APPENDIX K: DESK REFERENCES FOR INDEPENDENT LIVING SERVICES

REVISED: 04/01/06

DESK REFERENCES FOR INDEPENDENT LIVING SERVICES

Field - Sex

M = Male
F = Female

Field - Race ("X" all that apply)

White
African American
American Indian
Asian
Pacific Islander

Field - Ethnicity ("X" if applies)

Hispanic

Field - Language Preference (Enter Code)

Field - Area

1 = Counties in Asheville/Charlotte District
2 = Counties in Winston-Salem District
3 = Counties in Fayetteville/Raleigh District
4 = Counties in Greenville/Wilmington District

Field - Marital Status

1 = Married
2 = Widowed
3 = Divorced
4 = Separated
5 = Never Married

Field - Client Status

00= Referral
08 = Rejected
10 = Active
32 = Re-open for short period of time
48 = Closed Unsuccessful
49 = Closed Successful

Field - Eligibility Category

009 = With Regard to Income
019 = Without Regard to Income
099 = Eligibility Not Determined

Field - Deceased (Protected)

Y = Yes
Blank = Not Deceased

Field - Reason

1 = Goal Met by Client
2 = Client Unable to Participate in Ser. Del.
3 = Client Not Willing to Participate in Ser. Del.
4 = Client Not Eligible for ILS Services
5 = Unable to Locate Client
6 = Client Moved to Different Service Area
7 = Death of Client

Field - Vision Status

1 = Legally Blind
2 = Visually Impaired
9 = Unknown Vision Status

Field - Deaf/Blind

0 = No Hearing Loss
1 = Mild Hearing Loss-B/VI due to RP
2 = Moderate to Severe Loss-B/VI due to RP
3 = Profound Hearing Loss-B/VI due to RP
4 = Profound Prelingual Loss (before age 3) - B/VI due to Other Causes
5 = Profound Hearing Loss (between ages 3-21) - B/VI due to Other Causes
6 = Profound Hearing Loss (after age 21) - B/VI due to Other Causes
7 = Moderate to Severe Loss Prior to Age 21 - B/VI due to Other Causes
8 = Moderate to Severe Loss after Age 21 - B/VI due to Other Causes
9 = Mild Hearing Loss-B/VI due to Other

Field - SSBG Goal

1 = Achieving or Maintaining, Self-Sufficiency
2 = Preventing/Reducing, Inappropriate, Institutional Care
3 = Preventing/Remedying, Abuse, Neglect or Exploitation

Field - Reason

1 = Agency Funds Not Available
2 = No Suitable provider Causes
3 = Other

Field - Chore Eligibility

Y = Eligible for In-Home Aide Services (Chore)
Blank = Not Eligible

Field - Services Codes

110 = Health Support Services
330 = Individual & Family Adj. Services
350 = In-Home Aide: Level I Home Management
360 = Adjustment Services for B/VI

Field - Authorization

Chore:

Account: 536101
Center: 14101400Q8
Type of Service: 01
Case Service Code: D06

ILS:

Account: 536102

Center: 14101400Q7
Type of Service: 01
Case Service Codes: C07, C09, C11