Back to Transfer-In
HG

Hannah Gold

Draft
TR-2026-017 · DOB 1988-12-04
Date Created
2026-09-02
Assigned GOALS Case Manager
Sam Park
Assigned Assessor
Sam Vega
ProviderOne ID
143600819WA
Medicaid Eligibility
Verified
WLP Status
Verified
Current Outside Agency
Tacoma Rescue Mission
Transferring Programs
Housing
Service County
Pierce
Service City
Tacoma

Program Transfer Summary

ProgramCurrent AgencyRouteAuthorization StatusGOALS Program Status
HousingTacoma Rescue MissionTransfer to GOALSPending for AuthNot Active

Client Information

Preferred Name
—
Date of Birth
1988-12-04
ProviderOne ID
143600819WA
Primary Phone
(253) 555-0150
Secondary Phone
—
Email
hannah.gold@example.com
Address
4110 S Tacoma Way, Tacoma, WA 98409
Service County
Pierce
Service City
Tacoma
Preferred Contact
Phone
Preferred Language
English
Intake Source
Transfer-In

Current Agency and Provider

Agency
Tacoma Rescue Mission
Agency Contact
Belinda Ortiz
Agency Phone
(253) 555-0175
Agency Email
belinda.ortiz@tacomarescue.example.com
Current Provider
Belinda Ortiz
Provider Phone
(253) 555-0175
Provider Email
belinda.ortiz@tacomarescue.example.com
Transfer Request Date
2026-09-02
Transfer Reason
Existing Employment client adding Housing services; also has intake IN-004120.
Additional Notes
—

GOALS Assignment

Case Manager
Sam Park
Assigned Assessor
Sam Vega
Supervisor
Rachel Kim
GOALS Service County
Pierce
GOALS Service City
Tacoma
Expected Transfer Date
—
Internal Notes
Draft — still gathering information before submitting for authorization.