CLIENT:

		SOURCE:
				Memo: 
				Timestamp: 
				Detail:
				Pro?
				Client?
				Organization: {FACILITY}
				Source data: .....

		Is duplicate? FALSE
		
		INTAKE:
			Text: 
			Detail:

		DEMOGRAPHICS:
		
			Name:
				Prefix: 
				First: 
				Middle: 
				Last: 
				Suffix: 
				Nickname: 
				Maiden: 
				Previous: 
			
			DOB: 		SYTEM: Age in Years:
			Sex: 
			Gender identity: 
			Sexual orientation: 
			Sexually active: 
			Marital status: 
			Spouse: {RELATIONSHIP}
			
			Responsible party:
				Is someone else the responsible party? 
				if(isResponsiblePartySomeoneElse){
					{RELATIONSHIP}
				}
				
			Emergency contact: {RELATIONSHIP}
			
			PHONE:
			
				Home: 
				Mobile: 
				Work: 
				Memo: 
				
			EMAIL:
			
				Personal:
					1.  
					2. 
				
				Work:
					1. 
					2. 
					
			REMINDERS VIA:
				Email:
				Text:
				Phone:
				
			ADDRESS:
				
				Is home same as mailing address?
				
				Home:
					...
				
				Mailing:
					...
					
				Has secondary address?
					
					Is home same as mailing address?
				
					Home:
						...
					
					Mailing:
						...

			Family:
			
				Mother: {RELATIONSHIP}
				Father: {RELATIONSHIP}
				# siblings:
				Birth order:
				Multiple birth member?
			
			Relationships:
		
				foreach({RELATIONSHIP})	

			Citizenships:
			Education:
			Birth place: 
			Birth state: 
			Birth city: 
			Nationality:
			Religious affiliation:
			
			Religious Organization: {FACILITY}
			
			Special diet?
				Category:
				Memo:
				
			Preferred language:
			Other languages:
			English level:
			
			Driver license: [State] [Number...]
			
			Is hispanic?
			Is black/AA?
			Ethnicities:
			Race:
			Specific races:
			
			Is deceased?
			Date/time of death:
			Cause of death:
			
		PHARMACY: [STRING]
			Facility record: {FACILITY}
			
		SSN: 
			
		MCN:
			MCN: 
			SSN: 
			First name:
			Last name:
			DOB:
			Part B primary?
			Hospice?
			Response data:
			Billing address:
			Reason not Part B:
				Memo:
			Medicare Advantage?
				Plan:
		
		MCP: {PRO}
		Has MCP done onboarding visit?
			if(yes)
			MCP onboarding visit date:
					MCP onboarding visit note:
					Is MCP onboarding visit note outside system?
						Reason:
			
		MCP ONBOARDING PRO:

				// if(!has_mcp_done_onboarding_visit) {
				Is MCP onboarding active? // ONLY MAKES SENSE if !onboardingVisit
					Why is MCP onboarding not active? [category]
						Memo:
				
					Next onboarding attempt date/time: [DATE] [TIME]
			
			MCP Onboarding Pro: {PRO}
				Decision to accept/reject assignment?
				At: 
				
			(SYSTEM)
				# of MCP onboarding phone calls:
				# of MCP onboarding in-person visits:
				
				Attempts: (SEELCT * FROM interaction WEHRE purpsoe = "mcp_onbaoaridng")
					Date | Pro | Outcome | Memo | Geostamp
					
		Dietitian:
		
			RD: {rdPro}
			
			Eligible for MNT?
				Number of MNT hours left this calendar year: {0.5}
			
		CCM:
		
			Care Manager: {PRO}
			
			Eligible?
				if(not) Reason:
			
			Enrolled?
				Consent method:
					Memo:
				if(not)
				Why not enrolled?
					Memo:

			CCM Chronic Diagnoses:
				1. {cmReason1}
				2. {cmReason2}
			
		RM:
		
			RME: {rmePro} // manages equipment
			
			RMM: {rmmPro} // bills time each month
			
			Eligible?
				if(not) Reason:
			
			Enrolled?
				Consent method:
					Memo:
				if(not)
				Why not enrolled?
					Memo:

			Focus areas:
				1. 
				2. 
				
		EQUIPMENT:
		
			Awaiting setup?
				What equipment: 
			
			Setup completed?
				What equipment: 
				
			Service needed?
				What equipment: 

		WEBCAM:
			Has webcam device?
			Device type: 

		Patient portal:
			Username: 
			Password: if(set) *** else <i>Password not set.</i>

		Currently in meeting?
			if(yes)
			Meeting: {MEETING}