Initial
1
Vendor-1-13231-abd-11
Steve
Austin
10-06-11
123456789
Male
5551231234
English
Single
Biological Parent
No
No
None Required
1234 Main St.
Peoria
IL
61615
Peoria
Yes
Black/African American
Non-Hispanic
No
6
41000
Employed part-time
Lives with parent(s), relative(s), or guardian(s)
Grade 1-3
Blanche Austin
555-555-5555
IL
63123
4321 Msple St.
East Moline
Knoxville
217-555-5555
Mother
9812 Madison
IL
61403
12
6
No
Yes
Jill Smith
Jacyln Smith
Sister
Sister
Turner Family Clinic
Abbie Turner
abbie.turner@testemail.com
555-555-5555
Yes
Yes
No
No
No
No
No
No
No
No
No
No
2
3
No
2020-01-01
No
2020-01-01
Test date
Test location
Test person
Test reason
Yes
Yes
Yes
Yes
No
No
No
No
No
No
No
No
No
No
No
No
Yes
No
No
Yes
No
No
No
No
No
No
No
No
No
2
1
0
0
0
0
0
Yes
No
Yes
1
2
0
0
0
0
2
1
Yes
Yes
1
Yes
F02.80
No
F02.80
No
1
Action Items
01
Depression, Overeating
2
Goal
0101
I don’t know how to cope with what I have been through. I need to figure out ways to cope.
3
Objective
010101
See a counselor.
3
Service
01010101
See a counselor.
3
Service
01010102
See a counselor.
Initial
2
Vendor-1-13231-abd-12
Jaime
Sommers
05-21-03
012345678
Female
6185295268
English
Single
Own guardian
Yes
Yes
Yes
No
Yes
Yes
No
No
No
No
No
No
No
No
No
No
2
3
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0
0
0
0
0
0
No
No
Test date
Test location
Test person
Test reason
Lorem ipsum dolor sit amet, consectetur adipiscing elit. Nulla ultricies sem aliquam iaculis porttitor. Nulla gravida lacus mi, eu elementum justo aliquam bibendum. Quisque quis erat et augue molestie congue a non massa. Quisque et risus nulla. Proin posuere arcu turpis, sed efficitur dolor commodo eget. Donec suscipit elementum neque ut ullamcorper. Sed maximus rhoncus dui, vitae lacinia sapien posuere ut. Interdum et malesuada fames ac ante ipsum primis in faucibus. Morbi aliquam consequat justo, non ullamcorper diam iaculis eget. Mauris a est pellentesque, ultrices ipsum vitae, semper neque. Nunc sit amet lacinia libero.
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
F02.80
NDPDWOBD
No
F02.80
NPKDWOBD
No
1
Action Items
01
Depression, Overeating
2
Goal
0101
I don’t know how to cope with what I have been through. I need to figure out ways to cope.
3
Objective
010101
See a counselor.
3
Service
01010101
See a counselor.
2