New Intake

Client Information

Core identifying fields. Used for duplicate detection.

Client Name*Search Client Profile

ProviderOne ID*From Client Profile

Date of Birth*

MedicAid Eligibility*From Client Profile

WLP Status*From Client Profile

Service County*

Service City*

Program*Available: Housing, Employment

Intake StatusOptional — Updated manually

Primary ways to reach the client.

Cell Phone Number*

Email AddressOptional

Preferred Contact Format*

Residential AddressOptional

Residential CityOptional

Residential StateOptional

Zip CodeOptional

Assignment, registration, and notes.

Date of Registration*

Assigned Case Manager*

Intake NotesOptional — OPTIONAL

Diagnosis, health factors, and risk factors identified during initial assessment.

Current Enrollment: None

Available for New Intake: Housing, Employment

Available ProgramsSelect the program(s) for this intake

HousingEmployment

Select the applicable program to record diagnosis, health factors, and risk factors.

Whether the client is currently receiving substance use or behavioral health treatment, plus the assessed Risk Level.

Substance Use Treatment

Behavioral Health Treatment

Risk Level(Optional)

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

Number of days the client has been in each situation. Leave blank if unknown.

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.

Authorization, Consent, and Pre-Qualify Eligibility forms are handled from the Intake Detail page once this record is created.

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