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Outside Provider Cal-OMS Administrative Discharge - Cal-PM

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Enter Cal-OMS data for an outside provider when an administrative discharge is performed for a client enrolled in a California Outcomes Measurement System (Cal-OMS) treatment program.

  1. Go to: Avatar PM > Client Management > Client Information > Outside Provider Cal-OMS Administrative Discharge
  2. In the Provider field, select the Cal-OMS outside provider.
  3. In the Program field, select the Cal-OMS program. Programs must be associated with the same Cal-OMS Type of Service as the provider (Program Maintenance form, Cal-OMS Type of Service field).
  4. In the Cal-OMS Type of Service field, select the Cal-OMS type of service associated with the program.
  5. In the Provider's Participant ID field, enter the provider’s participant ID.
  6. This number is used to identify the client. This number must be entered exactly.
  7. In the Submission Type field:
    • Select Deletion if the Cal-OMS is to be deleted.
    • Select New if this is a new submission.
    • Select Resubmission if editing a previous admission.
  8. In the Select Serial Number field, select the serial number.
    • When Deletion or Resubmission is previously selected in the Submission Type field, the Select Serial Number field displays serials numbers and the client admission data entered in a previous Cal-OMS outside provider admission.
    • To enter a new serial number for a resubmission, select (none of these) and enter the new serial number in the Form Serial Number field.
  9. In the Form Serial Number field, enter the form serial number. Form serial number format:
    • Use a total of eight characters, starting with a capital letter. Spaces are not allowed. For example, A0001034.
    • For resubmissions, the serial number selected in the Select Serial Number field is display-only in this field.
    • The form serial number for a Cal-OMS admission record, and the Cal-OMS discharge record must match.
  10. In the Current First Name field, enter the client’s first name if different from the birth name. Enter "99904" if the client is unable to provide an answer.
  11. In the Current Last Name field, enter the client’s last name if different from the birth name. Enter "99904" if the client is unable to provide an answer.
  12. In the Sex field, select the client's sex.
  13. In the SSN field, enter the client’s social security number.
    • Enter "99900" to indicate that the client declines to state their social security number.
    • Enter "99904" to indicate that the client is unable to answer.
    • Note: Access to the Social Security Number field is defined in the User Definition and User Role Definition forms (Social Security Number Access field). This is defined by a system administrator. The user may be able to:
      • Enter new data for a client, edit and view data.
      • Enter new data for a client, and view data.
      • Enter new data for a client.
  14. In the Date Of Birth field, enter the client’s date of birth.
  15. In the Admission Date field, enter date of admission.
  16. In the Date Of Discharge field, enter the discharge date.
  17. In the Discharge Status field, select the client's discharge status.
  18. In the Birth First Name field, enter the client's first name at birth.
    • Enter "99902" if the client does not have a birth first name.
    • Enter "99904" if the client is unable to provide an answer.
  19. In the Birth Last Name field, enter the client's last name at birth.
    • Enter "99904" if the client is unable to provide an answer.
  20. In the ZIP Code At Current Residence field, enter the client's ZIP code.
    • Enter "00000" to indicate that the client is homeless.
    • Enter "XXXXX" to indicate that the client declines to state their ZIP code.
    • Enter "ZZZZZ" to indicate that the client is unable to answer.
  21. In the Place of Birth - County field, select the county from the list. Choose Other if the client was born outside California.
  22. In the Place of Birth - State field, select the client's place of birth.
  23. In the Driver's License Number field, enter the client’s driver’s license.
    • Enter "99900" to indicate that the client declines to state their driver’s license number.
    • Enter "99902" to indicate that the client has no or no applicable driver’s license number.
    • Enter "99904" to indicate that the client is unable to answer.
  24. In the Driver's License State field, select client's state.
  25. In the Mother's First Name field, enter the first name of the client's mother.
  26. In the Disability field, select the client disability.
  27. In the Consent field, select Yes if the client has given consent to be contacted in the future.
  28. In the Primary Drug (Code) field, select the client’s primary drug of use. If Other (Specify) is selected, in the Primary Drug Name field, enter the client’s primary drug name.
  29. In the Primary Drug Frequency field, enter the drug use frequency.
  30. In the Primary Drug Route of Administration field, select the client’s primary drug route.
  31. In the Pregnant At Any Time During Treatment field, select Yes if the client was pregnant at any time while being treated.
  32. Click Submit.
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