Transfer-In

Renata Vogel

DraftTR-000101
GOALS Client ID
CL-008221
Current Agency
Puget Sound Care Network
Assigned GOALS Case Manager
Unassigned
Date Created
1969-12-29
Transferring Programs
Employment
Missing before Pending for Auth: Assigned GOALS case manager.

Program Transfer Summary

ProgramCurrent AgencyRouteAuthorization StatusGOALS Program Status
EmploymentPuget Sound Care NetworkTransfer to GOALSPending for AuthNot Active
HousingPuget Sound Care NetworkNot Currently Receiving This ProgramNot ApplicableNot Managed by GOALS

Client Information

Preferred Name
Date of Birth
1975-02-08
ProviderOne ID
Primary Phone
(425) 555-0190
Secondary Phone
Email
r.vogel@email.com
Address
Service County
King
Service City
Renton
Preferred Contact
Preferred Language
Intake Source
Transfer-In

Current Agency and Provider

Agency
Puget Sound Care Network
Agency Contact
Agency Phone
Agency Email
Current Provider
Provider Phone
Provider Email
Transfer Request Date
1969-12-29
Transfer Reason
Additional Notes

GOALS Assignment

Case Manager
Unassigned
Supervisor
GOALS Service County
Not Set
GOALS Service City
Not Set
Expected Transfer Date
Internal Notes