Robert Nguyen

Approved

IN-004124 · DOB 1995-01-29

Date Created

2026-04-13

Assigned Staff

Dana Reyes

ProviderOne ID

P1-771902

MedicAid Eligibility

Verified

WLP Status

Verified

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

Substance Use Treatment

Unknown / Not Reported

Behavioral Health Treatment

Unknown / Not Reported

Risk Level(Optional)

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

Current Situation Duration

Days Homeless(Optional)

—

Days Unemployed(Optional)

—

Days in School(Optional)

—

Days in Training(Optional)

—

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

Client Information

First Name

Robert

Last Name

Nguyen

Date of Birth

1995-01-29

Phone Number

(425) 555-0166

Not provided

Center

California

Program

Housing

Staff Assignment

Assigned Staff

Dana Reyes

Date Assigned

2026-04-13

Intake Status History

4 transitions · most recent first

Status	Changed By	Date / Time
Approved	Dana Reyes	2026-04-13 14:22
New	Dana Reyes	2026-04-12 09:10
Draft	Dana Reyes	2026-04-11 10:00
New	System	2026-04-10 08:58

Authorization Upload

System-generated from ProviderOne batch imports

UploadedRead-only · updated automatically after each successful import

Authorization / Assessment ID

AUTH-004124

ProviderOne #

P1-771902

Auth Start Date

—

Auth End Date

—

Benefit Limitation

—

Imported File

ProviderOne Determination Batch.xlsx

Import Date / Time

2026-04-13

Matched Via

ProviderOne

Document Readiness

Required before moving from Draft to New

Authorization

Uploaded

Consent Form

Uploaded

Pre-Qualify Eligibility Questionnaire

Uploaded