Back to Intake Queue
HP

Hannah Park

New
IN-004119 · DOB 1998-08-21
Date Created
2026-04-10
Assigned Staff
Tyrell Banks
ProviderOne ID
Not provided
MedicAid Eligibility
Pending
WLP Status
Pending
Service County
Not provided
Service City
Not provided

Program Health & Risk Information

Housing

Diagnosis

Not recorded

Health Factors

Not recorded

Risk Factors

Not recorded

Recorded during intake from the client's initial assessment.

Treatment Status

Unknown / Not Reported

Unknown / Not Reported

Defaults to Not Assessed. High or Medium risk clients appear on the Dashboard High & Medium Risk Clients widget.

Current Situation Duration

—

—

—

—

Enter the number of days based on the client's current situation.

Client Information

First Name
Hannah
Last Name
Park
Date of Birth
1998-08-21
Phone Number
(206) 555-0192
Center
Washington State
Program
Housing

Staff Assignment

Assigned Staff
Tyrell Banks
Date Assigned
2026-04-10

Intake Status History

1 transitions · most recent first
StatusChanged ByDate / Time
NewSystem2026-04-10 09:00

Authorization Upload

System-generated from ProviderOne batch imports
Not UploadedRead-only · updated automatically after each successful import
No matching authorization has been uploaded for this client.

Document Readiness

Required before moving from Draft to New
Authorization
Not Uploaded
Consent Form
Not Uploaded
Pre-Qualify Eligibility Questionnaire
Not Uploaded