Appendix D, Service Record for CRS Data Reporting System

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