is active and no assessment information is available Special Shelter and Special Registry are unknown
Report run on 08312018 1102 AM Page 1 of 8 disaster_by_provrdf
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
Total by PSA 0
Report run on 08312018 1111 AM Page 1 of 5 eheap_exceptionsrdf
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
ALACH BAKER BAY BRADF BREVA BROWA CALHO CHARL CITRUS CLAY COLLIE COLUM DESOT DIXIE DUVAL ESCAM FLAGL FRANK GADSDAssisted Household Report UA ORD RD RD UN OTTE R BIA O BIA ER LIN EN
1 of Household Assisted 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Households AssistedWith Gross Income
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C 100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D 125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
3 Households with at leastOne member
A 60 Years or older 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B Disabled 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C Age 5 years or under 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D Under 60 Years Old 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Undup Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Assisted
Applicant Household Report
of Applicant Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
Report run on 08312018 1111 AM Page 2 of 5 eheap_exceptionsrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Energy Assisted Household Report
County of Assisted
Households
Households Assisted By Poverty Level
Under 75 75 - 100 101 - 125 126 - 150 Over 150 60 Years or older
At least one member who is
Age 5 years Age 2 years Age 3 years Disabled or younger and younger through 5
Under 60 Years Old
Undup Households
Assisted
Energy Assistance Total
Report run on 08312018 1107 AM Page 1 of 3 eheap_summaryrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Unduplicated Total 0 0
County of Assisted
Households Under 75 75 - 100
Households Assisted By Poverty Level
101 - 125 126 - 150 Over 150 60 Years or older Disabled
Age 5 years or younger
Age 2 years and younger
Age 3 years through 5
Under 60 Years Old
At least one member who is
Undup Households
Assisted
Other Assisted Household Report
Other Assistance Total
Report run on 08312018 1107 AM Page 2 of 3 eheap_summaryrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Applicant Household Report
County of Applicant
Households Under 75 75 - 100 101 - 125 126 - 150 Over 150 Income data
unavailable
Total 0
Report run on 08312018 1107 AM Page 3 of 3 eheap_summaryrdf
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01
Enrollment Active Consumer Count by Program PSA ALL Provider ALL PROVIDERS
County Description Program Count of Clients
BREVARD
ADI
CCE
HCE
LSP
NDP
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
MLTC
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
31
57
44
5
62
123
141
26
9
7
5
40
5
50
67
129
2
19
42
29
1
233
79
63
8
2
14
3
37
14
47
3
3
33
127
10
02
03
04
ALACHUA
BAKER
BAY
BRADFORD
Report run on 08312018 1148 AM Page 1 of 18 actv_countrdf
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05
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Enrollment Terminations with Reasons PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 Program All Programs Program Status ALL Program Status Worker ALL WORKERS
Last First Program Medicaid Provider Start End Name Name Client ID Status Description Worker Number Program Location Enrollment Enrollment
Count 0
Report run on 08312018 1150 AM Page 1 of 1 enroll_term_reasonrdf
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Enrollments with Care Plan Report
PSA ALL Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTIVE STATUS Care Plan Service ALL SERVICES Care Plan Start 01012017 Care Plan End 12312017
Care Plan Care Plan Care Plan Client Name
Unduplicated Client Count 0
Client ID Program Status Worker Start Date End Date Service
Report run on 08312018 1054 AM Page 1 of 1 enroll_careplrdf Report run by RSHQALL Dispose of this report so that it cannot be read or reconstructed
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PSA CLIENT_ID CLIENT_NAME OWNER PROVIDER_ID ASSESSMENT_DATE ASSESSOR_NAME MEDICAID_NUMBER CAREGIVER_CHANGE ENVIRONMENT_CHANGE HEALTH_CHANGE INCOME_CHANGE SITUATION_CHANGE INITIAL_ASSM ANNUAL_ASSM SSN REFERRAL_SOURCE 1114 N N N N Y N 771771777 SELFFAMILY 812017 JANE CASEWORKER 2 1001141633 TEST TEST N
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ata
Fixed Service Costs List PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Provider Location County Program Service Reimbursement Unit Rate Provider Cost Per Unit Begin Valid End Valid
Count 0
Report run on 08312018 0233 PM Page 1 of 1 fixed_service_costrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Gender
Provider Male Female Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 4 of 5 demo_all_prvrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Monthly Income
Provider 0 - - Higher than Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 5 of 5 demo_all_prvrdf
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None
Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Total Persons Served 0
Age lt 60 Years 0 0
Age 60 - 64 0 0
Age 65 - 74 0 0
Age 75 - 84 0 0
Age 85+ 0 0
Total Age 0 0
Average 000
Ethnicity Hispanic 0 0
Other Ethnicity 0 0
Unknown Ethnicity 0 0
Total 0 0
Race Asian 0 0
American Indian Alaska Native 0 0
Black 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority 0 0
White 0 0
Multiple 0 0
Unknown 0 0
Total 0 0
Sex Male 0 0
Female 0 0
Unknown Sex 0 0
Total 0 0
Monthly Income 0 - 0 0
- 0 0
Higher than 0 0
Unknown 0 0
Total 0 0
Report run on 08312018 1058 AM Page 1 of 2 demo_by_prov_detrdf Report run byRSHQALL Dispose of this report so that it can not be read or reconstructed
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Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Client ID Date Of Birth Ethnicity Race Sex Individual Monthly Income
Report run on 08312018 1058 AM Page 2 of 2 demo_by_prov_detrdf Report run byRSHQALL Dispose of this report so that it can not be read or reconstructed
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Demographics of Clients OAA Registered Served Only PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 City All Cities Program All Programs Service All Services County ALL COUNTIES Table OAA Registered Services Only Low Income Medium Income
Total Persons Served 0
Agelt 60 Years
Age 60 - 64
Age 65 - 74
Age 75 - 84
Age 85+
0
0
0
0
0
0
0
0
0
0
Monthly Income
0 -
-Higher than
Unknown
0
0
0
0
0
0
0
0
Total
Average
0
000
0 Total 0 0
Ethnicity Hispanic
Other
Unknown
0
0
0
0
0
0
Living Situation
Alone
Null
Policy Change
0
0
0
0
0
0
Total 0 0 Unknown
With Caregiver
0
0
0
0
Race Asian 0 0
With Other
With Other Caregiver
0
0
0
0
American Indian Alaska Native
Black
0
0
0
0Total Living Situation 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority
White
0
0
0
0 Limited English Proficiency
Multiple
Unknown
Total Race
0
0
0
0
0
0
Yes
No
Unknown
0
0
0
0
0
0
Total 0 0
Sex Male
Female
Unknown
0
0
0
0
0
0
Total 0 0
Report run on 08312018 1056 AM Page 1 of 1 demo_by_provrdf
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Disaster Assistance Clients for a Provider PSA ALL Provider All Providers Location 0000 Worker All Workers City All Cities Zip Code All Zip Codes Sort By ZIP
Provider 1036 Provider Name Location 0000 Worker CIRTS18634
Need Care Client Name Address City Zip County Phone Asst Reg Situation Relat Care phone Care Name
34946 N WO DA 000 SAINT JAMES DRIVE CENTRAL (025) 101-0620 Test NameTest Name SAINT LUCIE (005) 100-0369 Y
Client is active and no assessment information is available Special Shelter and Special Registry are unknown
Report run on 08312018 1102 AM Page 1 of 8 disaster_by_provrdf
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
Total by PSA 0
Report run on 08312018 1111 AM Page 1 of 5 eheap_exceptionsrdf
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
ALACH BAKER BAY BRADF BREVA BROWA CALHO CHARL CITRUS CLAY COLLIE COLUM DESOT DIXIE DUVAL ESCAM FLAGL FRANK GADSDAssisted Household Report UA ORD RD RD UN OTTE R BIA O BIA ER LIN EN
1 of Household Assisted 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Households AssistedWith Gross Income
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C 100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D 125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
3 Households with at leastOne member
A 60 Years or older 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B Disabled 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C Age 5 years or under 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D Under 60 Years Old 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Undup Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Assisted
Applicant Household Report
of Applicant Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
Report run on 08312018 1111 AM Page 2 of 5 eheap_exceptionsrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Energy Assisted Household Report
County of Assisted
Households
Households Assisted By Poverty Level
Under 75 75 - 100 101 - 125 126 - 150 Over 150 60 Years or older
At least one member who is
Age 5 years Age 2 years Age 3 years Disabled or younger and younger through 5
Under 60 Years Old
Undup Households
Assisted
Energy Assistance Total
Report run on 08312018 1107 AM Page 1 of 3 eheap_summaryrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Unduplicated Total 0 0
County of Assisted
Households Under 75 75 - 100
Households Assisted By Poverty Level
101 - 125 126 - 150 Over 150 60 Years or older Disabled
Age 5 years or younger
Age 2 years and younger
Age 3 years through 5
Under 60 Years Old
At least one member who is
Undup Households
Assisted
Other Assisted Household Report
Other Assistance Total
Report run on 08312018 1107 AM Page 2 of 3 eheap_summaryrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Applicant Household Report
County of Applicant
Households Under 75 75 - 100 101 - 125 126 - 150 Over 150 Income data
unavailable
Total 0
Report run on 08312018 1107 AM Page 3 of 3 eheap_summaryrdf
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01
Enrollment Active Consumer Count by Program PSA ALL Provider ALL PROVIDERS
County Description Program Count of Clients
BREVARD
ADI
CCE
HCE
LSP
NDP
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
MLTC
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
31
57
44
5
62
123
141
26
9
7
5
40
5
50
67
129
2
19
42
29
1
233
79
63
8
2
14
3
37
14
47
3
3
33
127
10
02
03
04
ALACHUA
BAKER
BAY
BRADFORD
Report run on 08312018 1148 AM Page 1 of 18 actv_countrdf
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05
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Enrollment Terminations with Reasons PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 Program All Programs Program Status ALL Program Status Worker ALL WORKERS
Last First Program Medicaid Provider Start End Name Name Client ID Status Description Worker Number Program Location Enrollment Enrollment
Count 0
Report run on 08312018 1150 AM Page 1 of 1 enroll_term_reasonrdf
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Enrollments with Care Plan Report
PSA ALL Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTIVE STATUS Care Plan Service ALL SERVICES Care Plan Start 01012017 Care Plan End 12312017
Care Plan Care Plan Care Plan Client Name
Unduplicated Client Count 0
Client ID Program Status Worker Start Date End Date Service
Report run on 08312018 1054 AM Page 1 of 1 enroll_careplrdf Report run by RSHQALL Dispose of this report so that it cannot be read or reconstructed
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PSA CLIENT_ID CLIENT_NAME OWNER PROVIDER_ID ASSESSMENT_DATE ASSESSOR_NAME MEDICAID_NUMBER CAREGIVER_CHANGE ENVIRONMENT_CHANGE HEALTH_CHANGE INCOME_CHANGE SITUATION_CHANGE INITIAL_ASSM ANNUAL_ASSM SSN REFERRAL_SOURCE 1114 N N N N Y N 771771777 SELFFAMILY 812017 JANE CASEWORKER 2 1001141633 TEST TEST N
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Fixed Service Costs List PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Provider Location County Program Service Reimbursement Unit Rate Provider Cost Per Unit Begin Valid End Valid
Count 0
Report run on 08312018 0233 PM Page 1 of 1 fixed_service_costrdf
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Demographics of Clients Served or Enrolled Provider Matrix PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 City All Cities Program AC Service All Services County All Counties Table CLIENT_ENROLLMENTS Low Income Medium Income
Monthly Income
Provider 0 - - Higher than Unknown Total Clients
Total Clients
note If a client is under multiple providers for the same parameters heshe will be counted multiple times
Report run on 08312018 1057 AM Page 5 of 5 demo_all_prvrdf
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None
Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Total Persons Served 0
Age lt 60 Years 0 0
Age 60 - 64 0 0
Age 65 - 74 0 0
Age 75 - 84 0 0
Age 85+ 0 0
Total Age 0 0
Average 000
Ethnicity Hispanic 0 0
Other Ethnicity 0 0
Unknown Ethnicity 0 0
Total 0 0
Race Asian 0 0
American Indian Alaska Native 0 0
Black 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority 0 0
White 0 0
Multiple 0 0
Unknown 0 0
Total 0 0
Sex Male 0 0
Female 0 0
Unknown Sex 0 0
Total 0 0
Monthly Income 0 - 0 0
- 0 0
Higher than 0 0
Unknown 0 0
Total 0 0
Report run on 08312018 1058 AM Page 1 of 2 demo_by_prov_detrdf Report run byRSHQALL Dispose of this report so that it can not be read or reconstructed
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Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Client ID Date Of Birth Ethnicity Race Sex Individual Monthly Income
Report run on 08312018 1058 AM Page 2 of 2 demo_by_prov_detrdf Report run byRSHQALL Dispose of this report so that it can not be read or reconstructed
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Demographics of Clients OAA Registered Served Only PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 City All Cities Program All Programs Service All Services County ALL COUNTIES Table OAA Registered Services Only Low Income Medium Income
Total Persons Served 0
Agelt 60 Years
Age 60 - 64
Age 65 - 74
Age 75 - 84
Age 85+
0
0
0
0
0
0
0
0
0
0
Monthly Income
0 -
-Higher than
Unknown
0
0
0
0
0
0
0
0
Total
Average
0
000
0 Total 0 0
Ethnicity Hispanic
Other
Unknown
0
0
0
0
0
0
Living Situation
Alone
Null
Policy Change
0
0
0
0
0
0
Total 0 0 Unknown
With Caregiver
0
0
0
0
Race Asian 0 0
With Other
With Other Caregiver
0
0
0
0
American Indian Alaska Native
Black
0
0
0
0Total Living Situation 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority
White
0
0
0
0 Limited English Proficiency
Multiple
Unknown
Total Race
0
0
0
0
0
0
Yes
No
Unknown
0
0
0
0
0
0
Total 0 0
Sex Male
Female
Unknown
0
0
0
0
0
0
Total 0 0
Report run on 08312018 1056 AM Page 1 of 1 demo_by_provrdf
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Disaster Assistance Clients for a Provider PSA ALL Provider All Providers Location 0000 Worker All Workers City All Cities Zip Code All Zip Codes Sort By ZIP
Provider 1036 Provider Name Location 0000 Worker CIRTS18634
Need Care Client Name Address City Zip County Phone Asst Reg Situation Relat Care phone Care Name
34946 N WO DA 000 SAINT JAMES DRIVE CENTRAL (025) 101-0620 Test NameTest Name SAINT LUCIE (005) 100-0369 Y
Client is active and no assessment information is available Special Shelter and Special Registry are unknown
Report run on 08312018 1102 AM Page 1 of 8 disaster_by_provrdf
Report run by RSHQALL Dispose of this report so that it can not be read or reconstructed
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
Total by PSA 0
Report run on 08312018 1111 AM Page 1 of 5 eheap_exceptionsrdf
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
ALACH BAKER BAY BRADF BREVA BROWA CALHO CHARL CITRUS CLAY COLLIE COLUM DESOT DIXIE DUVAL ESCAM FLAGL FRANK GADSDAssisted Household Report UA ORD RD RD UN OTTE R BIA O BIA ER LIN EN
1 of Household Assisted 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Households AssistedWith Gross Income
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C 100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D 125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
3 Households with at leastOne member
A 60 Years or older 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B Disabled 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C Age 5 years or under 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D Under 60 Years Old 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Undup Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Assisted
Applicant Household Report
of Applicant Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
Report run on 08312018 1111 AM Page 2 of 5 eheap_exceptionsrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Energy Assisted Household Report
County of Assisted
Households
Households Assisted By Poverty Level
Under 75 75 - 100 101 - 125 126 - 150 Over 150 60 Years or older
At least one member who is
Age 5 years Age 2 years Age 3 years Disabled or younger and younger through 5
Under 60 Years Old
Undup Households
Assisted
Energy Assistance Total
Report run on 08312018 1107 AM Page 1 of 3 eheap_summaryrdf
Report run by RSHQALL Dispose of this report so that it can not be read or reconstructed
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Unduplicated Total 0 0
County of Assisted
Households Under 75 75 - 100
Households Assisted By Poverty Level
101 - 125 126 - 150 Over 150 60 Years or older Disabled
Age 5 years or younger
Age 2 years and younger
Age 3 years through 5
Under 60 Years Old
At least one member who is
Undup Households
Assisted
Other Assisted Household Report
Other Assistance Total
Report run on 08312018 1107 AM Page 2 of 3 eheap_summaryrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Applicant Household Report
County of Applicant
Households Under 75 75 - 100 101 - 125 126 - 150 Over 150 Income data
unavailable
Total 0
Report run on 08312018 1107 AM Page 3 of 3 eheap_summaryrdf
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01
Enrollment Active Consumer Count by Program PSA ALL Provider ALL PROVIDERS
County Description Program Count of Clients
BREVARD
ADI
CCE
HCE
LSP
NDP
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
MLTC
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
31
57
44
5
62
123
141
26
9
7
5
40
5
50
67
129
2
19
42
29
1
233
79
63
8
2
14
3
37
14
47
3
3
33
127
10
02
03
04
ALACHUA
BAKER
BAY
BRADFORD
Report run on 08312018 1148 AM Page 1 of 18 actv_countrdf
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Enrollment Terminations with Reasons PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 Program All Programs Program Status ALL Program Status Worker ALL WORKERS
Last First Program Medicaid Provider Start End Name Name Client ID Status Description Worker Number Program Location Enrollment Enrollment
Count 0
Report run on 08312018 1150 AM Page 1 of 1 enroll_term_reasonrdf
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Enrollments with Care Plan Report
PSA ALL Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTIVE STATUS Care Plan Service ALL SERVICES Care Plan Start 01012017 Care Plan End 12312017
Care Plan Care Plan Care Plan Client Name
Unduplicated Client Count 0
Client ID Program Status Worker Start Date End Date Service
Report run on 08312018 1054 AM Page 1 of 1 enroll_careplrdf Report run by RSHQALL Dispose of this report so that it cannot be read or reconstructed
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PSA CLIENT_ID CLIENT_NAME OWNER PROVIDER_ID ASSESSMENT_DATE ASSESSOR_NAME MEDICAID_NUMBER CAREGIVER_CHANGE ENVIRONMENT_CHANGE HEALTH_CHANGE INCOME_CHANGE SITUATION_CHANGE INITIAL_ASSM ANNUAL_ASSM SSN REFERRAL_SOURCE 1114 N N N N Y N 771771777 SELFFAMILY 812017 JANE CASEWORKER 2 1001141633 TEST TEST N
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ata
Fixed Service Costs List PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Provider Location County Program Service Reimbursement Unit Rate Provider Cost Per Unit Begin Valid End Valid
Count 0
Report run on 08312018 0233 PM Page 1 of 1 fixed_service_costrdf
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None
Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Total Persons Served 0
Age lt 60 Years 0 0
Age 60 - 64 0 0
Age 65 - 74 0 0
Age 75 - 84 0 0
Age 85+ 0 0
Total Age 0 0
Average 000
Ethnicity Hispanic 0 0
Other Ethnicity 0 0
Unknown Ethnicity 0 0
Total 0 0
Race Asian 0 0
American Indian Alaska Native 0 0
Black 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority 0 0
White 0 0
Multiple 0 0
Unknown 0 0
Total 0 0
Sex Male 0 0
Female 0 0
Unknown Sex 0 0
Total 0 0
Monthly Income 0 - 0 0
- 0 0
Higher than 0 0
Unknown 0 0
Total 0 0
Report run on 08312018 1058 AM Page 1 of 2 demo_by_prov_detrdf Report run byRSHQALL Dispose of this report so that it can not be read or reconstructed
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Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Client ID Date Of Birth Ethnicity Race Sex Individual Monthly Income
Report run on 08312018 1058 AM Page 2 of 2 demo_by_prov_detrdf Report run byRSHQALL Dispose of this report so that it can not be read or reconstructed
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Demographics of Clients OAA Registered Served Only PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 City All Cities Program All Programs Service All Services County ALL COUNTIES Table OAA Registered Services Only Low Income Medium Income
Total Persons Served 0
Agelt 60 Years
Age 60 - 64
Age 65 - 74
Age 75 - 84
Age 85+
0
0
0
0
0
0
0
0
0
0
Monthly Income
0 -
-Higher than
Unknown
0
0
0
0
0
0
0
0
Total
Average
0
000
0 Total 0 0
Ethnicity Hispanic
Other
Unknown
0
0
0
0
0
0
Living Situation
Alone
Null
Policy Change
0
0
0
0
0
0
Total 0 0 Unknown
With Caregiver
0
0
0
0
Race Asian 0 0
With Other
With Other Caregiver
0
0
0
0
American Indian Alaska Native
Black
0
0
0
0Total Living Situation 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority
White
0
0
0
0 Limited English Proficiency
Multiple
Unknown
Total Race
0
0
0
0
0
0
Yes
No
Unknown
0
0
0
0
0
0
Total 0 0
Sex Male
Female
Unknown
0
0
0
0
0
0
Total 0 0
Report run on 08312018 1056 AM Page 1 of 1 demo_by_provrdf
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Disaster Assistance Clients for a Provider PSA ALL Provider All Providers Location 0000 Worker All Workers City All Cities Zip Code All Zip Codes Sort By ZIP
Provider 1036 Provider Name Location 0000 Worker CIRTS18634
Need Care Client Name Address City Zip County Phone Asst Reg Situation Relat Care phone Care Name
34946 N WO DA 000 SAINT JAMES DRIVE CENTRAL (025) 101-0620 Test NameTest Name SAINT LUCIE (005) 100-0369 Y
Client is active and no assessment information is available Special Shelter and Special Registry are unknown
Report run on 08312018 1102 AM Page 1 of 8 disaster_by_provrdf
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
Total by PSA 0
Report run on 08312018 1111 AM Page 1 of 5 eheap_exceptionsrdf
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
ALACH BAKER BAY BRADF BREVA BROWA CALHO CHARL CITRUS CLAY COLLIE COLUM DESOT DIXIE DUVAL ESCAM FLAGL FRANK GADSDAssisted Household Report UA ORD RD RD UN OTTE R BIA O BIA ER LIN EN
1 of Household Assisted 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Households AssistedWith Gross Income
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C 100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D 125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
3 Households with at leastOne member
A 60 Years or older 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B Disabled 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C Age 5 years or under 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D Under 60 Years Old 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Undup Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Assisted
Applicant Household Report
of Applicant Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
Report run on 08312018 1111 AM Page 2 of 5 eheap_exceptionsrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Energy Assisted Household Report
County of Assisted
Households
Households Assisted By Poverty Level
Under 75 75 - 100 101 - 125 126 - 150 Over 150 60 Years or older
At least one member who is
Age 5 years Age 2 years Age 3 years Disabled or younger and younger through 5
Under 60 Years Old
Undup Households
Assisted
Energy Assistance Total
Report run on 08312018 1107 AM Page 1 of 3 eheap_summaryrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Unduplicated Total 0 0
County of Assisted
Households Under 75 75 - 100
Households Assisted By Poverty Level
101 - 125 126 - 150 Over 150 60 Years or older Disabled
Age 5 years or younger
Age 2 years and younger
Age 3 years through 5
Under 60 Years Old
At least one member who is
Undup Households
Assisted
Other Assisted Household Report
Other Assistance Total
Report run on 08312018 1107 AM Page 2 of 3 eheap_summaryrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Applicant Household Report
County of Applicant
Households Under 75 75 - 100 101 - 125 126 - 150 Over 150 Income data
unavailable
Total 0
Report run on 08312018 1107 AM Page 3 of 3 eheap_summaryrdf
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01
Enrollment Active Consumer Count by Program PSA ALL Provider ALL PROVIDERS
County Description Program Count of Clients
BREVARD
ADI
CCE
HCE
LSP
NDP
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
MLTC
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
31
57
44
5
62
123
141
26
9
7
5
40
5
50
67
129
2
19
42
29
1
233
79
63
8
2
14
3
37
14
47
3
3
33
127
10
02
03
04
ALACHUA
BAKER
BAY
BRADFORD
Report run on 08312018 1148 AM Page 1 of 18 actv_countrdf
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Enrollment Terminations with Reasons PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 Program All Programs Program Status ALL Program Status Worker ALL WORKERS
Last First Program Medicaid Provider Start End Name Name Client ID Status Description Worker Number Program Location Enrollment Enrollment
Count 0
Report run on 08312018 1150 AM Page 1 of 1 enroll_term_reasonrdf
Report run by RSHQALL Dispose of this report so that it can not be read or reconstructed
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Enrollments with Care Plan Report
PSA ALL Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTIVE STATUS Care Plan Service ALL SERVICES Care Plan Start 01012017 Care Plan End 12312017
Care Plan Care Plan Care Plan Client Name
Unduplicated Client Count 0
Client ID Program Status Worker Start Date End Date Service
Report run on 08312018 1054 AM Page 1 of 1 enroll_careplrdf Report run by RSHQALL Dispose of this report so that it cannot be read or reconstructed
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PSA CLIENT_ID CLIENT_NAME OWNER PROVIDER_ID ASSESSMENT_DATE ASSESSOR_NAME MEDICAID_NUMBER CAREGIVER_CHANGE ENVIRONMENT_CHANGE HEALTH_CHANGE INCOME_CHANGE SITUATION_CHANGE INITIAL_ASSM ANNUAL_ASSM SSN REFERRAL_SOURCE 1114 N N N N Y N 771771777 SELFFAMILY 812017 JANE CASEWORKER 2 1001141633 TEST TEST N
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Fixed Service Costs List PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Provider Location County Program Service Reimbursement Unit Rate Provider Cost Per Unit Begin Valid End Valid
Count 0
Report run on 08312018 0233 PM Page 1 of 1 fixed_service_costrdf
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Demographics of Clients Served or Enrolled with Detail PSA ALL Start Date End Date Error Both the Begining Fiscal Year and the End Fiscal Year are RequiredTable client_enrollments Low Income Medium Income
Client ID Date Of Birth Ethnicity Race Sex Individual Monthly Income
Report run on 08312018 1058 AM Page 2 of 2 demo_by_prov_detrdf Report run byRSHQALL Dispose of this report so that it can not be read or reconstructed
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Demographics of Clients OAA Registered Served Only PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 City All Cities Program All Programs Service All Services County ALL COUNTIES Table OAA Registered Services Only Low Income Medium Income
Total Persons Served 0
Agelt 60 Years
Age 60 - 64
Age 65 - 74
Age 75 - 84
Age 85+
0
0
0
0
0
0
0
0
0
0
Monthly Income
0 -
-Higher than
Unknown
0
0
0
0
0
0
0
0
Total
Average
0
000
0 Total 0 0
Ethnicity Hispanic
Other
Unknown
0
0
0
0
0
0
Living Situation
Alone
Null
Policy Change
0
0
0
0
0
0
Total 0 0 Unknown
With Caregiver
0
0
0
0
Race Asian 0 0
With Other
With Other Caregiver
0
0
0
0
American Indian Alaska Native
Black
0
0
0
0Total Living Situation 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority
White
0
0
0
0 Limited English Proficiency
Multiple
Unknown
Total Race
0
0
0
0
0
0
Yes
No
Unknown
0
0
0
0
0
0
Total 0 0
Sex Male
Female
Unknown
0
0
0
0
0
0
Total 0 0
Report run on 08312018 1056 AM Page 1 of 1 demo_by_provrdf
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Disaster Assistance Clients for a Provider PSA ALL Provider All Providers Location 0000 Worker All Workers City All Cities Zip Code All Zip Codes Sort By ZIP
Provider 1036 Provider Name Location 0000 Worker CIRTS18634
Need Care Client Name Address City Zip County Phone Asst Reg Situation Relat Care phone Care Name
34946 N WO DA 000 SAINT JAMES DRIVE CENTRAL (025) 101-0620 Test NameTest Name SAINT LUCIE (005) 100-0369 Y
Client is active and no assessment information is available Special Shelter and Special Registry are unknown
Report run on 08312018 1102 AM Page 1 of 8 disaster_by_provrdf
Report run by RSHQALL Dispose of this report so that it can not be read or reconstructed
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
Total by PSA 0
Report run on 08312018 1111 AM Page 1 of 5 eheap_exceptionsrdf
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
ALACH BAKER BAY BRADF BREVA BROWA CALHO CHARL CITRUS CLAY COLLIE COLUM DESOT DIXIE DUVAL ESCAM FLAGL FRANK GADSDAssisted Household Report UA ORD RD RD UN OTTE R BIA O BIA ER LIN EN
1 of Household Assisted 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Households AssistedWith Gross Income
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C 100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D 125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
3 Households with at leastOne member
A 60 Years or older 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B Disabled 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C Age 5 years or under 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D Under 60 Years Old 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Undup Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Assisted
Applicant Household Report
of Applicant Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
Report run on 08312018 1111 AM Page 2 of 5 eheap_exceptionsrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Energy Assisted Household Report
County of Assisted
Households
Households Assisted By Poverty Level
Under 75 75 - 100 101 - 125 126 - 150 Over 150 60 Years or older
At least one member who is
Age 5 years Age 2 years Age 3 years Disabled or younger and younger through 5
Under 60 Years Old
Undup Households
Assisted
Energy Assistance Total
Report run on 08312018 1107 AM Page 1 of 3 eheap_summaryrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Unduplicated Total 0 0
County of Assisted
Households Under 75 75 - 100
Households Assisted By Poverty Level
101 - 125 126 - 150 Over 150 60 Years or older Disabled
Age 5 years or younger
Age 2 years and younger
Age 3 years through 5
Under 60 Years Old
At least one member who is
Undup Households
Assisted
Other Assisted Household Report
Other Assistance Total
Report run on 08312018 1107 AM Page 2 of 3 eheap_summaryrdf
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EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Applicant Household Report
County of Applicant
Households Under 75 75 - 100 101 - 125 126 - 150 Over 150 Income data
unavailable
Total 0
Report run on 08312018 1107 AM Page 3 of 3 eheap_summaryrdf
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01
Enrollment Active Consumer Count by Program PSA ALL Provider ALL PROVIDERS
County Description Program Count of Clients
BREVARD
ADI
CCE
HCE
LSP
NDP
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
MLTC
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
31
57
44
5
62
123
141
26
9
7
5
40
5
50
67
129
2
19
42
29
1
233
79
63
8
2
14
3
37
14
47
3
3
33
127
10
02
03
04
ALACHUA
BAKER
BAY
BRADFORD
Report run on 08312018 1148 AM Page 1 of 18 actv_countrdf
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Enrollment Terminations with Reasons PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 Program All Programs Program Status ALL Program Status Worker ALL WORKERS
Last First Program Medicaid Provider Start End Name Name Client ID Status Description Worker Number Program Location Enrollment Enrollment
Count 0
Report run on 08312018 1150 AM Page 1 of 1 enroll_term_reasonrdf
Report run by RSHQALL Dispose of this report so that it can not be read or reconstructed
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Enrollments with Care Plan Report
PSA ALL Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTIVE STATUS Care Plan Service ALL SERVICES Care Plan Start 01012017 Care Plan End 12312017
Care Plan Care Plan Care Plan Client Name
Unduplicated Client Count 0
Client ID Program Status Worker Start Date End Date Service
Report run on 08312018 1054 AM Page 1 of 1 enroll_careplrdf Report run by RSHQALL Dispose of this report so that it cannot be read or reconstructed
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PSA CLIENT_ID CLIENT_NAME OWNER PROVIDER_ID ASSESSMENT_DATE ASSESSOR_NAME MEDICAID_NUMBER CAREGIVER_CHANGE ENVIRONMENT_CHANGE HEALTH_CHANGE INCOME_CHANGE SITUATION_CHANGE INITIAL_ASSM ANNUAL_ASSM SSN REFERRAL_SOURCE 1114 N N N N Y N 771771777 SELFFAMILY 812017 JANE CASEWORKER 2 1001141633 TEST TEST N
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ata
Fixed Service Costs List PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Provider Location County Program Service Reimbursement Unit Rate Provider Cost Per Unit Begin Valid End Valid
Count 0
Report run on 08312018 0233 PM Page 1 of 1 fixed_service_costrdf
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Demographics of Clients OAA Registered Served Only PSA ALL Start Date 01012017 End Date 12312017 Provider ALL PROVIDERS Location 0000 City All Cities Program All Programs Service All Services County ALL COUNTIES Table OAA Registered Services Only Low Income Medium Income
Total Persons Served 0
Agelt 60 Years
Age 60 - 64
Age 65 - 74
Age 75 - 84
Age 85+
0
0
0
0
0
0
0
0
0
0
Monthly Income
0 -
-Higher than
Unknown
0
0
0
0
0
0
0
0
Total
Average
0
000
0 Total 0 0
Ethnicity Hispanic
Other
Unknown
0
0
0
0
0
0
Living Situation
Alone
Null
Policy Change
0
0
0
0
0
0
Total 0 0 Unknown
With Caregiver
0
0
0
0
Race Asian 0 0
With Other
With Other Caregiver
0
0
0
0
American Indian Alaska Native
Black
0
0
0
0Total Living Situation 0 0
Native Hawaiian Pacific Islander 0 0
Other Minority
White
0
0
0
0 Limited English Proficiency
Multiple
Unknown
Total Race
0
0
0
0
0
0
Yes
No
Unknown
0
0
0
0
0
0
Total 0 0
Sex Male
Female
Unknown
0
0
0
0
0
0
Total 0 0
Report run on 08312018 1056 AM Page 1 of 1 demo_by_provrdf
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Disaster Assistance Clients for a Provider PSA ALL Provider All Providers Location 0000 Worker All Workers City All Cities Zip Code All Zip Codes Sort By ZIP
Provider 1036 Provider Name Location 0000 Worker CIRTS18634
Need Care Client Name Address City Zip County Phone Asst Reg Situation Relat Care phone Care Name
34946 N WO DA 000 SAINT JAMES DRIVE CENTRAL (025) 101-0620 Test NameTest Name SAINT LUCIE (005) 100-0369 Y
Client is active and no assessment information is available Special Shelter and Special Registry are unknown
Report run on 08312018 1102 AM Page 1 of 8 disaster_by_provrdf
Report run by RSHQALL Dispose of this report so that it can not be read or reconstructed
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
Total by PSA 0
Report run on 08312018 1111 AM Page 1 of 5 eheap_exceptionsrdf
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EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
ALACH BAKER BAY BRADF BREVA BROWA CALHO CHARL CITRUS CLAY COLLIE COLUM DESOT DIXIE DUVAL ESCAM FLAGL FRANK GADSDAssisted Household Report UA ORD RD RD UN OTTE R BIA O BIA ER LIN EN
1 of Household Assisted 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Households AssistedWith Gross Income
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C 100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D 125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
3 Households with at leastOne member
A 60 Years or older 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B Disabled 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C Age 5 years or under 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D Under 60 Years Old 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Undup Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Assisted
Applicant Household Report
of Applicant Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
Report run on 08312018 1111 AM Page 2 of 5 eheap_exceptionsrdf
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ata
EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Energy Assisted Household Report
County of Assisted
Households
Households Assisted By Poverty Level
Under 75 75 - 100 101 - 125 126 - 150 Over 150 60 Years or older
At least one member who is
Age 5 years Age 2 years Age 3 years Disabled or younger and younger through 5
Under 60 Years Old
Undup Households
Assisted
Energy Assistance Total
Report run on 08312018 1107 AM Page 1 of 3 eheap_summaryrdf
Report run by RSHQALL Dispose of this report so that it can not be read or reconstructed
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ata
EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Unduplicated Total 0 0
County of Assisted
Households Under 75 75 - 100
Households Assisted By Poverty Level
101 - 125 126 - 150 Over 150 60 Years or older Disabled
Age 5 years or younger
Age 2 years and younger
Age 3 years through 5
Under 60 Years Old
At least one member who is
Undup Households
Assisted
Other Assisted Household Report
Other Assistance Total
Report run on 08312018 1107 AM Page 2 of 3 eheap_summaryrdf
Report run by RSHQALL Dispose of this report so that it can not be read or reconstructed
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ata
EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Applicant Household Report
County of Applicant
Households Under 75 75 - 100 101 - 125 126 - 150 Over 150 Income data
unavailable
Total 0
Report run on 08312018 1107 AM Page 3 of 3 eheap_summaryrdf
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ata
01
Enrollment Active Consumer Count by Program PSA ALL Provider ALL PROVIDERS
County Description Program Count of Clients
BREVARD
ADI
CCE
HCE
LSP
NDP
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
MLTC
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
31
57
44
5
62
123
141
26
9
7
5
40
5
50
67
129
2
19
42
29
1
233
79
63
8
2
14
3
37
14
47
3
3
33
127
10
02
03
04
ALACHUA
BAKER
BAY
BRADFORD
Report run on 08312018 1148 AM Page 1 of 18 actv_countrdf
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05
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ata
Enrollment Terminations with Reasons PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 Program All Programs Program Status ALL Program Status Worker ALL WORKERS
Last First Program Medicaid Provider Start End Name Name Client ID Status Description Worker Number Program Location Enrollment Enrollment
Count 0
Report run on 08312018 1150 AM Page 1 of 1 enroll_term_reasonrdf
Report run by RSHQALL Dispose of this report so that it can not be read or reconstructed
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ata
Enrollments with Care Plan Report
PSA ALL Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTIVE STATUS Care Plan Service ALL SERVICES Care Plan Start 01012017 Care Plan End 12312017
Care Plan Care Plan Care Plan Client Name
Unduplicated Client Count 0
Client ID Program Status Worker Start Date End Date Service
Report run on 08312018 1054 AM Page 1 of 1 enroll_careplrdf Report run by RSHQALL Dispose of this report so that it cannot be read or reconstructed
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ata
PSA CLIENT_ID CLIENT_NAME OWNER PROVIDER_ID ASSESSMENT_DATE ASSESSOR_NAME MEDICAID_NUMBER CAREGIVER_CHANGE ENVIRONMENT_CHANGE HEALTH_CHANGE INCOME_CHANGE SITUATION_CHANGE INITIAL_ASSM ANNUAL_ASSM SSN REFERRAL_SOURCE 1114 N N N N Y N 771771777 SELFFAMILY 812017 JANE CASEWORKER 2 1001141633 TEST TEST N
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ata
Fixed Service Costs List PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Provider Location County Program Service Reimbursement Unit Rate Provider Cost Per Unit Begin Valid End Valid
Count 0
Report run on 08312018 0233 PM Page 1 of 1 fixed_service_costrdf
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Disaster Assistance Clients for a Provider PSA ALL Provider All Providers Location 0000 Worker All Workers City All Cities Zip Code All Zip Codes Sort By ZIP
Provider 1036 Provider Name Location 0000 Worker CIRTS18634
Need Care Client Name Address City Zip County Phone Asst Reg Situation Relat Care phone Care Name
34946 N WO DA 000 SAINT JAMES DRIVE CENTRAL (025) 101-0620 Test NameTest Name SAINT LUCIE (005) 100-0369 Y
Client is active and no assessment information is available Special Shelter and Special Registry are unknown
Report run on 08312018 1102 AM Page 1 of 8 disaster_by_provrdf
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ata
EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
Total by PSA 0
Report run on 08312018 1111 AM Page 1 of 5 eheap_exceptionsrdf
Report run by RSHQALL Dispose of this report so that it can not be read or reconstructed
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ata
EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
ALACH BAKER BAY BRADF BREVA BROWA CALHO CHARL CITRUS CLAY COLLIE COLUM DESOT DIXIE DUVAL ESCAM FLAGL FRANK GADSDAssisted Household Report UA ORD RD RD UN OTTE R BIA O BIA ER LIN EN
1 of Household Assisted 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Households AssistedWith Gross Income
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C 100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D 125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
3 Households with at leastOne member
A 60 Years or older 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B Disabled 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C Age 5 years or under 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D Under 60 Years Old 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Undup Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Assisted
Applicant Household Report
of Applicant Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
Report run on 08312018 1111 AM Page 2 of 5 eheap_exceptionsrdf
Report run by RSHQALL Dispose of this report so that it can not be read or reconstructed
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ata
EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Energy Assisted Household Report
County of Assisted
Households
Households Assisted By Poverty Level
Under 75 75 - 100 101 - 125 126 - 150 Over 150 60 Years or older
At least one member who is
Age 5 years Age 2 years Age 3 years Disabled or younger and younger through 5
Under 60 Years Old
Undup Households
Assisted
Energy Assistance Total
Report run on 08312018 1107 AM Page 1 of 3 eheap_summaryrdf
Report run by RSHQALL Dispose of this report so that it can not be read or reconstructed
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ata
EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Unduplicated Total 0 0
County of Assisted
Households Under 75 75 - 100
Households Assisted By Poverty Level
101 - 125 126 - 150 Over 150 60 Years or older Disabled
Age 5 years or younger
Age 2 years and younger
Age 3 years through 5
Under 60 Years Old
At least one member who is
Undup Households
Assisted
Other Assisted Household Report
Other Assistance Total
Report run on 08312018 1107 AM Page 2 of 3 eheap_summaryrdf
Report run by RSHQALL Dispose of this report so that it can not be read or reconstructed
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ata
EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Applicant Household Report
County of Applicant
Households Under 75 75 - 100 101 - 125 126 - 150 Over 150 Income data
unavailable
Total 0
Report run on 08312018 1107 AM Page 3 of 3 eheap_summaryrdf
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ata
01
Enrollment Active Consumer Count by Program PSA ALL Provider ALL PROVIDERS
County Description Program Count of Clients
BREVARD
ADI
CCE
HCE
LSP
NDP
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
MLTC
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
31
57
44
5
62
123
141
26
9
7
5
40
5
50
67
129
2
19
42
29
1
233
79
63
8
2
14
3
37
14
47
3
3
33
127
10
02
03
04
ALACHUA
BAKER
BAY
BRADFORD
Report run on 08312018 1148 AM Page 1 of 18 actv_countrdf
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05
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ata
Enrollment Terminations with Reasons PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 Program All Programs Program Status ALL Program Status Worker ALL WORKERS
Last First Program Medicaid Provider Start End Name Name Client ID Status Description Worker Number Program Location Enrollment Enrollment
Count 0
Report run on 08312018 1150 AM Page 1 of 1 enroll_term_reasonrdf
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ata
Enrollments with Care Plan Report
PSA ALL Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTIVE STATUS Care Plan Service ALL SERVICES Care Plan Start 01012017 Care Plan End 12312017
Care Plan Care Plan Care Plan Client Name
Unduplicated Client Count 0
Client ID Program Status Worker Start Date End Date Service
Report run on 08312018 1054 AM Page 1 of 1 enroll_careplrdf Report run by RSHQALL Dispose of this report so that it cannot be read or reconstructed
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ata
PSA CLIENT_ID CLIENT_NAME OWNER PROVIDER_ID ASSESSMENT_DATE ASSESSOR_NAME MEDICAID_NUMBER CAREGIVER_CHANGE ENVIRONMENT_CHANGE HEALTH_CHANGE INCOME_CHANGE SITUATION_CHANGE INITIAL_ASSM ANNUAL_ASSM SSN REFERRAL_SOURCE 1114 N N N N Y N 771771777 SELFFAMILY 812017 JANE CASEWORKER 2 1001141633 TEST TEST N
Test D
ata
Fixed Service Costs List PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Provider Location County Program Service Reimbursement Unit Rate Provider Cost Per Unit Begin Valid End Valid
Count 0
Report run on 08312018 0233 PM Page 1 of 1 fixed_service_costrdf
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ata
EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
Total by PSA 0
Report run on 08312018 1111 AM Page 1 of 5 eheap_exceptionsrdf
Report run by RSHQALL Dispose of this report so that it can not be read or reconstructed
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ata
EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
ALACH BAKER BAY BRADF BREVA BROWA CALHO CHARL CITRUS CLAY COLLIE COLUM DESOT DIXIE DUVAL ESCAM FLAGL FRANK GADSDAssisted Household Report UA ORD RD RD UN OTTE R BIA O BIA ER LIN EN
1 of Household Assisted 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Households AssistedWith Gross Income
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C 100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D 125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
3 Households with at leastOne member
A 60 Years or older 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B Disabled 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C Age 5 years or under 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D Under 60 Years Old 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Undup Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Assisted
Applicant Household Report
of Applicant Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
Report run on 08312018 1111 AM Page 2 of 5 eheap_exceptionsrdf
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ata
EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Energy Assisted Household Report
County of Assisted
Households
Households Assisted By Poverty Level
Under 75 75 - 100 101 - 125 126 - 150 Over 150 60 Years or older
At least one member who is
Age 5 years Age 2 years Age 3 years Disabled or younger and younger through 5
Under 60 Years Old
Undup Households
Assisted
Energy Assistance Total
Report run on 08312018 1107 AM Page 1 of 3 eheap_summaryrdf
Report run by RSHQALL Dispose of this report so that it can not be read or reconstructed
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ata
EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Unduplicated Total 0 0
County of Assisted
Households Under 75 75 - 100
Households Assisted By Poverty Level
101 - 125 126 - 150 Over 150 60 Years or older Disabled
Age 5 years or younger
Age 2 years and younger
Age 3 years through 5
Under 60 Years Old
At least one member who is
Undup Households
Assisted
Other Assisted Household Report
Other Assistance Total
Report run on 08312018 1107 AM Page 2 of 3 eheap_summaryrdf
Report run by RSHQALL Dispose of this report so that it can not be read or reconstructed
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ata
EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Applicant Household Report
County of Applicant
Households Under 75 75 - 100 101 - 125 126 - 150 Over 150 Income data
unavailable
Total 0
Report run on 08312018 1107 AM Page 3 of 3 eheap_summaryrdf
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ata
01
Enrollment Active Consumer Count by Program PSA ALL Provider ALL PROVIDERS
County Description Program Count of Clients
BREVARD
ADI
CCE
HCE
LSP
NDP
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
MLTC
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
31
57
44
5
62
123
141
26
9
7
5
40
5
50
67
129
2
19
42
29
1
233
79
63
8
2
14
3
37
14
47
3
3
33
127
10
02
03
04
ALACHUA
BAKER
BAY
BRADFORD
Report run on 08312018 1148 AM Page 1 of 18 actv_countrdf
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05
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ata
Enrollment Terminations with Reasons PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 Program All Programs Program Status ALL Program Status Worker ALL WORKERS
Last First Program Medicaid Provider Start End Name Name Client ID Status Description Worker Number Program Location Enrollment Enrollment
Count 0
Report run on 08312018 1150 AM Page 1 of 1 enroll_term_reasonrdf
Report run by RSHQALL Dispose of this report so that it can not be read or reconstructed
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ata
Enrollments with Care Plan Report
PSA ALL Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTIVE STATUS Care Plan Service ALL SERVICES Care Plan Start 01012017 Care Plan End 12312017
Care Plan Care Plan Care Plan Client Name
Unduplicated Client Count 0
Client ID Program Status Worker Start Date End Date Service
Report run on 08312018 1054 AM Page 1 of 1 enroll_careplrdf Report run by RSHQALL Dispose of this report so that it cannot be read or reconstructed
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ata
PSA CLIENT_ID CLIENT_NAME OWNER PROVIDER_ID ASSESSMENT_DATE ASSESSOR_NAME MEDICAID_NUMBER CAREGIVER_CHANGE ENVIRONMENT_CHANGE HEALTH_CHANGE INCOME_CHANGE SITUATION_CHANGE INITIAL_ASSM ANNUAL_ASSM SSN REFERRAL_SOURCE 1114 N N N N Y N 771771777 SELFFAMILY 812017 JANE CASEWORKER 2 1001141633 TEST TEST N
Test D
ata
Fixed Service Costs List PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Provider Location County Program Service Reimbursement Unit Rate Provider Cost Per Unit Begin Valid End Valid
Count 0
Report run on 08312018 0233 PM Page 1 of 1 fixed_service_costrdf
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ata
EHEAP Enrollment and Exceptions (for applications with Date Stamp before 10012015)PSA ALL Start Date 01012014 End Date 12312014 Provider All Providers Location 0000 Program All Programs City All Cities Annual Poverty Line for each additional household member
ALACH BAKER BAY BRADF BREVA BROWA CALHO CHARL CITRUS CLAY COLLIE COLUM DESOT DIXIE DUVAL ESCAM FLAGL FRANK GADSDAssisted Household Report UA ORD RD RD UN OTTE R BIA O BIA ER LIN EN
1 of Household Assisted 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Households AssistedWith Gross Income
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C 100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D 125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
3 Households with at leastOne member
A 60 Years or older 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B Disabled 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C Age 5 years or under 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D Under 60 Years Old 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Undup Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Assisted
Applicant Household Report
of Applicant Households 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
A Under 75 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B 75 - 100 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C100 - 125 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D125 - 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Over 150 Poverty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F No Income Data Avail 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 or Not Enough Info
Report run on 08312018 1111 AM Page 2 of 5 eheap_exceptionsrdf
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ata
EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Energy Assisted Household Report
County of Assisted
Households
Households Assisted By Poverty Level
Under 75 75 - 100 101 - 125 126 - 150 Over 150 60 Years or older
At least one member who is
Age 5 years Age 2 years Age 3 years Disabled or younger and younger through 5
Under 60 Years Old
Undup Households
Assisted
Energy Assistance Total
Report run on 08312018 1107 AM Page 1 of 3 eheap_summaryrdf
Report run by RSHQALL Dispose of this report so that it can not be read or reconstructed
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ata
EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Unduplicated Total 0 0
County of Assisted
Households Under 75 75 - 100
Households Assisted By Poverty Level
101 - 125 126 - 150 Over 150 60 Years or older Disabled
Age 5 years or younger
Age 2 years and younger
Age 3 years through 5
Under 60 Years Old
At least one member who is
Undup Households
Assisted
Other Assisted Household Report
Other Assistance Total
Report run on 08312018 1107 AM Page 2 of 3 eheap_summaryrdf
Report run by RSHQALL Dispose of this report so that it can not be read or reconstructed
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ata
EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Applicant Household Report
County of Applicant
Households Under 75 75 - 100 101 - 125 126 - 150 Over 150 Income data
unavailable
Total 0
Report run on 08312018 1107 AM Page 3 of 3 eheap_summaryrdf
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ata
01
Enrollment Active Consumer Count by Program PSA ALL Provider ALL PROVIDERS
County Description Program Count of Clients
BREVARD
ADI
CCE
HCE
LSP
NDP
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
MLTC
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
31
57
44
5
62
123
141
26
9
7
5
40
5
50
67
129
2
19
42
29
1
233
79
63
8
2
14
3
37
14
47
3
3
33
127
10
02
03
04
ALACHUA
BAKER
BAY
BRADFORD
Report run on 08312018 1148 AM Page 1 of 18 actv_countrdf
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05
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ata
Enrollment Terminations with Reasons PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 Program All Programs Program Status ALL Program Status Worker ALL WORKERS
Last First Program Medicaid Provider Start End Name Name Client ID Status Description Worker Number Program Location Enrollment Enrollment
Count 0
Report run on 08312018 1150 AM Page 1 of 1 enroll_term_reasonrdf
Report run by RSHQALL Dispose of this report so that it can not be read or reconstructed
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ata
Enrollments with Care Plan Report
PSA ALL Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTIVE STATUS Care Plan Service ALL SERVICES Care Plan Start 01012017 Care Plan End 12312017
Care Plan Care Plan Care Plan Client Name
Unduplicated Client Count 0
Client ID Program Status Worker Start Date End Date Service
Report run on 08312018 1054 AM Page 1 of 1 enroll_careplrdf Report run by RSHQALL Dispose of this report so that it cannot be read or reconstructed
Test D
ata
PSA CLIENT_ID CLIENT_NAME OWNER PROVIDER_ID ASSESSMENT_DATE ASSESSOR_NAME MEDICAID_NUMBER CAREGIVER_CHANGE ENVIRONMENT_CHANGE HEALTH_CHANGE INCOME_CHANGE SITUATION_CHANGE INITIAL_ASSM ANNUAL_ASSM SSN REFERRAL_SOURCE 1114 N N N N Y N 771771777 SELFFAMILY 812017 JANE CASEWORKER 2 1001141633 TEST TEST N
Test D
ata
Fixed Service Costs List PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Provider Location County Program Service Reimbursement Unit Rate Provider Cost Per Unit Begin Valid End Valid
Count 0
Report run on 08312018 0233 PM Page 1 of 1 fixed_service_costrdf
Report run by RSHQALL Dispose of this report so that it can not be read or reconstruced
Test D
ata
EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Energy Assisted Household Report
County of Assisted
Households
Households Assisted By Poverty Level
Under 75 75 - 100 101 - 125 126 - 150 Over 150 60 Years or older
At least one member who is
Age 5 years Age 2 years Age 3 years Disabled or younger and younger through 5
Under 60 Years Old
Undup Households
Assisted
Energy Assistance Total
Report run on 08312018 1107 AM Page 1 of 3 eheap_summaryrdf
Report run by RSHQALL Dispose of this report so that it can not be read or reconstructed
Test D
ata
EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Unduplicated Total 0 0
County of Assisted
Households Under 75 75 - 100
Households Assisted By Poverty Level
101 - 125 126 - 150 Over 150 60 Years or older Disabled
Age 5 years or younger
Age 2 years and younger
Age 3 years through 5
Under 60 Years Old
At least one member who is
Undup Households
Assisted
Other Assisted Household Report
Other Assistance Total
Report run on 08312018 1107 AM Page 2 of 3 eheap_summaryrdf
Report run by RSHQALL Dispose of this report so that it can not be read or reconstructed
Test D
ata
EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Applicant Household Report
County of Applicant
Households Under 75 75 - 100 101 - 125 126 - 150 Over 150 Income data
unavailable
Total 0
Report run on 08312018 1107 AM Page 3 of 3 eheap_summaryrdf
Report run by RSHQALL Dispose of this report so that it can not be read or reconstructed
Test D
ata
01
Enrollment Active Consumer Count by Program PSA ALL Provider ALL PROVIDERS
County Description Program Count of Clients
BREVARD
ADI
CCE
HCE
LSP
NDP
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
MLTC
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
31
57
44
5
62
123
141
26
9
7
5
40
5
50
67
129
2
19
42
29
1
233
79
63
8
2
14
3
37
14
47
3
3
33
127
10
02
03
04
ALACHUA
BAKER
BAY
BRADFORD
Report run on 08312018 1148 AM Page 1 of 18 actv_countrdf
Report run by RSHQALL Dispose of this Report so that it can not be read or reconstructed
05
Test D
ata
Enrollment Terminations with Reasons PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 Program All Programs Program Status ALL Program Status Worker ALL WORKERS
Last First Program Medicaid Provider Start End Name Name Client ID Status Description Worker Number Program Location Enrollment Enrollment
Count 0
Report run on 08312018 1150 AM Page 1 of 1 enroll_term_reasonrdf
Report run by RSHQALL Dispose of this report so that it can not be read or reconstructed
Test D
ata
Enrollments with Care Plan Report
PSA ALL Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTIVE STATUS Care Plan Service ALL SERVICES Care Plan Start 01012017 Care Plan End 12312017
Care Plan Care Plan Care Plan Client Name
Unduplicated Client Count 0
Client ID Program Status Worker Start Date End Date Service
Report run on 08312018 1054 AM Page 1 of 1 enroll_careplrdf Report run by RSHQALL Dispose of this report so that it cannot be read or reconstructed
Test D
ata
PSA CLIENT_ID CLIENT_NAME OWNER PROVIDER_ID ASSESSMENT_DATE ASSESSOR_NAME MEDICAID_NUMBER CAREGIVER_CHANGE ENVIRONMENT_CHANGE HEALTH_CHANGE INCOME_CHANGE SITUATION_CHANGE INITIAL_ASSM ANNUAL_ASSM SSN REFERRAL_SOURCE 1114 N N N N Y N 771771777 SELFFAMILY 812017 JANE CASEWORKER 2 1001141633 TEST TEST N
Test D
ata
Fixed Service Costs List PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Provider Location County Program Service Reimbursement Unit Rate Provider Cost Per Unit Begin Valid End Valid
Count 0
Report run on 08312018 0233 PM Page 1 of 1 fixed_service_costrdf
Report run by RSHQALL Dispose of this report so that it can not be read or reconstruced
Test D
ata
EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Unduplicated Total 0 0
County of Assisted
Households Under 75 75 - 100
Households Assisted By Poverty Level
101 - 125 126 - 150 Over 150 60 Years or older Disabled
Age 5 years or younger
Age 2 years and younger
Age 3 years through 5
Under 60 Years Old
At least one member who is
Undup Households
Assisted
Other Assisted Household Report
Other Assistance Total
Report run on 08312018 1107 AM Page 2 of 3 eheap_summaryrdf
Report run by RSHQALL Dispose of this report so that it can not be read or reconstructed
Test D
ata
EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Applicant Household Report
County of Applicant
Households Under 75 75 - 100 101 - 125 126 - 150 Over 150 Income data
unavailable
Total 0
Report run on 08312018 1107 AM Page 3 of 3 eheap_summaryrdf
Report run by RSHQALL Dispose of this report so that it can not be read or reconstructed
Test D
ata
01
Enrollment Active Consumer Count by Program PSA ALL Provider ALL PROVIDERS
County Description Program Count of Clients
BREVARD
ADI
CCE
HCE
LSP
NDP
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
MLTC
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
31
57
44
5
62
123
141
26
9
7
5
40
5
50
67
129
2
19
42
29
1
233
79
63
8
2
14
3
37
14
47
3
3
33
127
10
02
03
04
ALACHUA
BAKER
BAY
BRADFORD
Report run on 08312018 1148 AM Page 1 of 18 actv_countrdf
Report run by RSHQALL Dispose of this Report so that it can not be read or reconstructed
05
Test D
ata
Enrollment Terminations with Reasons PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 Program All Programs Program Status ALL Program Status Worker ALL WORKERS
Last First Program Medicaid Provider Start End Name Name Client ID Status Description Worker Number Program Location Enrollment Enrollment
Count 0
Report run on 08312018 1150 AM Page 1 of 1 enroll_term_reasonrdf
Report run by RSHQALL Dispose of this report so that it can not be read or reconstructed
Test D
ata
Enrollments with Care Plan Report
PSA ALL Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTIVE STATUS Care Plan Service ALL SERVICES Care Plan Start 01012017 Care Plan End 12312017
Care Plan Care Plan Care Plan Client Name
Unduplicated Client Count 0
Client ID Program Status Worker Start Date End Date Service
Report run on 08312018 1054 AM Page 1 of 1 enroll_careplrdf Report run by RSHQALL Dispose of this report so that it cannot be read or reconstructed
Test D
ata
PSA CLIENT_ID CLIENT_NAME OWNER PROVIDER_ID ASSESSMENT_DATE ASSESSOR_NAME MEDICAID_NUMBER CAREGIVER_CHANGE ENVIRONMENT_CHANGE HEALTH_CHANGE INCOME_CHANGE SITUATION_CHANGE INITIAL_ASSM ANNUAL_ASSM SSN REFERRAL_SOURCE 1114 N N N N Y N 771771777 SELFFAMILY 812017 JANE CASEWORKER 2 1001141633 TEST TEST N
Test D
ata
Fixed Service Costs List PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Provider Location County Program Service Reimbursement Unit Rate Provider Cost Per Unit Begin Valid End Valid
Count 0
Report run on 08312018 0233 PM Page 1 of 1 fixed_service_costrdf
Report run by RSHQALL Dispose of this report so that it can not be read or reconstruced
Test D
ata
EHEAP Summary PSA ALL
Provider ALL PROVIDERS
Location 0000
Start Date 01012017 End Date 12312017
Applicant Household Report
County of Applicant
Households Under 75 75 - 100 101 - 125 126 - 150 Over 150 Income data
unavailable
Total 0
Report run on 08312018 1107 AM Page 3 of 3 eheap_summaryrdf
Report run by RSHQALL Dispose of this report so that it can not be read or reconstructed
Test D
ata
01
Enrollment Active Consumer Count by Program PSA ALL Provider ALL PROVIDERS
County Description Program Count of Clients
BREVARD
ADI
CCE
HCE
LSP
NDP
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
MLTC
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
31
57
44
5
62
123
141
26
9
7
5
40
5
50
67
129
2
19
42
29
1
233
79
63
8
2
14
3
37
14
47
3
3
33
127
10
02
03
04
ALACHUA
BAKER
BAY
BRADFORD
Report run on 08312018 1148 AM Page 1 of 18 actv_countrdf
Report run by RSHQALL Dispose of this Report so that it can not be read or reconstructed
05
Test D
ata
Enrollment Terminations with Reasons PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 Program All Programs Program Status ALL Program Status Worker ALL WORKERS
Last First Program Medicaid Provider Start End Name Name Client ID Status Description Worker Number Program Location Enrollment Enrollment
Count 0
Report run on 08312018 1150 AM Page 1 of 1 enroll_term_reasonrdf
Report run by RSHQALL Dispose of this report so that it can not be read or reconstructed
Test D
ata
Enrollments with Care Plan Report
PSA ALL Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTIVE STATUS Care Plan Service ALL SERVICES Care Plan Start 01012017 Care Plan End 12312017
Care Plan Care Plan Care Plan Client Name
Unduplicated Client Count 0
Client ID Program Status Worker Start Date End Date Service
Report run on 08312018 1054 AM Page 1 of 1 enroll_careplrdf Report run by RSHQALL Dispose of this report so that it cannot be read or reconstructed
Test D
ata
PSA CLIENT_ID CLIENT_NAME OWNER PROVIDER_ID ASSESSMENT_DATE ASSESSOR_NAME MEDICAID_NUMBER CAREGIVER_CHANGE ENVIRONMENT_CHANGE HEALTH_CHANGE INCOME_CHANGE SITUATION_CHANGE INITIAL_ASSM ANNUAL_ASSM SSN REFERRAL_SOURCE 1114 N N N N Y N 771771777 SELFFAMILY 812017 JANE CASEWORKER 2 1001141633 TEST TEST N
Test D
ata
Fixed Service Costs List PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Provider Location County Program Service Reimbursement Unit Rate Provider Cost Per Unit Begin Valid End Valid
Count 0
Report run on 08312018 0233 PM Page 1 of 1 fixed_service_costrdf
Report run by RSHQALL Dispose of this report so that it can not be read or reconstruced
Test D
ata
01
Enrollment Active Consumer Count by Program PSA ALL Provider ALL PROVIDERS
County Description Program Count of Clients
BREVARD
ADI
CCE
HCE
LSP
NDP
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
MLTC
O3C1
O3C2
OA3B
OA3E
ADI
CCE
HCE
O3C1
O3C2
OA3B
OA3E
OA3ES
ADI
CCE
HCE
31
57
44
5
62
123
141
26
9
7
5
40
5
50
67
129
2
19
42
29
1
233
79
63
8
2
14
3
37
14
47
3
3
33
127
10
02
03
04
ALACHUA
BAKER
BAY
BRADFORD
Report run on 08312018 1148 AM Page 1 of 18 actv_countrdf
Report run by RSHQALL Dispose of this Report so that it can not be read or reconstructed
05
Test D
ata
Enrollment Terminations with Reasons PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 Program All Programs Program Status ALL Program Status Worker ALL WORKERS
Last First Program Medicaid Provider Start End Name Name Client ID Status Description Worker Number Program Location Enrollment Enrollment
Count 0
Report run on 08312018 1150 AM Page 1 of 1 enroll_term_reasonrdf
Report run by RSHQALL Dispose of this report so that it can not be read or reconstructed
Test D
ata
Enrollments with Care Plan Report
PSA ALL Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTIVE STATUS Care Plan Service ALL SERVICES Care Plan Start 01012017 Care Plan End 12312017
Care Plan Care Plan Care Plan Client Name
Unduplicated Client Count 0
Client ID Program Status Worker Start Date End Date Service
Report run on 08312018 1054 AM Page 1 of 1 enroll_careplrdf Report run by RSHQALL Dispose of this report so that it cannot be read or reconstructed
Test D
ata
PSA CLIENT_ID CLIENT_NAME OWNER PROVIDER_ID ASSESSMENT_DATE ASSESSOR_NAME MEDICAID_NUMBER CAREGIVER_CHANGE ENVIRONMENT_CHANGE HEALTH_CHANGE INCOME_CHANGE SITUATION_CHANGE INITIAL_ASSM ANNUAL_ASSM SSN REFERRAL_SOURCE 1114 N N N N Y N 771771777 SELFFAMILY 812017 JANE CASEWORKER 2 1001141633 TEST TEST N
Test D
ata
Fixed Service Costs List PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Provider Location County Program Service Reimbursement Unit Rate Provider Cost Per Unit Begin Valid End Valid
Count 0
Report run on 08312018 0233 PM Page 1 of 1 fixed_service_costrdf
Report run by RSHQALL Dispose of this report so that it can not be read or reconstruced
Test D
ata
Enrollment Terminations with Reasons PSA ALL Start Date 01012017 End Date 12312017 Provider All Providers Location 0000 Program All Programs Program Status ALL Program Status Worker ALL WORKERS
Last First Program Medicaid Provider Start End Name Name Client ID Status Description Worker Number Program Location Enrollment Enrollment
Count 0
Report run on 08312018 1150 AM Page 1 of 1 enroll_term_reasonrdf
Report run by RSHQALL Dispose of this report so that it can not be read or reconstructed
Test D
ata
Enrollments with Care Plan Report
PSA ALL Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTIVE STATUS Care Plan Service ALL SERVICES Care Plan Start 01012017 Care Plan End 12312017
Care Plan Care Plan Care Plan Client Name
Unduplicated Client Count 0
Client ID Program Status Worker Start Date End Date Service
Report run on 08312018 1054 AM Page 1 of 1 enroll_careplrdf Report run by RSHQALL Dispose of this report so that it cannot be read or reconstructed
Test D
ata
PSA CLIENT_ID CLIENT_NAME OWNER PROVIDER_ID ASSESSMENT_DATE ASSESSOR_NAME MEDICAID_NUMBER CAREGIVER_CHANGE ENVIRONMENT_CHANGE HEALTH_CHANGE INCOME_CHANGE SITUATION_CHANGE INITIAL_ASSM ANNUAL_ASSM SSN REFERRAL_SOURCE 1114 N N N N Y N 771771777 SELFFAMILY 812017 JANE CASEWORKER 2 1001141633 TEST TEST N
Test D
ata
Fixed Service Costs List PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Provider Location County Program Service Reimbursement Unit Rate Provider Cost Per Unit Begin Valid End Valid
Count 0
Report run on 08312018 0233 PM Page 1 of 1 fixed_service_costrdf
Report run by RSHQALL Dispose of this report so that it can not be read or reconstruced
Test D
ata
Enrollments with Care Plan Report
PSA ALL Provider ALL PROVIDERS Location 0000 Program ALL PROGRAMS Program Status ACTIVE STATUS Care Plan Service ALL SERVICES Care Plan Start 01012017 Care Plan End 12312017
Care Plan Care Plan Care Plan Client Name
Unduplicated Client Count 0
Client ID Program Status Worker Start Date End Date Service
Report run on 08312018 1054 AM Page 1 of 1 enroll_careplrdf Report run by RSHQALL Dispose of this report so that it cannot be read or reconstructed
Test D
ata
PSA CLIENT_ID CLIENT_NAME OWNER PROVIDER_ID ASSESSMENT_DATE ASSESSOR_NAME MEDICAID_NUMBER CAREGIVER_CHANGE ENVIRONMENT_CHANGE HEALTH_CHANGE INCOME_CHANGE SITUATION_CHANGE INITIAL_ASSM ANNUAL_ASSM SSN REFERRAL_SOURCE 1114 N N N N Y N 771771777 SELFFAMILY 812017 JANE CASEWORKER 2 1001141633 TEST TEST N
Test D
ata
Fixed Service Costs List PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Provider Location County Program Service Reimbursement Unit Rate Provider Cost Per Unit Begin Valid End Valid
Count 0
Report run on 08312018 0233 PM Page 1 of 1 fixed_service_costrdf
Report run by RSHQALL Dispose of this report so that it can not be read or reconstruced
Test D
ata
PSA CLIENT_ID CLIENT_NAME OWNER PROVIDER_ID ASSESSMENT_DATE ASSESSOR_NAME MEDICAID_NUMBER CAREGIVER_CHANGE ENVIRONMENT_CHANGE HEALTH_CHANGE INCOME_CHANGE SITUATION_CHANGE INITIAL_ASSM ANNUAL_ASSM SSN REFERRAL_SOURCE 1114 N N N N Y N 771771777 SELFFAMILY 812017 JANE CASEWORKER 2 1001141633 TEST TEST N
Test D
ata
Fixed Service Costs List PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Provider Location County Program Service Reimbursement Unit Rate Provider Cost Per Unit Begin Valid End Valid
Count 0
Report run on 08312018 0233 PM Page 1 of 1 fixed_service_costrdf
Report run by RSHQALL Dispose of this report so that it can not be read or reconstruced
Test D
ata
Fixed Service Costs List PSA ALL Program AC
Provider ALL PROVIDERS Service AA
Location 0000
Start Date 01012017 End Date 12312017
PSA Provider Location County Program Service Reimbursement Unit Rate Provider Cost Per Unit Begin Valid End Valid
Count 0
Report run on 08312018 0233 PM Page 1 of 1 fixed_service_costrdf
Report run by RSHQALL Dispose of this report so that it can not be read or reconstruced
Test D
ata
