| Client ID |
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, a 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). |
| Satellite Code |
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. (Retrieved from the Agency Master record and displayed on the screen.) |
| Status |
Display - Indicates the status of the record.
PENDING: The record has not been submitted to DHS.
SUBMITTED: The record has been submitted to DHS and is awaiting results.
ACCEPTED: The record has been approved by DHS.
REJECTED: The record has been rejected by DHS with an error.
INCOMPLETE: The record has not been updated by the provider to include the new client case information. |
| Submit Date |
Display - The date on which the record was submitted to DHS for processing. |
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: The complete legal first name.
Middle initial (MI): Middle initial should be reported, unless the client does not have one.
Last Name: The complete legal last name.
Name Suffix: the suffix should be reported, if the client has one of the following: Jr., Sr., III, IV, etc |
| Mother's Maiden Last Name |
The complete legal maiden last name of the client's mother. Use UNKNOWN if this information is not available. |
| Social Security Number (SSN) |
Mandatory - The client's social security number (SSN). A valid SSN is mandatory for the following types of clients:
1 - Medicaid eligible clients
2 - DD Clients
3 - MH clients in a fee-for-service program
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). |
| Birth Date |
Mandatory - The date on which the client was born. Format: MMDDYYYY
MM = month
DD = day
YYYY = year (centry and year) |
| Sex |
Mandatory - Sex of the client. MALE or FEMAIL |
| Race |
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.
WHITE: A person having origins in any of the original peoples of Europe, North Africa or the Middle East.
BLACK/AFRICAN AMERICAN: A person having origins in any of the black racial groups of Africa.
ASIAN: A person having origins in any of the original peoples of the Far East, Southeast Asia, the Indian subcontinent. This area includes, for example, China, India, Japan and Korea.
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.
NATIVE HAWAIIAN OR OTHER PACIFIC ISLANDER: A person having origins in any of the original peoples of Hawaii, Guam, Samoa or other Pacific Island.
UNKNOWN |
| RIN - (Recipient ID Number)(Formally referred to as Medicaid ID) |
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 Recipient ID. |
State Operated Facility ID
(Formerly referred to as DMHDD ID) |
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. |
| Language |
Mandatory - Primary language of the client.
ENGLISH, SPANISH, OTHER WESTERN EUROPEAN, EASTERN EUROPEAN, BOSNIAN, POLISH, RUSSIAN, ASIAN, ARABIC, CHINESE, INDIAN, KOREAN, VIETNAMESE, AFRICAN, AMERICAN SIGN LANGUAGE, OTHER, UNKNOWN |
| Hispanic Origin |
Mandatory - Indicates the Hispanic origin of a person of Spanish culture or origin, regardless of race.
NOT OF HISPANIC ORIGIN, MEXICAN/MEXICAN AMERICAN, PUERTO RICAN, CUBAN, CENTRAL/SOUTH AMERICAN, OTHER HISPANIC, UNKNOWN, NOT CLASSIFIED |
| Area of Residence |
Mandatory - The geographic location where the client currently lives. Refer to the current Directory of Geographic Information.
County Code: indicating county, Chicago, out-of-state (10300) or unknown (10400).
Township Code: if the client resides outside the Chicago city limits, but within the county that requires this further information. The two-digit numeric code must include the zero to the left if the code is less than ten. For example: Berwyn Township in Cook County is '02'.
OR
Report Community Area - if the client resides within the Chicago city limits. This two-digit numeric code must include the zero to the left if the code is less than ten. For example: 400-599 W. Addison St. is '06'. |
| Medicaid Site ID |
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). |
| DHS Case ID |
Mandatory - The public aid eligibility Case ID number for the client.
Report all 0's if client has no DHS Case ID. Report all 9's if client's DHS Case ID is not known. DHS Case ID consists of 13 positions. If client's Case ID has 15 positions on the eligibility card, ignore the group code (the two middle numbers). Exp. 04 010 00 A1234567 (ignore the 00) |
| Client Address |
Mandatory - The current address of the client.
Street: street or box number
City: City
State: the 2 digit Post Office abbreviation for the State.
Zip Code & Suffix: Postal zip code (include suffix, if known)
NOTE: If the client is homeless report the address of the agency proving the service. |
| Education Level |
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 |
Mandatory - Describes the current employment status of the client.
10 - Employed, including on vacation or sick leave (report this code if specifics are unknown for 11, 12, 13, 14)
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 |
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 |
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 - Eligible determination pending
4 - Potentially eligible but has not applied or status unknown
5 - Determined to be ineligible
9 - Eligibility status unknown |
| DFI/CFI Enrollment |
Mandatory - Designates whether the client is enrolled in a DFI/CFI program.
N - Not Applicable
Y - DFI/CFI enrolled |
| Citizenship |
Mandatory - Indicates the citizenship status of the client.
Y - U.S. Citizen
N - Non - U.S. Citizen
U - Unknown |
| Military Status |
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 |
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 - Unknown |
Interpreter Services Needed
|
Mandatory - The type of interpreter services required by the client.
SERVICES NOT NEEDED, AMERICAN SIGN LANGUAGE, FOREIGN LANGUAGE UNKNOWN |
| Disaster Guest Information |
Mandatory - When the client is an Illinois guest due to a disaster select the appropriate disaster.
Disaster Guest - Indicates which disaster brought the client to Illinois.
Guest State - The Post Office abbreviation for the client's home state.
Guest/Parrish - The Federal Information Processing Standards (FIPS) county code where the client lived in their state. |
| Optional Data |
Optional - These fields may be used by agencies for collecting data in classifications of their own choice. |
