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JP

Jose Perez

Pending
IN-004131 · DOB 1991-05-25
Date Created
2026-04-08
Assigned Staff
Dana Reyes
ProviderOne ID
101169862WA
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

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

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—

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—

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

Client Information

First Name
Jose
Last Name
Perez
Date of Birth
1991-05-25
Phone Number
(253) 431-3773
Email
Not provided
Center
Washington State
Program
Housing

Staff Assignment

Assigned Staff
Dana Reyes
Date Assigned
2026-04-08

Intake Status History

1 transitions · most recent first
StatusChanged ByDate / Time
PendingSystem2026-04-08 09:00

Authorization Upload

System-generated from ProviderOne batch imports
UploadedRead-only · updated automatically after each successful import
Authorization / Assessment ID
H2964202605
ProviderOne #
101169862WA
Auth Start Date
—
Auth End Date
—
Benefit Limitation
—
Imported File
ProviderOne Determination Batch.xlsx
Import Date / Time
2026-04-08
Matched Via
ProviderOne

Document Readiness

Required before moving from Draft to New
Authorization
Uploaded
Consent Form
Uploaded
Pre-Qualify Eligibility Questionnaire
Uploaded