Volume I - Client Case Registration

The client case registration process may consist of up to four different records for a client. At the time of registration, each client must have a CLIENT DEMOGRAPHIC INFORMATION record and a corresponding CLIENT MENTAL HEALTH (MH) and/or CLIENT DEVELOPMENTAL DISABILITIES (DD) INFORMATION record submitted. If the client has a guardian, a CLIENT GUARDIANSHIP INFORMATION record must also be submitted.

Example:

For a DD client - submit a CLIENT DEMOGRAPHIC INFORMATION record and a CLIENT DD INFORMATION record.
For a MH client - submit a CLIENT DEMOGRAPHIC INFORMATION record and a CLIENT MH INFORMATION record.
For a dually diagnosed client - submit a CLIENT DEMOGRAPHIC INFORMATION record, a CLIENT MH INFORMATION record and a CLIENT DD INFORMATION record.
For a client with a guardian - submit a CLIENT DEMOGRAPHIC INFORMATION record, a CLIENT GUARDIANSHIP INFORMATION record, and the appropriate MH or DD information record(s).

If a client is already registered and information needs to be added or changed, only the new or changed record(s) should be submitted.

Note: In the record formats that follow, all numeric fields should be right justified and zero filled. All alpha fields should be left justified, and space filled.

1.1 Client Demographic Information Record Format
1.2 Client Guardianship Information Record Format
1.3 Client MH Information Record Format
1.4 Client DD Information Record Format
1.5 Client Case Information Trailer Record Format

1.1 Client Demographic Information Record Format

Field Name	From	Thru	Length	Format	Description
Agency FEIN	1	9	9	numeric	Mandatory -The agency's nine digit Federal Employer Identification Number (FEIN).
Filler	10	11	2	alpha	Leave this field blank. Value: spaces
Agency Satellite Code	12	13	2	numeric	Mandatory - An organizational subpart within an agency that has a unique physical location, but does not have a different FEIN assigned to it. This code is assigned by DHS. If no satellite code is assigned, report zeros in this field.
Client ID	14	22	9	numeric	Mandatory - For all DD clients, and all MH clients who will be billed for fee for service programs or the Individual Care Grant (ICG) program, the individual's SSN must be used For other MH clients, an unique ID number may be assigned by the agency. If SSN is not used for MH clients, any unique number up to 9 digits is allowed (all zeros is not valid).
Record Type	23	23	1	alpha	Mandatory - Report the value: A A - indicates CLIENT DEMOGRAPHIC INFORMATION record
Filler	24	39	16	alpha	Leave this field blank. Value: spaces
Record Status	40	40	1	alpha	Leave this field blank. Value: spaces This field will be returned with a value indicating whether the record was ACCEPTED or REJECTED during processing at DHS. A - Accepted by DHS R - Rejected by DHS
Filler	41	41	1	alpha	Leave this field blank. Value: spaces
Medicaid Site ID	42	44	3	numeric	Mandatory- The three digit Department of Public Aid (DPA) assigned Medicaid site ID number where the client is registered. Non-Medicaid enrolled agencies should report 000 for this field. NOTE: The Medicaid Site ID is assigned by DPA and is the three digits which are appended to the agency's nine digit Federal Employer Identification Number (FEIN).
Client Name -					Mandatory- The complete legal name of the client. The name must match the name as it appears on the client's Department of Public Aid MediPlan card, Social Security card, and/or documentation of other benefits.
First Name	45	58	14	alpha	The complete legal first name.
Middle Initial	59	59	1	alpha	Middle initial should be reported, unless the client does not have one.
Last Name	60	89	30	alpha	The complete legal last name.
Suffix	90	92	3	alpha	The suffix should be reported, if the client has one (Jr, Sr, III, IV, etc.)
Mother's Maiden Last Name	93	122	30	alpha	The complete legal maiden last name of the client's mother. Report UNKNOWN if this name cannot be determined.
Social Security Number	123	131	9	numeric	Mandatory - The client's social security number (SSN). A valid SSN is mandatory for Medicaid eligible clients and DD clients NOTE: When the SSN is used for the client ID, the client's SSN must be reported in this field as well as the client ID field. Report 000000000 if the client has no SSN (allowed only for MH clients). Report 999999999 if the client's SSN is not known (allowed only for MH clients).
Recipient ID (RIN)	132	140	9	numeric	Mandatory - The client's recipient identification number (RIN). A valid RIN is mandatory for Medicaid eligible and MH clients. Report 000000000 if the client has no Medicaid Recipient ID.
State-Operated Facility ID (formerly referred to as DMHDD ID)	141	149	9	numeric	Mandatory - The State-Operated Facility ID number for the client if he/she has been served in a State-Operated DD or MH facility. Report 000000000 if the client has no State-Operated facility ID. Report 999999999 if the client's State-Operated facility ID is not known.
Birth Date	150	157	8	numeric	Mandatory - The date on which the client was born. Format: YYYYMMDD YYYY = century and year MM = month DD = day Example: 19990801
Sex	158	158	1	alpha	Mandatory - Sex of the client. F - Female M - Male
Race #1	159	160	2	numeric	Mandatory - Race of the client. Although the categories are intended to be mutually-exclusive, a client may be included in the group to which he/she appears to belong, identifies with, or is regarded in the community as belonging. 10 - White. A person having origins in any of the original peoples of Europe, North Africa, or the Middle East. 20 - Black/African American. A person having origins in any of the black racial groups of Africa. 30 - Asian. A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent. This area includes, for example, China, India, Japan, and Korea. 40 - American Indian/Alaskan Native. A person having origins in any of the original peoples of North, Central, or South America and who maintains tribal affiliation or community attachment. 50 - Native Hawaiian or Other Pacific Islander. A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Island. 99 - Unknown
Hispanic Origin	161	162	2	numeric	Mandatory - Indicates the Hispanic origin of a person of Spanish culture or origin, regardless of race. 00 - Not of Hispanic origin 11 - Mexican/Mexican American 12 - Puerto Rican 13 - Cuban 14 - Central or South American 18 - Other Hispanic 99 - Unknown, Not Classified
Language	163	164	2	numeric	Mandatory - Primary language of the client. 10 - English 20 - Spanish 30 - Other Western European 40 - Eastern European 41 - Bosnian 42 - Polish 43 - Russian 50 - Asian 51 - Arabic 52 - Chinese 53 - Indian 54 - Korean 55 - Vietnamese 60 - African 70 - American Sign Language 90 - Other 99 - Unknown
Area of Residence					Mandatory - The geographic location where the client currently lives. Refer to the current Directory of Geographic Information.
County	165	167	3	numeric	Report the code of the county, out-of-state, or unknown.
Township / Community Area	168	169	2	numeric	Report Community Area-if the client resides in Chicago. Report Township-if the client resides outside the Chicago city limits, but within a county that requires this further information.
Race #2	170	171	2	alpha	Optional - If used, same description as for Race #1 above (excluding 99 -Unknown); if not used, this field must be blank (value spaces).
Race #3	172	173	2	alpha	Optional - If used, same description as for Race #1 above (excluding 99 -Unknown); if not used, this field must be blank (value spaces).
Race #4	174	175	2	alpha	Optional - If used, same description as for Race #1 above (excluding 99 -Unknown); if not used, this field must be blank (value spaces).
Race #5	176	177	2	alpha	Optional - If used, same description as for Race #1 above (excluding 99 -Unknown); if not used, this field must be blank (value spaces).
Interpreter Services Needed	178	178	1	numeric	Mandatory - The type of interpreter services required by the client. 0 - Services Not Needed 1 - American Sign Language 2 - Foreign Language 9 - Unknown
Education Level	179	180	2	numeric	Mandatory - Identifies the highest grade level completed by the client. 00 - Never attended school __ - Last primary/secondary grade completed (Report the appropriate grade level 01-11) 20 - Preschool/kindergarten 30 - High School diploma 31 - General Equivalency Diploma (GED) 32 - Special Education Certificate of Completion 40 - Post-secondary training 41 - One year college 42 - Two years college 43 - Three years college 50 - College Bachelor's degree 60 - Post Graduate college degree 99 - Unknown
Employment Status	181	182	2	numeric	Mandatory - Describes the current employment status of the client. 10 - Employed, including on vacation or sick leave 11 - Employed full time (unsubsidized employment, including self-employment) 12 - Employed part time (unsubsidized employment, including self-employment) 13 - Employed (full or part time) in subsidized or supported employment 14 - Attending vocational/day program, including programs funded by DHS or by other entities 20 - Unemployed/layoff from job,30 - Not in the Labor Force (retired, homemaker, student, resident/inmate of institution) 90 - Other (not seeking employment/vocational services) 99 - Unknown
Marital Status	183	183	1	numeric	Mandatory - Marital status of the client. 1 - Never Married 2 - Married 3 - Widowed 4 - Divorced 5 - Separated 9 - Unknown, declines to specify
SSI-SSDI Eligibility	184	184	1	numeric	Mandatory - Describes the Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI) eligibility status for the client. Note: Only codes 1, 2, and 3 are acceptable for waiver clients. 0 - Not Applicable 1 - Eligible, receiving payments 2 - Eligible, not receiving payments 3 - Eligibility determination pending 4 - Potentially eligible but has not applied or status unknown 5 - Determined to be ineligible,9 - Eligibility status unknown
DFI-CFI Enrollment	185	185	1	alpha	Mandatory - Designates whether the client is enrolled in DFI or CFI. N - Not Applicable Y - Enrolled in DFI/CFI (DFI Donated Funds Initiative, CFI Contracted Funds Initiative)
Citizenship	186	186	1	alpha	Mandatory - Indicates the citizenship status of the client. Y - U.S. Citizen N - Non-U.S. Citizen U - Unknown
Military Status	187	187	1	alpha	Mandatory - Indicates the military status of the client. A veteran is any person who has served on active duty in the armed forces of the United States, including the Coast Guard. Not counted as veterans are those whose only service was in the Reserves, National Guard, or Merchant Marines. 0 - Not a Veteran 1 - Veteran 2 - Currently on active duty 9 - Unknown
Court / Forensic Treatment	188	189	2	numeric	Mandatory - Status of forensic/ court-ordered treatment plans at the time of registration. NOTE: Criminal court-ordered treatment should be used only when the order is an outcome of criminal proceeding against the client (including juveniles). 00 - Not applicable 01 - Department of Corrections client (e.g., probation, parole) 02 - Unable to Stand Trial 03 - Unable to Stand Trial-ET (Extended Term) 04 - Unable to Stand Trial-G2 05 - Not Guilty by Reason of Insanity 06 - Civil court-ordered treatment 07 - Criminal court-ordered treatment 08 - Court-ordered evaluation/assessment only 99 - Forensic status unknown
Previous Client ID	190	198	9	alpha	Optional - Use this field when a change is being made to the client ID number. This field should contain the existing ID for the client (as it was originally reported). The Client ID in positions 14 - 22, will contain the "new" Client ID number. Only one 'A' record should be submitted at a time with a Client ID Change.
Client Address -					Mandatory - The current address of the client.
Street	199	238	40	alpha	Street or box number
City	239	258	20	alpha	City
State	259	260	2	alpha	The Post Office abbreviation for State.
Zip Code	261	265	5	numeric	Postal zip code
Zip Code Suffix	266	269	4	alpha	The last four positions of the zip code. (Optional) NOTE: If the client is homeless report the address of the agency providing the service.
Disaster Information					If not used, these fields must be blank (value spaces). Mandatory - Use these fields when the client is an Illinois guest due to a disaster or the client is seeking services due to an incident.
Guest State	270	271	2	alpha	The Post Office abbreviation for the client's home state. Note: For Type "NI" leave blank
Guest County	272	274	3	alpha	The Federal Information Processing Standards (FIPS) county code where the client lived in their state. Note: For Type "NI" leave blank
Disaster Type	275	276	2	alpha	Indicates which disaster brought the client to Illinois. HK - Hurricane Katrina HR - Hurricane Rita NI - Northern IL University (NIU) Incident
Filler	277	394	118	alpha	Leave this field blank. Value: spaces
Submit Date	395	402	8	numeric	Mandatory - The date on which the record is being submitted to DHS. Example: 19990801 Format: YYYYMMDD YYYY = century and year MM = month DD = day
Process Date	403	410	8	alpha	Leave this field blank. Value: spaces, This field will be returned with the date the data was processed by DHS. Format: YYYYMMDD YYYY = century and year MM = month DD = day
Reject Codes					Leave these fields blank. Value: spaces
Code 1	411	413	3	alpha	These fields will be returned after DHS has processed the record. If the record is rejected during processing by DHS, up to three error codes will be noted, indicating the reason the record was rejected
Code 2	414	416	3	alpha	These fields will be returned after DHS has processed the record. If the record is rejected during processing by DHS, up to three error codes will be noted, indicating the reason the record was rejected
Code 3	417	419	3	alpha	These fields will be returned after DHS has processed the record. If the record is rejected during processing by DHS, up to three error codes will be noted, indicating the reason the record was rejected
Warning Codes					Leave these fields blank. Value: spaces
Code 1	420	422	3	alpha	These fields will be returned after DHS has processed the record. Up to two warning codes will be noted, indicating the reason the data was changed by DHS or needs agency update.
Code 2	423	425	3	alpha	These fields will be returned after DHS has processed the record. Up to two warning codes will be noted, indicating the reason the data was changed by DHS or needs agency update.
Filler	426	439	14	alpha	Leave this field blank. Value: spaces
Software Indicator	440	440	1	alpha	Mandatory - Report the value: Z Z - indicates agency's own software created the file.
Filler	441	450	10	alpha	Leave this field blank. Value: spaces

1.2 Client Guardianship Information Record Format

Field Name	From	Thru	Length	Format	Description
Agency FEIN	1	9	9	numeric	Mandatory - The agency's nine digit Federal Employer Identification Number (FEIN).
Filler	10	11	2	alpha	Leave this field blank. Value: spaces
Agency Satellite Code	12	13	2	numeric	Mandatory - An organizational subpart within an agency that has a unique physical location, but does not have a different FEIN assigned to it. This code is assigned by DHS. If no satellite code is assigned report zeros in this field.
Client ID	14	22	9	numeric	Mandatory - For all DD clients, and all MH clients who will be billed for fee for service programs or the Individual Care Grant (ICG) program, the individual's SSN must be used. For other MH clients, an unique ID number may be assigned by the agency. If SSN is not used for MH clients, any unique number up to 9 digits is allowed (all zeros is not valid).
Record Type	23	23	1	alpha	Mandatory - Report the value: B B - indicates CLIENT GUARDIANSHIP INFORMATION record
Filler	24	39	16	alpha	Leave this field blank. Value: spaces
Record Status, (continued on next page), (continued)	40	40	1	alpha	Leave this field blank. Value: spaces This field will be returned with a value indicating whether the record was ACCEPTED or REJECTED during processing at DHS. A - Accepted by DHS R - Rejected by DHS
Filler	41	41	1	alpha	Leave this field blank. Value: spaces
Guardian Type	42	43	2	alpha	Mandatory - Describes the relationship of the guardian to the client. The provider must obtain a copy of the legal guardianship documents to verify that guardianship is official, except for parent of minor child. NOTE: Type of guardianship should be verified by review of the court order and periodically updated. NOTE: To delete all previous DHS accepted guardian information, report '01' in Guardian Type and leave all other guardianship information fields blank. 01 - Delete guardian(s) 02 - Parent of minor child 0-17 03 - Limited of Person 04 - Limited of Estate 05 - Plenary of Person 06 - Plenary of Estate
Guardian Name					Mandatory - report the name of the guardian or responsible person.
First Name	44	57	14	alpha	The complete first name
Middle Initial	58	58	1	alpha	Middle initial
Last Name	59	88	30	alpha	The complete last name NOTE: If the person listed is not the parent of a minor child or a court appointed guardian, the provider must have in the client's file a current signed release of information to authorize release of this information.
Guardian Address					Mandatory - report the complete address of the guardian or responsible person.
Street Address	89	128	40	alpha	Street or box number
City	129	148	20	alpha	City
State	149	150	2	alpha	Post Office abbreviation for State
Zip Code	151	155	5	alpha	Postal zip code
Zip Code Suffix	156	159	4	alpha	The last four positions of the zip code, if known. (Optional)
Appointment Date	160	167	8	alpha	Mandatory - when GUARDIAN TYPE is 03, 04, 05, 06, report the date of appointment as guardian by the court. Format: YYYYMMDD YYYY - century and year MM - month DD - day Example: 19990801 NOTE: When guardian type is 02, leave this field blank.
Guardian Information, - Guardian 2,					NOTE: If there is only one Guardian, leave the second set of Guardian information fields blank, value spaces.
Guardian Type	168	169	2	alpha	Mandatory, if applicable - Describes the relationship of the second guardian to the client. 02 - Parent of minor child 0-17 03 - Limited of Person 04 - Limited of Estate 05 - Plenary of Person 06 - Plenary of Estate
Guardian First Name	170	183	14	alpha	The complete first name
Middle Initial	184	184	1	alpha	Middle initial
Last Name	185	214	30	alpha	The complete last name
Street Address	215	254	40	alpha	Street or box number
City	255	274	20	alpha	City
State	275	276	2	alpha	Post Office abbreviation for State
Zip Code	277	281	5	alpha	Postal zip code
Zip Code Suffix	282	285	4	alpha	The last four positions of the zip code, if known. (Optional)
Appointment Date	286	293	8	alpha	When GUARDIAN TYPE is 03, 04, 05, 06, report the date of appointment as guardian by the court. Format: YYYYMMDD YYYY - century and year MM - month DD - day Example: 19990801 NOTE: When guardian type is 02, leave this field blank.
Filler	294	394	101	alpha	Leave this field blank. Value: spaces
Submit Date	395	402	8	numeric	Mandatory - The date on which the record is being submitted to DHS. Format: YYYYMMDD YYYY = century and year MM = month DD = day
Process Date	403	410	8	alpha	Leave this field blank. Value: spaces This field will be returned with the date the data was processed by DHS. Format: YYYYMMDD YYYY = century and year MM = month DD = day
Reject Codes					Leave these fields blank. Value: spaces
Code 1	411	413	3	alpha	These fields will be returned after DHS has processed the record. If the record is rejected during processing by DHS, up to three error codes will be noted, indicating the reason the record was rejected by DHS.
Code 2	414	416	3	alpha	These fields will be returned after DHS has processed the record. If the record is rejected during processing by DHS, up to three error codes will be noted, indicating the reason the record was rejected by DHS.
Code 3	417	419	3	alpha	These fields will be returned after DHS has processed the record. If the record is rejected during processing by DHS, up to three error codes will be noted, indicating the reason the record was rejected by DHS.
Warning Codes					Leave these fields blank. Value: spaces
Code 1	420	422	3	alpha	These fields will be returned after DHS has processed the record. Up to two warning codes will be noted, indicating the reason the data was changed by DHS or needs agency update.
Code 2	423	425	3	alpha	These fields will be returned after DHS has processed the record. Up to two warning codes will be noted, indicating the reason the data was changed by DHS or needs agency update.
Filler	426	439	14	alpha	Leave this field blank. Value: spaces
Software Indicator	440	440	1	alpha	Mandatory - Report the value: Z Z - indicates agency's own software created the file.
Filler	441	450	10	alpha	Leave this field blank. Value: spaces

1.3 Client MH Information Record Format

Field Name	From	Thru	Length	Format	Description
Agency FEIN	1	9	9	numeric	Mandatory - The agency's nine digit Federal Employer Identification Number (FEIN).
Filler	10	11	2	alpha	Leave this field blank. Value: spaces
Agency Satellite Code	12	13	2	numeric	Mandatory - An organizational subpart within an agency that has a unique physical location, but does not have a different FEIN assigned to it. This code is assigned by DHS. If no satellite code is assigned, report zeros in this field.
Client ID	14	22	9	numeric	Mandatory - For all DD clients, and all MH clients who will be billed for fee for service programs or the Individual Care Grant (ICG) program, the individual's SSN must be used. For other MH clients, an unique ID number may be assigned by the agency. If SSN is not used for MH clients, any unique number up to 9 digits is allowed (all zeros is not valid).
Record Type	23	23	1	alpha	Mandatory - Report the value: M M - indicates CLIENT MH INFORMATION record
Closing Date	24	31	8	numeric	Leave blank if the client is active. Mandatory - when closing the Client MH Information. The date that the agency terminated its commitment to provide services to the individual. Format: YYYYMMDD YYYY - Century and year MM - Month DD - Day Example: 19990801
Registration Date	32	39	8	numeric	Mandatory - Date on which the client was registered with the agency. This is the date of the first billable or reportable service event or intake interview with the client, parent, or guardian. Format: YYYYMMDD YYYY - century and year MM - month DD - day Example: 19980801
Record Status	40	40	1	alpha	Leave this field blank. Value: spaces This field will be returned with a value indicating whether the record was ACCEPTED or REJECTED during processing at DHS. A - Accepted by DHS R - Rejected by DHS
Filler	41	41	1	alpha	Leave this field blank. Value: spaces
Residential Arrangement	42	43	2	numeric	Mandatory - Describes the client's primary residential situation at the present time while services are being initiated or provided. 10 - Homeless (e.g.,living on the street, in an emergency shelter, or transient) 21 - Private residence (e.g.,structure with accommodations for sleeping in which some individual knowingly owns or rents for the purpose of housing the client) , - client supervised (not considered to be living independently) 22 - Private residence (e.g.,structure with accommodations for sleeping in which some individual knowingly owns or rents for the purpose of housing the client) , - client unsupervised (considered to be living independently) 31 - Other residential setting (e.g.,group homes, half-way houses, supported living situations), - client supervised (not considered to be living independently) 32 - Other residential setting (e.g.,group homes, half-way houses, supported living situations), - client unsupervised (considered to be living independently) 40 - State-Operated Facility (Mental Health Center or Developmental Center) 50 - Jail or correctional facility/institution (e.g., detention centers, institutions/training schools) 60 - Other institutional setting (e.g., psychiatric, VA, or community hospitals, residential treatment centers, nursing homes, intermediate care facilities) 80 - Boarding school 90 - Other 99 - Unknown
Household Composition	44	45	2	numeric	Mandatory - The client's household composition. 10 - Lives alone 20 - Lives with one or more relatives (e.g., biological, step, or adoptive relationships) 30 - Lives with non-related persons (e.g., professional child care staff and other children in group care, foster parents and other foster children) 99 - Unknown
Filler	46	46	1	alpha	Value: spaces (Previously Diagnosis Code Type)
Filler	47	47	1	alpha	Value: spaces (Previously Principal Diagnosis Indicator)
Filler	48	92	45	alpha	Value: spaces (Previously Diagnosis Information AXIS I - Diagnosis 1 Diagnosis 2 Diagnosis 3 AXIS II - Diagnosis 1 Diagnosis 2 Diagnosis 3 AXIS III - Diagnosis 1 Diagnosis 2 Diagnosis 3 )
GAF/CGAS					Mandatory - Current functioning scale score as assessed in the registration process. GAF scores are to be obtained by rating the adult's current level of functioning (i.e., within the past week), while CGAS scores are to be obtained by rating the child's or adolescent's most impaired level of general functioning over the previous month.
Score	93	94	2	alpha	Valid Values: 01-99 Mandatory - The functional scale used. C - Children's Global Assessment Scale (CGAS) G - Global Assessment of Functioning (GAF) NOTE: Scale selection will prescribe which client functioning information should be reported. If CGAS scale is used - report the Child and Adolescent section for Client Functioning; if GAF scale is used, report the Adult section for Client Functioning.
Scale Used	95	95	1	alpha	Valid Values: 01-99 Mandatory - The functional scale used. C - Children's Global Assessment Scale (CGAS) G - Global Assessment of Functioning (GAF) NOTE: Scale selection will prescribe which client functioning information should be reported. If CGAS scale is used - report the Child and Adolescent section for Client Functioning; if GAF scale is used, report the Adult section for Client Functioning.
Client Functioning - Adult					Mandatory - Use this section if the GAF scale was used for Axis V Diagnosis Information. If this section is not used, leave these fields blank; value spaces. Determination of impairment criteria for adults. Report one of the following codes for each impairment category.
Social Group/School	96	97	2	alpha
Employment	98	99	2	alpha
Financial	100	101	2	alpha
Community Living	102	103	2	alpha	00 - Client does not meet serious impairment criteria 01 - Client meets serious impairment criteria, Client has serious impairment in social, occupational, or school functioning. Client is unemployed or working only part-time due to mental illness and not for reasons of physical disability or some other role responsibility (e.g., student or primary care giver for dependent family member); is employed in a sheltered setting or supportive work situation, or has markedly limited work skills. Client requires help to seek public financial assistance for out-of-hospital maintenance (e.g., Medicaid, SSI, SSDI, other indicators). Client does not seek appropriate supportive community services, e.g., recreational, educations, or vocational support services, without assistance.
Client Functioning - Adult
Supportive Social	104	105	2	alpha	Client lacks supportive social systems in the community (e.g., no intimate or confiding relationship with anyone in their personal life, no close friends or group affiliations, is highly transient or has inability to co-exist within family setting.
Daily Living Activity	106	107	2	alpha	Client requires assistance in basic life and survival skills (e.g., must be reminded to take medication, must have transportation to mental health clinic and other supportive services, needs assistance in self-care, household management, food preparation or money management, etc., is homeless or at risk of becoming homeless).
Inappropriate or Dangerous Behavior	108	109	2	alpha	Client exhibits inappropriate or dangerous social behavior which results in demand for intervention by the mental health and/or judicial/legal system.
Previous Functional Impairment	110	111	2	alpha	Currently receiving Mental health treatment, has a history within the past five years of functional impairment meeting two of the functional criteria listed above which persisted for a least 12 months, and there is documentation supporting the professional judgement that regression in functional impairment would occur without continuing treatment.
Client Functioning - Children & Adolescents					Mandatory - Only use this section if the CGAS scale was used for Axis V Diagnosis Information. If this section is not used, leave these fields blank; value spaces. Determination of impairment criteria for children and adolescents. Report one of the following codes for each impairment category. 00 - Client does not meet serious impairment criteria 01 - Client meets serious impairment criteria
Self Care	112	113	2	alpha	Consistent inability to take care of age appropriate personal grooming, hygiene, clothes and meeting of nutritional needs.
Community	114	115	2	alpha	Consistent lack of age appropriate behavioral controls, decision-making, judgement, and value systems which result in potential involvement or involvement of the juvenile justice system.
Social Relations	116	117	2	alpha	Consistent inability to develop and maintain satisfactory relationships with peers or adults.
Client Functioning - Children & Adolescents
Family Relations	118	119	2	alpha	A pattern of disregard for safety and welfare of self or others (e.g., fire setting, serious and chronic destructiveness), significantly disruptive behavior exemplified by repeated and/or unprovoked violence to siblings and/or parents or inability to conform to reasonable limitations and expectations. The degree of impairment requires intensive (i.e., beyond age appropriate) supervision by parent/care giver and may result in removal from family or its equivalent.
School	120	121	2	alpha	Inability to pursue educational goals in a normal time frame (e.g., consistently failing grades, repeated truancy, expulsion, property damage or violence towards others ) that cannot be remedied by a classroom setting (whether traditional or specialized).
History of Illness					Mandatory - Determination of the client's previous contacts with elements of the mental health delivery system. Report one of the following codes for each category. 00 - Client does not meet treatment history criteria 01 - Client meets treatment history criteria
Continuous Treatment	122	123	2	numeric	Continuous treatment of six months or more in one or a combination of the following treatment modalities: inpatient treatment; day treatment; partial hospitalization
Continuous Residential	124	125	2	numeric	Six months continuous residence in residential treatment programming.
Multiple Residential	126	127	2	numeric	Two or more admissions to inpatient treatment, day treatment, partial hospitalization or residential treatment programming within a 12 month period.
Outpatient	128	129	2	numeric	History of using the following outpatient services over a one year period, whether continuously or intermittently: psycho tropic medication management; case management; out reach and engagement services, including SASS and intensive community-based services
Previous Treatment	130	131	2	numeric	Previous treatment in an outpatient modality and a history of at least one mental health psychiatric hospitalization
MH CILA Enrollment	132	132	1	alpha	Mandatory - Designates whether the client is enrolled in the DHS funded MH CILA program. N - Not applicable Y - Enrolled in MH CILA
Family Household Size	133	134	2	numeric	Mandatory - The total number of the client's family members in the household, including the client. NOTE: A family includes a householder and one or more people living in the same household who are related to the householder by birth, marriage, or adoption. All people in the household who are related to the householder are regarded as members of his or her family. A family household may contain people not related to the householder, but those people are not included as part of the householder's family. Range: 01 - 99 (99 = Unknown)
Household Income	135	140	6	numeric	Mandatory - The total monthly income of all family members in the client's household. NOTE: "Total Income" is the sum of the amounts reported separately for wages, salary, commissions, bonuses, or tips; self-employment income from own non-farm or farm businesses, including proprietorships and partnerships; interest, dividends, net rental income, royalty income, or income from estates and trusts; Social Security or Railroad Retirement income; Supplemental Security Income (SSI); any public assistance or welfare payments from the state or local welfare office; retirement, survivor, or disability pensions; and any other sources of income received regularly such as Veterans' (VA) payments, unemployment compensation, child support, or alimony. Range:000000 - 999999 (999999 = Unknown)
Client Income	141	146	6	numeric	Mandatory - The total income of the client. See definition of "Total Income" above Range:000000 - 999999 (999999 = Unknown)
Co-Occurring Disorders	147	147	1	alpha	Mandatory - Indicates whether or not the client has been screened for co-occurring mental illness/substance abuse disorders. Y - Yes N - No
Justice System Involvement	148	148	1	numeric	Mandatory - Describes the client's criminal justice system involvement at the time of case registration. 0 - Not Applicable 1 - Arrested 2 - Charged with a Crime 3 - Incarcerated (jail) 4 - Incarcerated (prison) 5 - Juvenile Detention Center 8 - Other 9 - Unknown
Functional Impairment - Adults					If not used, these fields must be blank (value spaces). Optional - Use this section if the Multnomah Community Ability Scale (MCAS) was used. NOTE: Consult the MCAS instrument for full descriptions of each item. Staff using the MCAS must be trained by a DMH approved trainer. Determination of functional impairment criteria for adults. Report the appropriate rating for each MCAS domain. Domains 1 - 13 and 15 - 17 Range: 1 - 5 9 Unknown Domain 14 Range: 0 - 5 9 Unknown
Domain #1	149	149	1	alpha	Physical Health - Impairment of client by his/her physical health status.
Domain #2	150	150	1	alpha	Intellectual Functioning - General intellectual functioning
Domain #3	151	151	1	alpha	Thought Process - Impairment as evidenced by symptoms such as hallucinations, delusions, tangentiality, etc.
Domain #4	152	152	1	alpha	Mood Abnormality - Impairment as evidenced by such symptoms as constricted mood, extreme mood swings, etc.
Domain #5	153	153	1	alpha	Response to Stress and Anxiety - Impairment as evidenced by inappropriate and/or stressful events, etc.
Domain #6	154	154	1	alpha	Ability to Manage Money - Successfulness of ability of client to manage his/her money and control expenditures.
Domain #7	155	155	1	alpha	Independence in Daily Life - Ability to perform independently in day-to-day living.
Domain #8	156	156	1	alpha	Acceptance of Illness - How well client accepted his/her psychiatric disability.
Domain #9	157	157	1	alpha	Social Acceptability - Other people's reactions to the client.
Domain #10	158	158	1	alpha	Social Interest - Frequency with which client initiates social contracts or responds to other's initiation of contact.
Domain #11	159	159	1	alpha	Social Effectiveness - Effectiveness of client's interaction with others.
Domain #12	160	160	1	alpha	Social Network - Extensiveness of client's social support network.
Domain #13	161	161	1	alpha	Meaningful Activity - Frequency with which client is involved in meaningful activities that are satisfying to him/her.
Domain #14	162	162	1	alpha	Medication Compliance - Frequency with which client complies with his/her medication regimen.
Domain #15	163	163	1	alpha	Cooperation with Treatment Providers - Frequency with which client cooperates with providers (for example, keeping appointments, complying with treatment plan, etc).
Domain #16	164	164	1	alpha	Alcohol/Drug Abuse - Frequency with which client abuses drugs/alcohol.
Domain #17	165	165	1	alpha	Impulse Control - Frequency of episodes of acting out (e.g., temper outbursts, spending sprees, aggressive actions, etc).
Functional Impairment - Children & Adolescents					If not used, these fields must be blank (value spaces). Optional - Use this section if the Child and Adolescent Functional Assessment Scale (CAFAS) was used. NOTE: Consult the CAFAS instrument for full descriptions of each item. The CAFAS is copyrighted. Staff using the CAFAS must be trained by a DMH approved trainer. Determination of functional impairment criteria for children and adolescents. Report the appropriate rating for each CAFAS domain. Range: 00 - 30 99 Could Not Rate
Domain #1	166	167	2	alpha	School/Work - Extent to which child/adolescent meets performance expectations of school/work.
Domain #2	168	169	2	alpha	Home - Extent to which self-care is appropriate and household chores are perform satisfactorily.
Domain #3	170	171	2	alpha	Community - Extent to which child/adolescent community role performance is satisfactory.
Domain #4	172	173	2	alpha	Behavior Towards Others - Extent to which behavior towards others is impaired.
Domain #5	174	175	2	alpha	Mood/Emotion - Extent to which expression of feelings or control is impaired.
Domain #6	176	177	2	alpha	Self-Harm Behavior - Extent to which child/adolescent displays behavior that is harmful to self (e.g. resulting in pain or injury)
Domain #7	178	179	2	alpha	Substance Use - Impairment due to the use of alcohol/drugs.
Domain #8	180	181	2	alpha	Thinking - Impairment in thought process.
Domain #9	182	183	2	alpha	Care-Giver Resources: Material Needs - Extent to which care-giver provides for child/adolescent basic needs (e.g. housing, food, etc)
Domain #10	184	185	2	alpha	Family/Social Support - Extent to which adequate resources exist to care for child/adolescent.
DLA/TLA Meeting Information at Discharge	186	187	2	alpha	If not used, this field must be blank (value spaces). Optional- The location of the first face to face meeting with the client or the reason a meeting did not take place upon discharge/triage from the State Operated Facility. Meeting Locations 01 - At Client's Home/Residence 02 - At Agency 03 - At State Hospital 04 - At Other Location, Reasons for No Meeting 10 - Client Not Located 11 - Client Refused Contact with Agency 12 - Client Moved Out of Service Area 13 - Client in Jail/DOC 14 - Client Readmitted to SOF 15 - Access to Client Denied by Residential Facility 19 - Other Reason for No Meeting 99 - Unknown Reason for No Meeting
DLA/TLA Agency Involvement in Discharge	188	189	2	alpha	If not used, this field must be blank (value spaces). Optional - The agency's type of involvement in the client's discharge/triage from the State Operated Facility or the reason the agency was not involved in the discharge process. Agency Involved 01 - Participation in Person 02 - Participation by Phone, Agency Not Involved 10 - Agency Not Notified by State Operated Facility 11 - Agency Not Available 12 - Agency Involvement Refused by Client 99 - Agency Involvement Unknown
Discharge/Triage Date	190	197	8	alpha	If not used, this field must be blank (value spaces). Optional - The date on which the client was discharged from the State Operated Facility or the date of triage. Format: YYYYMMDD YYYY - Century and year MM - Month DD - Day Example: 20050801
Filler	198	199	2	alpha	Leave this field blank. Value: spaces
MH Cross Disabilities Database Information					If not used, these fields must be blank (value spaces). Mandatory - when reporting MH Cross Disabilities Database Information
Form Completion Date	200	207	8	alpha	The date on which the MH cross disabilities database form was completed. Format: YYYYMMDD
Primary Care Giver Age	208	209	2	alpha	The age of the primary care giver. Range: 18-98 00 - Not Applicable 99 - Unknown
Type of Services Needed	210	211	2	Alpha	Describes the type of services needed by the client as determined by the assessment staff. 01 - Residential/Living Arrangements 02 - Vocational Rehabilitation 03 - Transportation 04 - Medical 05 - Substance Abuse Treatment 06 - MH Case Management 07 - Hospitalization 90 - Other 99 - Unknown
Type of Services Sought	212	213	2	alpha	Describes the type of services sought by the client as determined by the consumer. 00 - Not Applicable 01 - Residential/Living Arrangements 02 - Vocational Rehabilitation 03 - Transportation 04 - Medical 05 - Substance Abuse Treatment 06 - MH Case Management 07 - Hospitalization 90 - Other 99 - Unknown
Types of Services Needed - Other Description	214	243	30	alpha	Specifies the type of services needed when Other (90) is selected
Type of Services Sought - Other Description	244	273	30	alpha	Specifies the type of services sought when Other (90) is selected
MH Diagnosis Codes and Types					Mandatory Describes the major mental illnesses or developmental disabilities for which the client is seeking or receiving services. Report any valid diagnosis code and the appropriate diagnosis code type for the following fields. Diagnosis Code Type for ICD-9 codes is 9. Diagnosis Code Type for ICD-10 codes is A. NOTE: Do not include the period imbedded in the diagnosis code. Example, for diagnosis code 295.10, report 29510 in the field.
Diagnosis Code Type 1	274	274	1	alpha
Diagnosis Code 1	275	282	8	alpha
Diagnosis Code Type 2	283	283	1	alpha
Diagnosis Code 2	284	291	8	alpha
Diagnosis Code Type 3	292	292	1	alpha
Diagnosis Code 3	293	300	8	alpha
Diagnosis Code Type 4	301	301	1	alpha
Diagnosis Code 4	302	309	8	alpha
Diagnosis Code Type 5	310	310	1	alpha
Diagnosis Code 5	311	318	8	alpha
Diagnosis Code Type 6	319	319	1	alpha
Diagnosis Code 6	320	327	8	alpha
Diagnosis Code Type 7	328	328	1	alpha
Diagnosis Code 7	329	336	8	alpha
Diagnosis Code Type 8	337	337	1	alpha
Diagnosis Code 8	338	345	8	alpha
Diagnosis Code Type 9	346	346	1	alpha
Diagnosis Code 9	347	354	8	alpha
Filler	355	389	35	alpha
MH Closing Information					Leave blank if the client is active. Mandatory - when closing the Client MH Information.
Closing Disposition	390	391	2	numeric	Describes the disposition of the client at the point he/she stops receiving services. 01 - Deceased 02 - Completed treatment: client no longer needs services from this provider 03 - Refused treatment: client refuses further treatment from this provider 04 - Transfer: client has been transferred to another community provider, including providers of mental health or developmental disability services, substance abuse treatment, general social services, hospital outpatient services, or other medical care 05 - Moved: client/guardian from service area/out of state, with no transfer to another provider 06 - Transfer to Long Term Care provider setting (ICFDD, IMD, VA inpatient hospital) 07 - Transfer to State-Operated facility 08 - Incarcerated 90 - Other: Includes discharge of long-term inactive clients and of persons who have been lost to contact 99 - Unknown
GAF/CGAS Score at Closing	392	393	2	numeric	Current functioning scale score as assessed at the time of the case closing process. GAF scores are to be obtained by rating the adult's current level of functioning (i.e., within the past week at last contact), while CGAS scores are to be obtained by rating the child's or adolescent's most impaired level of general functioning over the previous month of the last contact. Valid Values: 00 - 99
Scale Used for Closing	394	394	1	alpha	The functional scale used. C - Children's Global Assessment Scale (CGAS) G - Global Assessment of Functioning (GAF)
Submit Date	395	402	8	numeric	Mandatory - The date on which the record is being submitted to DHS. Format: YYYYMMDD YYYY - century and year MM - month DD - day Example: 19990801
Process Date	403	410	8	alpha	Leave this field blank. Value: spaces. This field will be returned with the date the data was processed by DHS. Format: YYYYMMDD YYYY - century and year MM - month DD - day Example: 19990801
Reject Codes					Leave these fields blank. Value: spaces
Code 1	411	413	3	alpha	These fields will be returned after DHS has processed the record. If the record is rejected during processing by DHS, up to three error codes will be noted, indicating the reason the record was rejected by DHS.
Code 2	414	416	3	alpha	These fields will be returned after DHS has processed the record. If the record is rejected during processing by DHS, up to three error codes will be noted, indicating the reason the record was rejected by DHS.
Code 3	417	419	3	alpha	These fields will be returned after DHS has processed the record. If the record is rejected during processing by DHS, up to three error codes will be noted, indicating the reason the record was rejected by DHS.
Warning Codes					Leave these fields blank. Value: spaces
Code 1	420	422	3	alpha	These fields will be returned after DHS has processed the record. Up to two warning codes will be noted, indicating the reason the data was changed by DHS or needs agency update.
Code 2	423	425	3	alpha	These fields will be returned after DHS has processed the record. Up to two warning codes will be noted, indicating the reason the data was changed by DHS or needs agency update.
Filler	426	439	14	alpha	Leave this field blank. Value: spaces
Software Indicator	440	440	1	alpha	Mandatory - Report the value: Z. Z - indicates agency's own software created the file.
Filler	441	450	10	alpha	Leave this field blank. Value: spaces

1.4 Client DD Information Record Format

Field Name	From	Thru	Length	Format	Description
Agency FEIN	1	9	9	numeric	Mandatory - The agency's nine digit Federal Employer Identification Number (FEIN).
Filler	10	11	2	alpha	Leave this field blank Value: spaces
Agency Satellite Code	12	13	2	numeric	Mandatory - An organizational subpart within an agency that has a unique physical location, but does not have a different FEIN assigned to it. This code is assigned by DHS. If no satellite code is assigned, report zeros in this field.
Client ID	14	22	9	numeric	Mandatory - For all DD clients, and all MH clients who will be billed for fee for service programs or the Individual Care Grant (ICG) program, the individual's SSN must be used. For other MH clients, an unique ID number may be assigned by the agency. If SSN is not used for MH clients, any unique number up to 9 digits is allowed (all zeros is not valid).
Record Type	23	23	1	alpha	Mandatory - Report the value: D D - indicates CLIENT DD INFORMATION record
Closing Date	24	31	8	numeric	Leave blank if the client is active Mandatory - when closing the Client DD Information The date that the agency terminated its commitment to provide services to the individual. Format: YYYYMMDD YYYY - century and year MM - month DD - day Example: 19990801
Registration Date	32	39	8	numeric	Mandatory - Date on which the client was registered with the agency. This is the date of the first billable or reportable service event or intake interview with the client, parent, or guardian Format: YYYYMMDD YYYY - century and year MM - month DD - day Example: 19990801
Record Status	40	40	1	alpha	Leave this field blank Value: spaces This field will be returned with a value indicating whether the record was ACCEPTED or REJECTED during processing at DHS. A - Accepted by DHS R - Rejected by DHS
Filler	41	41	1	alpha	Leave this field blank Value: spaces
Residential Arrangement	42	43	2	numeric	Mandatory - Describes the client's primary residential situation at the present time while services are being initiated or provided 10 - Homeless (e.g.,living on the street, in an emergency shelter, or transient) 20 - Family home or own home, may include foster homes that are not DHS funded 40 - State-Operated Facility (Mental Health Center or Developmental Center) 50 - Jail or correctional facility/institution (e.g., detention centers, institutions/training schools) 61 - IMD-Private Institution for persons with Mental Diseases 62 - Private ICF/MI that serves 17 or more clients 63 - Private ICF/MI for 16 or fewer persons 64 - MH-funded community setting 65 - Private ICF/DD for 17 or more clients 66 - Private ICF/DD for 16 or fewer persons 67 - Private Skilled Nursing Facilities for Pediatrics (SNF/Peds) 68 - DD-funded community setting where individuals with disabilities reside 69 - DD-funded Foster Care setting where individuals with disabilities reside 70 - Nursing Facility, including licensed private Intermediate Care facilities (ICF) and Skilled Nursing Facilities (SNF) 71 - Licensed Shelter Care Facility DD 72 - Community Residential Alcoholism home 73 - Alcohol inpatient residential setting 74 - Substance abuse inpatient residential setting 80 - Boarding school 81 - Crisis care 90 - Other 99 - Unknown
Individuals in Setting	44	45	2	alpha	Mandatory - when RESIDENTIAL ARRANGEMENT is 68 or 69 Report the number of individuals residing in the DD-funded community or Foster Care setting This field must be blank when RESIDENTIAL ARRANGEMENT is NOT 68 or 69.
Area of Origin					Mandatory - The geographic location where the client has family or community ties. Refer to the current Directory of Geographic Information.
County	46	48	3	numeric	Report the code of the county, out-of-state, or unknown.
Township/Community Area	49	50	2	numeric	Report Community Area - if the family/community ties are in Chicago Report Township - if the family/community ties are outside the Chicago city limits, but within a county that requires this further information.
Zip Code	51	55	5	numeric	The postal zip code.
Zip Code Suffix	56	59	4	alpha	The last four positions of the postal zip code, if known. (Optional)
Age at Onset	60	61	2	numeric	Mandatory - The age (or approximate age) that the client first experienced the developmental disabilities identified Valid Ages: 00-21
ICAP/SIB Score Information
Service Score	62	63	2	numeric	Mandatory - Required only for clients with developmental disabilities who are receiving waiver-funded or other services which require administration of the Inventory for Client and Agency Planning (ICAP) or Scales of Independent Behavior (SIB). The ICAP is currently required for all clients receiving Community-Integrated Living Arrangement (CILA) services or Developmental Training (DT) services, and for all Medicaid waiver clients receiving other waiver-funded services, including adult residential services, (HIP, SHP, CLF) and supported employment., Report the ICAP or SIB service score that the client received on the most recent ICAP/SIB administered Range: 01 to 99 00 - Not Applicable NOTE: If the Service Score is not available, but the ICAP Service Level is known, enter the ICAP Service Level as the first digit and enter 5 as the second digit; this is the mid-point of the range.
Behavioral Score Indicator	64	64	1	alpha	Use this field to indicate whether the Behavioral Score is a negative or positive number N - negative value P - positive value
Behavioral Score	65	66	2	numeric	The General Maladaptive Index (GMI) score that the client received on the most recent ICAP/SIB administered Range: -70 to +10 +99 - Not Applicable
Score Type	67	67	1	alpha	SCORE TYPE: Indicates whether the ICAP or SIB was administered I - Inventory for Client and Agency Planning (ICAP) S - Scales of Independent Behavior (SIB) N - Not Applicable
Filler	68	68	1	alpha	Value: spaces (Previously Diagnosis Code Type)
Filler	69	69	1	alpha	Value: spaces (Previously Principal Diagnosis Indicator)
Filler	70	114	45	alpha	Value: spaces (Previously Diagnosis Information AXIS I Diagnosis 1 Diagnosis 2 Diagnosis 3 AXIS II Diagnosis 1 Diagnosis 2 Diagnosis 3 AXIS III Diagnosis 1 Diagnosis 2 Diagnosis 3)
DD Diagnosis Codes and Types					Mandatory Describes the major mental illnesses or developmental disabilities for which the client is seeking or receiving services. Report any valid diagnosis code and the appropriate diagnosis code type for the following fields Diagnosis Code Type for ICD-9 codes is 9 Diagnosis Code Type for ICD-10 codes is A NOTE: Do not include the period imbedded in the diagnosis code. Example, for diagnosis code 295.10, report 29510 in the field.
Diagnosis Code Type 1	115	115	1	alpha
Diagnosis Code 1	116	123	8	alpha
Diagnosis Code Type 2	124	124	1	alpha
Diagnosis Code 2	125	132	8	alpha
Diagnosis Code Type 3	133	133	1	alpha
Diagnosis Code 3	134	141	8	alpha
Diagnosis Code Type 4	142	142	1	alpha
Diagnosis Code 4	143	150	8	alpha
Diagnosis Code Type 5	151	151	1	alpha
Diagnosis Code 5	152	159	8	alpha
Diagnosis Code Type 6	160	160	1	alpha
Diagnosis Code 6	161	168	8	alpha
Diagnosis Code Type 7	169	169	1	alpha
Diagnosis Code 7	170	177	8	alpha
Diagnosis Code Type 8	178	178	1	alpha
Diagnosis Code 8	179	186	8	alpha
Diagnosis Code Type 9	187	187	1	alpha
Diagnosis Code 9	188	195	8	alpha
Filler	196	366	171	alpha	Leave this field blank Value: spaces
Mobility	367	367	1	alpha	Mandatory - From ICAP, Part C, Functional Limitations and Needed Assistance, Question 9 Valid Values : 1 - Walks with or without aids 2 - Usually in a wheelchair or does not walk. 3 - Limited to bed most of the day. 4 - Confined to bed for the entire day.
Filler	368	388	21	alpha	Leave this field blank Value: spaces
DD Closing Information					Leave blank if the client is active Mandatory - when closing the Client DD Information
Closing Disposition	389	390	2	numeric	Describes the disposition of the client at the point he/she stops receiving services 01 - Deceased 02 - Completed treatment: client no longer needs services from this provider 03 - Refused treatment: client refuses further treatment from this provider 04 - Transfer: client has been transferred to another community provider, including providers of mental health or developmental disability services, substance abuse treatment, general social services, hospital outpatient services, or other medical care 05 - Moved: client/guardian from service area/out of state, with no transfer to another provider 06 - Transfer to Long Term Care provider setting (ICFDD, IMD, VA inpatient hospital) 07 - Transfer to State-Operated facility 08 - Incarcerated 90 - Other: Includes discharge of long-term inactive clients and of persons who have been lost to contact 99 - Unknown
DD Closing Information					Leave blank if the client is active Mandatory - when closing the Client DD Information.
Residential Arrangement At Closing	391	392	2	numeric	Describes the client's primary residential situation at the time he/she stops receiving services. 10 - Homeless (e.g.,living on the street, in an emergency shelter, or transient) 20 - Family home or own home, may include foster homes that are not DHS-funded 40 - State-Operated Facility (Mental Health Center or Developmental Center) 50 - Jail or correctional facility/institution (e.g., detention centers, institutions/training schools) 61 - IMD-Private Institution for persons with Mental Diseases 62 - Private ICF/MI that serves 17 or more clients 63 - Private ICF/MI for 16 or fewer persons 64 - MH-funded community setting 65 - Private ICF/DD for 17 or more clients 66 - Private ICF/DD for 16 or fewer persons 67 - Private Skilled Nursing Facilities for Pediatrics (SNF/Peds) 68 - DD-funded community setting where individuals with disabilities reside 69 - DD-funded Foster Care setting where individuals with disabilities reside 70 - Nursing Facility, including licensed private Intermediate Care facilities (ICF) and Skilled Nursing Facilities (SNF) 71 - Licensed Shelter Care Facility 72 - Community Residential Alcoholism home 73 - Alcohol inpatient residential setting 74 - Substance abuse inpatient residential setting 80 - Boarding school 81 - Crisis Care 90 - Other 99 - Unknown Mandatory - for closing when RESIDENTIAL ARRANGEMENT is 68 or 69. Report the number of individuals residing in the DD-funded community or Foster Care setting.
Individuals in Setting at Closing	393	394	2	alpha	This field must be blank when RESIDENTIAL ARRANGEMENT AT CLOSING is NOT 68 or 69.
Submit Date	395	402	8	numeric	Mandatory - The date on which the record is being submitted to DHS Format: YYYYMMDD YYYY - century and year MM - month DD - day Example: 19990801
Process Date	403	410	8	alpha	Leave this field blank Value: spaces This field will be returned with the date the data was processed by DHS. Format: YYYYMMDD YYYY - century and year MM - month DD - day Example: 19990801
Reject Codes					Leave these fields blank Value: spaces
Code 1	411	413	3	alpha	These fields will be returned after DHS has processed the record. If the record is rejected during processing by DHS, up to three error codes will be noted, indicating the reason the record was rejected by DHS.
Code 2	414	416	3	alpha	These fields will be returned after DHS has processed the record. If the record is rejected during processing by DHS, up to three error codes will be noted, indicating the reason the record was rejected by DHS.
Code 3	417	419	3	alpha	These fields will be returned after DHS has processed the record. If the record is rejected during processing by DHS, up to three error codes will be noted, indicating the reason the record was rejected by DHS.
Warning Codes					Leave these fields blank Value: spaces
Code 1	420	422	3	alpha	These fields will be returned after DHS has processed the record. Up to two warning codes will be noted, indicating the reason the data was changed by DHS or needs agency update.
Code 2	423	425	3	alpha	These fields will be returned after DHS has processed the record. Up to two warning codes will be noted, indicating the reason the data was changed by DHS or needs agency update.
Filler	426	439	14	alpha	Leave this field blank Value: spaces
Software Indicator	440	440	1	alpha	Mandatory - Report the value: Z Z - indicates agency's own software created the file.
Filler	441	450	10	alpha	Leave this field blank Value: spaces

1.5 Client Case Information Trailer Record Format

Field Name	From	Thru	Length	Format	Description
Agency FEIN	1	9	9	numeric	Mandatory - The agency's nine digit Federal Employer Identification Number (FEIN).
Filler	10	11	2	alpha	Leave this field blank. Value: spaces
Agency Satellite Code	12	13	2	numeric	Mandatory - An organizational subpart within an agency that has a unique physical location, but does not have a different FEIN assigned to it. This code is assigned by DHS. If no satellite code is assigned, report zeros in this field.
Trailer Nines	14	22	9	numeric	Mandatory - Report the value: 999999999 in this field.
Record Type	23	23	1	alpha	Mandatory - Value: T T - indicates the CLIENT TRAILER record
Record Count	24	31	8	numeric	Mandatory - Report the number of records in the file, including the trailer record.
Agency Name	32	61	30	alpha	Mandatory - Report the Agency Name.
Filler	62	439	378	alpha	Leave this field blank. Value: spaces
Software Indicator	440	440	1	alpha	Mandatory - Report the value: Z Z - indicates agency's own software created the file.
Filler	441	450	10	alpha	Leave this field blank. Value: spaces