Back to Intake Queue
AW

Andre Washington

Draft
IN-004126 · DOB 1985-07-22
Date Created
2026-04-14
Assigned Staff
Marcus Hill
ProviderOne ID
Not provided
MedicAid Eligibility
Pending
WLP Status
Pending
Service County
Not provided
Service City
Not provided
Authorization, Consent Form, and Pre-Qualify Eligibility Questionnaire must be Client Signed / Uploaded before moving this intake from Draft to New.

Program Health & Risk Information

Employment

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
Andre
Last Name
Washington
Date of Birth
1985-07-22
Phone Number
(206) 555-0188
Email
Not provided
Center
California
Program
Employment

Staff Assignment

Assigned Staff
Marcus Hill
Date Assigned
2026-04-14

Intake Status History

1 transitions · most recent first
StatusChanged ByDate / Time
DraftSystem2026-04-14 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
Uploaded