Transfer-InGOALS Client ID CL-008142 Current Agency XYZ NGO Assigned GOALS Case Manager Dana Reyes Date Created 1969-12-23 Transferring Programs
John Mercer
Pending for AuthTR-000104Employment
Pending since 1969-12-24 · 20703 calendar days · 14787 business days · expected response by 1969-12-31 — follow up with Wellpoint.
Program Transfer Summary
| Program | Current Agency | Route | Authorization Status | GOALS Program Status |
|---|---|---|---|---|
| Employment | XYZ NGO | Transfer to GOALS | Pending for Auth | Not Active |
| Housing | XYZ NGO | Remain with Current Agency | Not Applicable | Not Managed by GOALS |
Client Information
- Preferred Name
- Johnny
- Date of Birth
- 1981-04-19
- ProviderOne ID
- 203441902WA
- Primary Phone
- (206) 555-0311
- Secondary Phone
- —
- john.mercer@email.com
- Address
- 812 Pine St Apt 4
- Service County
- King
- Service City
- Seattle
- Preferred Contact
- Phone
- Preferred Language
- English
- Intake Source
- Transfer-In
Current Agency and Provider
- Agency
- XYZ NGO
- Agency Contact
- Rhonda Bass
- Agency Phone
- (206) 555-7710
- Agency Email
- rbass@xyzngo.org
- Current Provider
- Cheryl Mendez
- Provider Phone
- (206) 555-7712
- Provider Email
- cmendez@xyzngo.org
- Transfer Request Date
- 1969-12-23
- Transfer Reason
- Client relocated closer to the GOALS Seattle center.
- Additional Notes
- Housing services stay with ABC NGO at the client's request.
GOALS Assignment
- Case Manager
- Dana Reyes
- Supervisor
- Sam Vega
- GOALS Service County
- King
- GOALS Service City
- Seattle
- Expected Transfer Date
- 1970-01-06
- Internal Notes
- Employment only. Do not touch the Housing program.