For more information please refer to the Data Reporting System User Guide.
| Required Information | Description |
|---|---|
|
Facility Name |
Provider name |
|
Facility Number |
ReHabWorks/Contract number |
|
CRS ID Case Number |
CRS assigned id case number |
|
Facility case number |
Facility assigned case or medical record number. If facility does not have such a number, repeat CRS ID case number in this field |
|
Participant First Name |
Participant first name |
|
Participant Last Name |
Participant last name |
|
Service Authorization number (ID purchase order) |
Id purchase order (same as service authorization) number |
|
PABI Setting |
Residential or Non Residential |
|
Service Type |
See Service list |
|
Service Description |
See Service List |
|
Service Location |
See Location list |
|
Service Location Other (Specify) |
If other, specify |
|
Service Start Date |
Service date of therapy |
|
Provided by |
See Provider Type List |
|
Total Number of Therapists |
Number of therapists delivering service |
|
Number of 15 Minute Units Delivered |
Number of 15 minute units delivered |
|
Setting type – “Individual”, “Group”, or Team |
Individual, Group or Team |
|
If Group, Enter # of Participants |
If group, number of participants |