SWITS User Manual - County of Sonoma
Contents
1. 4 Th paler Gee i Tg Du GA Tha dictus tria erac Sp dt CO rs DE 3 Tha dictus ib risa io cia del in dar cnc acy ie Eod eed eed or init atii a er wien pU Tra palet Gorin cor Moi cur in A Ae Pre inco er oe en a eS ed Ier Mar eT binin or Doa Pachca Nee ird igh Py peoqna a d crite fasse kolakoeor qa Gab naso Ko Tir Lise Sabi AN ii Ce ince utn Dor euren cui Pacha ln acd nepatwienda dag nci prese arce SP abcr daacvel eril abusi Pea cr batp negar avc dial uae in appo labe ar sal avid fan AZ LL C Eee 2 or Fiche law acl A Pad 2 fir Pacha el Langan eked reni fF Ovi Agna cohol rye dicbus eed Bri Paid e P4 Job Pao Aue roit AL tree COHSEANT FOR RELEASE OF COMFIDEHTIAL IKFGRMATION dara d Jaison duiheri e Wesrtrl Taming Agancy 53 drsdosa ks Tam Agency Pra ol wisg orribla Adina Urbi Ducharga F5O deya Baheatcon Health asaarari Pirihi Geechee HO ceu AH mum Peeters U nisl Dischurrg HEE cien Chai Scng Lirdd Discharge 20 cory Cher Diria Tha puizcum of tha deciau method haram m n Tasting j Aasi La evt Uni ers saris ani nce refer fend ghee paramiag Conti ily of Ashes and Fue Albee Parii Pinca 42 CER Mad 2 asd Fre Had Didi Oa did Ascona le Aor PRP FUA 457 E UT PES TAL T S al Sacr Du screened pas ed nov ridus Gee sriaas oiii ive Een Le ar regale ades Lr bred Delf iy caesi Visi cineieni at ap Deo ecg Ks Doo den red Ima dcien h s base lakee i uico on E ans Iain ap iro Dog cciam aa pear acay di ordicald2. Disclosed To TIT X Non System Agency L Agency Purpose For Discosuro IBBERRRNRSRSRRRRR E G Consent Date 5 4 2005 Screening Assessments Rer Has the client signed the Ng paper agreement form E Notes Client Information Options Consent Expires Upon Disclosure Selection Treatment pischargetuD Days 90 Admission UD 90 Outcomes P AK Status Review UD 90 C Date Signed DS Days ATR Interviews UD 90 DLL e Behavioral Health Assessment UD 90 Other Event OE e sumo 4 CASI Scores UD 90 Referrals C Crim Just Cond Client Information Profile UD 90 Episode List CJC Expl Client Screening UD 90 ME i DENS ASI Assessment UD 90 System Administration Description DENS ASI Lite UD 90 My Settings Client s 18th Birthday Discharge Client s 18th Bithi 5 4 2006 Reports GPRA Assessment UD 90 Mi la Other RA Cancel SaD Fi Client Disclosure Agreement Microsoft Internet Explorer Gal Wiles Westa g Agency Westat Outpatient Facility k g x Case 1 Print Report Printdew Help Logout Home Page Client Disclosure Agreement Create Referral Using this Disclosure Agreement Agency gt Client List Client Profile Hote Consented information may not be redisclosed Client Name Jetson Jane Client ID F1190530J467100 Disclosed From Agency vvestat Testing Age
3. This document focuses on the elements required to record client consent referral and walt list Tale desrzii 0 0 P Total Pages 14 California December 2005 SWITS User Manual Consent Referral and Wait List Consent Creating a Referral Accepting a Referral Waitlist Consent Referral and Wait List Consent 1 Entry Steps Client Profile Intake F Client Consent List Microsoft Internet Explorer Eek eM bes Loc Westat Testing Agency HERI 2 Consents are required before sharing any hi Mili 0 0 information about a client with anyone outside the MEE agency In this system you need to setup an Client List FEI Development Agency Revoked independent consent with each agency with whom eee Ere you are going to share information pa menee res acie Wait List Reports_Triggerpoint Active 3 Goto Client List and select the Activity List for ORE one Saree the desired client Select Consent from the row menu Notes Treatment 4 Review Existing Consents There may be coat several consents already on record Review any existing consents to see if they will suffice Ensure Episode List they have not been revoked If it has been cea aie revoked it will be noted in Status Reports oi Once you have determined that you need to create a new consent use the Add New Client Consent Record hyperlink Consent Referral and Wait List Consent ey Pg Bes Entities with Disclosure Agreements Thisisa drop dow
4. Consent to Referral 20 Zl fields See Next Page For Creating A Referral S s r a Client Referral Microsoft Internet Explorer ICAI WI Tes Kelly2 Maureen User E Westat Testing Agency Westat Outpatient Facil Loc Client Home Page Client Referral for Jetson Jane Agency Client List Client Profile Non Episode Contact Activity List Intake Wait List Tx Team Agency Westat Testing Agency Facility Westat Outpatient Facility Staff Member Kelly2 Maureen Program State Reporting Category Reason 00000 y If Other E i Admission E Screening gt Assessments gt hoi Is Consent Verification Required i i es gt ls Consent Verified M Continue This Episode of Care e v Treatment Outcomes Discharge Comments Consent Referrals Episode List System Administration My Settings gt Reports Referral Status Referral Created Pending Created Date 5 4 2005 3 25 PM Once you have created a signed consent you may associate the consent with a referral Use the review button to select the consent agreement The Client Disclosure Agreement screen allows you to create a referral for the client using the Create Referral Using the Disclosure Agreement hyperlink It will take you to the Client Referral screen pre populating many of the Home Page Agency Client List Client Profile Non Episode Contact Activity List Intak
5. Signed Consents v Agency VWestat Testing Agency v Fadiy 7 v Staff Member Kelly2 Maureen referring the client It asks if your agreement requires a paper consent verification Consent Verified This states whether consent was verified or not if necessary due to your agency agreement Continue this Episode of Care Select yes no as appropriate Please note an episode of care can only be continued if a referral is to another program within the facility Intake Wait List Tx Team Screening Assessments gt Admission gt Notes Treatment Outcomes Discharge Consent Episode List System Administration My Settings gt Reports Program State Reporting Category Reason CY If Other ls Consent Verification Required E b Is Consent Verified ELT b Continue This Episode of Care E i Referral Status Referral Created Pending Created Date 5 4 2005 3 27 PM Staff Member v Program v State Reporting Category Mon System Agency Non System Modality Non System Specifier Appt Date Undetermined Consents Granted Finish Consent Referral and Wait List Referred To Select the Signed Consents Agency and Facility from the drop down box If you are referring to a specific staff at that Agency select the name of the Staff Member from the drop down box When selecting an agency from the Signed Consents drop down it will populate the Consents Granted box
6. A Tx Team Non System Agency 5 Has the Client Signed the Paper Agreement RAT Purpose For Disclosure Form The client may have given verbal emet nete cert crei ne RR paper agreement form pe rm iSS O n 5 b ut h as n ot yet S Ig n ed th e fo rm E Notes Client Information Options Consent Expires Upon Disclpsure Selection i Treatment erview Hym hission E Indicate whether or not a signed paper record of Raut CASI Scores Doo sep Maeion n P i ient Information Profile C Date Signed DS 4pays dhavioral Heal ssessme QU the consent is on file You may not transfer any pereeo pewsasrAsesmet Soe enon C A scenes Md onse i Exp data until the paper form has been signed and Referrals C crim sust Cond Episode List GPRA Assessment CJC Exp reco rd ed System Administration siis eR J Description Generate Consent Form To obtain a signature para P al you may use the Print Report icon in the icon bar cuu dm It will generate a PDF form which may be printed for signature After obtaining the signature you TOUT may select Yes for Signed e Consent Pired OSDAIOOS COHFISGENHTLIALITY GF ALCOHOL ANT ORUG ABUSE PATENT RECORDS Tii cas Uca Bay o8 A ais clue ae Di uri ecce dina Dv Nis pcenam dr Seed Sp iier e ad Aezuva or Garay Di icai riy co ad pei dr rii bole Mr picem Fiil dr patai uer Uv ae oF edie aty crn da tkfyors dr Sub ad dc alo or cp ebaoser oe
7. Active Reporte _ Triggerpoint Revoked test Active starbucks Revoked Test Agency Active User Kelly2 Maureen Loc Westat Testing Agency Westat Outpatient Facility f Client i a 1 Client Disclosure Agreement Entities with Disclosure Agreements Disclosed To Agency Reports Triggerpoint Disclosed To Entity Non System Agency Purpose For Disclosure XX Consent Date 2 3 2005 Has the client signed the Yes paper agreement form Client Information Options Consent Expires Upon C Discharge UD CASI Scores Days E o8 Revoked Yes Active Yes Active No Active Yes Active Yes Active Yes Active No Revoked Yes Active No Disclosure Selection Admission UD 0 AK Status Review UD 0 Mental Status Report TCU Drug Screen C Date Signed DS Days ATR Interview UD 0 TCU Intake Interview e e M Behavioral Health Assessment UD 0 Treatment review _ OES EYent OEJ eee Client Information Profile UD 0 c Crim Just Cond Client Screening UD 0 CIC Exp DENS ASI Assessment UD 0 29 DENS ASI Lite UD 0 Description Discharge UD 0 GPRA Assessment UD 0 Intake Transaction UD 0 M Comments Other Disclosures Yes Mo Yes Yes Yes Mo Yes or Mo Review Consent Referral Client Consent List Microsoft Internet Explorer User fe A TAJ ex y VM E S rig k ient Kelly2 Maureen Westat Testing Agency Westat Outpatient and Wait List
8. Outside Agencies Agency Client Id Client Name DOB SSN Gender Actions Sonoma Training Agency South CR1070770 Conrad Rodneys 7 7 1970 212 55 1234 Male Activity List a http test ssawebtech org CalWITS Microsoft Internet Explorer ex y M tes Home Page Agency b Client List Y Client Profile gt Non Episode Contact Prstivity List Y Intake Wait List Tx Team Screening gt Assessments M Admission gt Notes gt Treatment gt Annual Update gt Discharge gt Consent Referrals Episode List System Administration gt My Settings gt Reports cy Done User Conrad Rodney Loc Administrative Agency Administrative Unit Client Conrad Rodneys CR1070770 Case 1 Print dew Consented Case Activity List from Sonoma Training Agency South for Conrad PROHIBITION ON REDISCLOSURE OF INFORMATION CONCERNING CLIENT IN ALCOHOL OR DRUG ABUSE TREATMENT This notice accompanies a disclosure of information concerning a client in alcohol drug abuse treatment made to you with consent of such client This information has been disclosed to you from records protected by Federal confidentiality rules 42 C Part 2 The Federal rules prohibit you from making any further disclosure of this information unless further disclosure is expres permitted by the written consent of the person to whom it pertains or as otherwise permitted by 42 CFR Part 2 A gene authorization for the release of medical or other information is NOT sufficient for t
9. Yes Is Consent Verified Yes Y Continue This Episode of Care No 0 v Referral Status Referral Created Pending Created Date 5 4 2005 3 27 PM Program Screening Assessments gt Non System Agency Test Agency Non System Modality DUI Education v Non System Specifier MEM E Appt Date Undetermined Consents Granted Consent Date 5 4 2005 Disclosure Domains Admission UD 90 DENS ASI Assessment UD 90 ATR Interview UD 90 Behavioral Health Assessment UD 90 CASI Scores UD 90 Client Information Profile UD 90 Admission Notes Treatment Outcomes Discharge Consent Episode List System Administration gt My Settings gt Reports E Referrals Microsoft Internet Explorer User Kelly2 Maureen Gal Wii S Loc Westat Testing Agency Westat Outpatient Facility Client tase 1 Br Home Page i Referrals for Westat Outpatient Facility Referral CreatediPending Y ae lame Referred From Agency Referred From Facility Referred To Modality Referral Status Referral Created Date Agency List gency Conrad Chinese Testing FEHWs Substance Abuse Referral AM5 2004 Agency Profile Rodney Agency lt img Outpatient Created Pending Aliases Barr Referral Marshall Reports_Triggerpoint Healthsouth Intensive Outpatient CreatediPending 1 20 2005 Contacts Cohen Referral Governance gt Seth Reports Trigagerpoint Healthsouth Intensive Outpa
10. ei aab curiosas Hor abc it ee mal guiendy Vila Taaki Aguicy nsus dot cosdias my Vadit i iibri Her iga ar civis Forme bal Und Lr cacdaer ed ec ty Dir Ost Decree A Tuin od mgr d onn Evi ig1aiu rm of pasci pant mim Sars egrets ci wi rmm Guin Segratuce ci panmi GUREN or Sores Pa eee ee ECQUE cl PRCHIEITON OM MES SCLOSUWEE OF IMPORRATIORN COMCERNIAG CLIENT IM ALCOHOL OF DRUG ABUSE TREATMENT Ate coder prot vn Ann ung a Fae Stee of ie Sore unseunge Sore eo Un ee eee ny Ue Ben Core oF dhe eer do eon E pai or ote paire Eus da CPT ad 2 4 pay cii vrrbren cv for iar ree cx mici of otter riceeur pn oi PAT avec for ia poe 7 Peter cider sich eee vu cf os Soret fp cenas Chel oF ote amm aco cr aay ee paba Fauarimd Gy Relivo herem aie Oued 1 pl 1 Conldantal ad Frapriai ay Facit Ciiis Ciri Hema Jara Juco Agac Here Wi Taire Agency A niska Pacii m Wastzi Dapalent Pacii Cams Pimia i Consent Referral and Wait List Consent Regulations The client must have the option to consent to various bodies of data without disclosing ALL data Consent Options An expiration date must be associated with EACH body of data selected for consent Select the Option in the left hand box click on the appropriate Expiry Option and then click on the right pointing arrow to move the selections to the right hand box See Basic Elements Training module for more information on how to use this control to make selections a Discharge The
11. for a specific staff member select that person from the drop down list Date The date will default to the current date this can be changed as needed Added to Wait List By This will default to the user logged into the system It may be changed as needed Dually diagnosed MICA Injecting Pregnant HIV Special conditions may affect the facility program staff selection and criticality of treatment Many of these values pre populate from the Intake screen Referred to Interim Services This will indicate whether interim assistance such as counseling will be provided until the program has an opening Assistance Needed to Place this Client This will indicate if assistance is needed to place this client in another program If the client gets enrolled in the same program as he she was waiting for the system will take them off the wait list If the client needs to be removed from the wait list for any other reason go to the Wait List screen and complete the Wait End Date Removed from Wait List by and Reason fields and provide any additional details in the comments box Client Wait List Microsoft Internet Explorer Tex yp VM ES Home Page Agency Client List Client Profile Non Episode Contact Activity List Intake Tx Team Screening Assessments gt Admission Notes Treatment Outcomes Discharge Consent Referrals Episode List System Administration My Settings Report
12. Date Undetermined v Non Staff Physicians gt Comments is RSS Referral y e ia you accept a client the following things Staff Usage Me ee n um Consent Date 12 9 2005 appe System Administraties Disclosure Domains 1 The client will be taken off of the referrals My Settings gt 2 T Admission UD 5 o cie us Pacewccented er rome UD 5 In list inum EA v Intake Transaction UD 5 Created Date 12 9 2005 7 35 PM 2 If the client does not already exist in your agency the complete client profile will be copied into your agency from the sending agency d You will be automatically taken to the intake screen to start an Episode of Care for the client you are accepting ero eer User Conrad Rodney capu Lac Administrative Agancy Admini Home Page Agency ient List F Dient Profile P Non Epaode Contact Activity List F Vias List Ta Team Screening i Assexsmenis M Admission i Hotes ie Tregimi ie Annual Update i Discharge i Canaent Chronic Life Threatening ness CLT No Referral Contact w Injection Drug User No v Referral Datel Presenting Problem n Cleats Own Words ASssesqoent Datel Return Court Date Date Closed ncs TERM Pe Cancel Eae fih Consent Referral and Wait List Consented Clients If a client from another agency has given their consent to allow that agency to share their data with your agency the
13. Note A signed Consent is required before sending a referral since you are disclosing the identity of the client through the referral If no consent exists you must go back to the consent screen and create one Select a Program to which you are referring and State Reporting Category will get populated You may provide Comments Click Finish when done If you are sending the referral to a SWITS agency once you complete and Save the Client Referral screen the facility to which you have referred the client will see the referral appear in their Referrals In screen under Agency gt Referrals In Similarly referrals sent to you by another using SWITS using agency can be seen in your Referrals In screen You will see referrals you have made in your Referral Out screen amp Client Referral Microsoft Internet Exp User Kelly2 Maureen Westat Testing Agency Westat Outpatient Fa cility prer tears Ys e E Client Client Referral for Jetson Jane Signed Consents TestAgency v Agency Non System Agency Home Page Agency Client List Client Profile Non Episode Contact Activity List intake Program Adult outpatient Wait List Tx Team Agency VYestat Testing Agency Facility Westat Outpatient Facility Staff Member Kelly2 Maureen Facility Staff Member State Reporting z Category Adult outpatient Reason Client decined 0v ipse Category fOher Is Consent Verification Required
14. Referral 23 Goto Client List and select the desired client feum me agency Adolescent Services Outpatient CreatediPending Go to Activity Li st Su b menu and select bid a Reports Triggerpoint Healthsouth Intensive Outpatient Msi nt Referrals ien n pra Reports Triggerpoint Healthsouth Short Term Residential ha oy Outcomes pita Reports Triggerpoint Healthsouth drin x Dupain ir d T P ane reatme erminate 24 Client Referral List To create a lien referral Consent m Reports Triggerpoint Healthsouth Basic Education Wait List from this screen click on the hyperlink for Add a d i Episode List New Client Referral Record This will take you ENORET to the Client Referral screen My Settings Reports 25 Information about your Agency Facility and Staff Member will come pre populated and is read only Client Referral Microsoft Internet Explorer x 26 Referred By Select the Reason for referral Is 3M Client Referral Microsof i User Kelly2 Maureen Y Loc Westat Testing Agency Westat Outpatient Facility Gay Wiles Client B Client Referral for Jetson Jane Agency VYestat Testing Agency Facility Westat Outpatient Facility Consent Verification Required Is Consent Verified and Continue this Episode of Care 7 ome Page Agency gt Client List Client Profile Non Episode Contact Activity List 1 Consent Verification Requested This refers to the agreement between your agency and the agency to which you are
15. Referral Created Date Agency List Conrad Chinese Testing Substance Abuse Referral cce pt n g a e e r ra Agency Profile Rodney Agencysimg gt FE Outpatient Created Pending Hoe acid vali Reports Triggerpoint Healthsouth Intensive Outpatient hid ding 1 20 2005 Cohen Referral i Governance gt Reports_Triggerpoint Healthsouth Intensive Outpatient _ 1 20 2005 When another agency has referred a client to your MIENNE E agency that client will show up in your Referrals Announcements p 1 Referrals In listing E nttp test ssawebtech org CalWII5 Microsoft Internet Explorer m User Conrad Rod ears ea Aaaa Aa E Home Page Client Referral for Jetson George Agency Y Agency List Y gency Sonoma Agency Signed Consents Administrative Agency Agency Profile gt ANE Facility Sonoma Facility Agency Administrative Agency Before accepting the referral you should Review nep Staff Mombor ty i n Goeman e Program Staff Member the referral which opens the Client Referral Relationships gt Ses a ogram Outpatient Screen konm Y gt State Reporting Nonresidential Outpatient Treatment Rec Reason Lack of appropriate Category Referrals Out If Other Non System Agency You can then set the Referral Status to Wait List ls Consent Verification Required No Non System Modality a P laced Acce pted m bed Is Consent Verified No Non System Specifier Tx Team Groups gt Continue This Episode of Care No Appt
16. ait List option in iust the menu Click this to launch the Client Waiting S ob List screen ii UE Reports To put the client on a wait list for a program click the Put Client on Waiting for Another Program hyperlink This will bring up the Client Wait List Screen Client Wait List Microsoft Internet Explorer SEE 5 d Wi if S we Wee Testing ATE Westat Outpatient Facility Client Print Report PrintMew Help Home Page Client Wait List for Jetson Jane Agency gt Client List Client Profile Non Episode Contact Activity List Select Staff Intake Modality Tx Team Screening Wait End Date Agency WWestat Testing Agency Facility Westat Outpatient Facility Select Program Wait Start Date Assessments gt Added to Wait List By Admission Notes Dually Diagnosed Assistance Needed to Place This Client Treatment Outcomes Patient is Injecting Mo Referred to Interim Services Patient is Pregnant Yes HI Positive No Due Date 8 14 2005 Discharge Consent Referrals Episode List Removed From Wait List By System Administration Reason v My Settings Comments Reports Admit Client Consent Referral and Walit List Wait List Select Program The client must be put on the wait list for a specific program Select the program and the modality will populate Select Staff If you want to place the client on the wait list
17. consent will expire based on the date of discharge the number of days entered b Date Signed The consent will expire based on the Consent Date the number of days entered G Other Event The consent will expire based on some specified event The user must specify the date of expiration d Criminal Justice Condition The consent will expire based on a criminal justice condition The user must specify the date of expiration There are Description and Comments text boxes at the bottom of this screen that will allow you to be more specific about consent information Client Information Options Consent Expires Upon Disclosure Selection Digcharge LlD Days 90 Date Signed DS Days Ak Status Review ATR Interview Behavioral Health amp szeszsment CASI Scores Other Event OE Ex 4 Client Information Profile J C crim uA Cod Client Screening CJC Ep DENS ASI Assessment DEMS ASI Lite Description Discharge GPRA Assessment a Client Information Options Consent Expires Upon Disclosure Selection Admission UD 90 ATR Interview F CASI Scores L Client Screening DENS ASI Assessment Daya p0 AK Status Review UD 90 Client Information Protie UD 301 DENS ASI Lite Date Signed DS Days g Behavioral Health Assessment UD 90 Other Event OE Ep Coole Crim Just Cond GPRA Assessment CJC Expl Intake Transaction Mental Status Repor
18. e Wait List Tx Team 6 3 2004 12 7 2004 12 8 2004 12 9 2004 2 3 2005 2 3 2005 4 2005 5 4 2005 Screening Assessments gt Admission gt Car WIS Home Page Agency Client List Client Profile Non Episode Contact Activity List Intake Wait List Tx Team Screening Assessments Admission Notes gt Treatment gt Outcomes gt Discharge Episode List System Administration My Settings X Reports Signed Consents Test Agency 00000 v Agency Mon System Agency Facility Staff Member Program State Reporting Category Mon System Agency Test Agency Non SystemModaity wj NoSytemspeer v Appt Date Undetermined Consents Granted Consent Date 5 4 2005 Disclosure Domains Admission UD 90 AK Status Review UD 90 ATR Interview UD 90 Behavioral Health Assessment UD 90 CASI Scores UD 90 Client Information Profile UD 90 E Client Disclosure Ag Client Consent List Revoked Active Active Active FEI Development Agency Administrative Agency FEI Dev Child Agency Renee Test Renee Test Active Reports Triggerpoint Active test Active Starbucks Test Agency Revoked Active reement Microsoft Internet Explorer User Kelly2 Maureen P Loc Westat Testing Agency Westat Outpatient F Client ase 1 A Disclosed From Agenc Entities with Disclosure Agreements Disclosed To Agency Non System Agency Di
19. er disclosure is expres Activity Lis permitted by the written consent of the person to whom it pertains or as otherwise permitted by 42 CFR Part 2 A gene int k authorization for the release of medical or other information is NOT sufficient for this purpose The Federal rules restrict any use T the information to criminally investigate or prosecute any alcohol or drug abuse patient Wait List TODO Activity Consent Period Created Date Status Actions Admission Not Available Screening b Client Information Profile Until Discharge 2 6 2005 2 34 27 PM In Progress Rev I a Assessments gt Admission b Notes gt Treatment gt Annual Update gt Discharge gt Consent Referrals Episode List System Administration gt My Settings gt Reports E http test ssawebtech org CalWITS Microsoft Internet Explorer User Conrad Rodney G a jj Wi TS Loc Administrative Agency Administrative Unit Client Conrad Rodneys CR1070770 Case 1 Print Report Print dem Print Page Home Page Client Profile Agency b State Client ID CR1070770 Client List Middle Name Provider Client ID Client Profile Y Current Last Name Conrad SSN 212 55 1234 Alternate Names Current First Name Rodneys Birth First Name Rodney Driver s License 1234567 Maryland Contact Info ALI SN Birth Last Name Conrad Medicaid 3 E Information Mothers First Name Betty Collatera
20. his purpose The Federal rules restrict any use the information to criminally investigate or prosecute any alcohol or drug abuse patient Activity Consent Period Created Date Status Actions Admission Not Available Client Information Profile Until Discharge 12 6 2005 2 34 27 PM In Progress Review lt gt aD Internet Consent Referral and Wait List Consented Clients Clicking on the review link on any of the activities will take you to the record in the consented from agency Note that the record appears in read only mode This is because you are only allowed to view and not edit records that are consented to you a http test ssawebtech org CalWITS Microsoft Internet Explorer User Conrad Rodney Ez G a j Wi TiS Loc Administrative Agency Administrative Unit Client Conrad Rodneys CR1070770 Case 1 Print dew Home Page Consented Case Activity List from Sonoma Training Agency South for Conrad Agency b PROHIBITION ON REDISCLOSURE OF INFORMATION CONCERNING CLIENT IN ALCOHOL OR DRUG ABUSE TREATMENT Client List This notice accompanies a disclosure of information concerning a client in alcohoVdrug abuse treatment made to you with Client Profile gt consent of such client This information has been disclosed to you from records protected by Federal confidentiality rules 42 C Non Episode Contact Part 2 The Federal rules prohibit you from making any further disclosure of this information unless furth
21. l Contacts Gender 1 Male Place of Birth Not Applicable None or not Other Numbers Consent on File for Confidential DOB 7 7 1970 7 Future Contact History No Readmit Until Has Paper File Yes Non Episode Contact Record Created By Denis Ron Created Date 12 6 2005 2 34 PM Activity List gt Last Updated By Conrad Rodney Last Updated Date 12 9 2005 7 22 PM Episode List System Administration gt sh Ter My Settings gt 9 Alternate Names Reports Last Name First Name Middle Name Actions Address Type Address Confidential Created Updated Actions aD Internet Co a Se nt J Refe rral i Client Waiting List Microsoft Internet Explorer TER 2 nN d Wa it L i St C a Wi Jas ea erat Ted M Westat Outpatient Facility x ro Client Print Report Print Mew Help Logout Home Page Agency Full lame Program Staff Pregnant Due Dual Diag HIV IV Drugs Interim Ser Placement Asst Start Date Actions ieee Jetson E Y 8 14 2005 N No N Y N 7 6 2004 Revi m a Client Profile Jane Outpatient es o o Mo es o eview Wa I t L I S t iUd Lo Jetson Adult Y 84 2005 No N 841 2004 Revi Activity List Jane outpatient a o iu oe Intake Entry Steps Client Profile Intake Tx Team Screening gt Assessments gt To place a client on the Wait List you must first Admission have entered the Client Profile and Intake Notes Treatment Outcomes Select the client from the Client List and click Seno vo Activity List You will see the W
22. n list of the Agencies for which an Agency Disclosure Agreement has been created If you select an agency from this list it will pre fill the Disclosed to Agency and the bodies of consented data in the Disclosure Selections The client may disallow access to any body of data by de selecting the item Agency Client List Client Profile Mon Episode Contact Activity List Intake Wait List Tx Team Screening Assessments Admission Motes Treatment Outcomes gt Disclosed to Agency Select the Agency you intend to send client information You may only select one at a time You will have to create another consent if you wish to send information to a second agency Discharge gt Referrals Episode List System Administration My Settings If the agency you are disclosing information to is ba another provider that uses SWITS they will be able to see this client s record as soon as you complete and save the consent record If it becomes necessary to share information with entities which are not listed in the drop down box you may select the Not System Agency and type in the name of the individual or agency in the Disclosed to Entity box Consent Date The consent date defaults to the current date If the consent has been granted earlier and is on file SWITS allows you to change the date in this field Client Disclosure Agreement Microsoft Internet Explorer User Kelly2 Maureen Loc We
23. n that client will appear in your search list under the Clients with Consents from Outside Agencies portion of the client search screen Note That client will only appear during the duration of the consent Clicking on the Activity List for that consented client will take you to the following screen which lists only those activities in which your agency has been given access Note You are seeing the actual records as they appear in the other agency In the example to the right the Admission has not been started yet therefore it s status is Not Available a http test ssawebtech org CalWITS Microsoft Internet Explorer ex Wiis Home Page Agency b Client Profile gt Non Episode Contact Activity List gt Episode List System Administration gt My Settings gt Reports EEk User Loc Client Conrad Rodney EL Administrative Agency Administrative Unit E 1 Print deu Logout 1 s PS Some of the clients listed below have alternate names aliases that matched your criteria and were therefore S returned Agency Administrative Agency First Name lod SSN eU Client ID 23 Facility wv Last Name EE psf Provider Client ID P Staff v Primary Care Staff Case Status All Clients Clear ZT Client List Export Add Client Client ID Full Name DOB SSN Gender Actions CR1070770 Jetson Jane 7 7 1970 212 55 1234 Female Profile Activity List Clients with Consents from
24. ncy Non Episode Contact Entities with Disclosure Rr Activity List Agreements _ as Intake Disclosed To Agency Non System Agency wv Wait List Tx Team Disclosed To Enty Fest Agency 1 Non System Agency Test Agency Purpose For Disclosure Testing Screening Assessments b Consent Date 5 4 2005 EI Has the client signed the Ng v paper agreement form m Notes Client Information Options Consent Expires Upon Disclosure Selection Treatment DENS ASI Lite C pischargetuD Days S0 Admission UD 90 Outcomes AK Status Review UD 90 E ae C Date Signed DS pays ATR Interview UD 90 rmm t C Behavioral Health Assessment UD 90 Other Event OE E 6 4 2006 4 efl Scores UD 90 C Cliemt Information Profile UD 90 Eee jemamem lt lt onto opt DENS ASI Assessment UB 90 System Administration Description Discharge Client s 18th Birthday 5 4 2006 My Settings Client s 18th Birthday GPRA Assessment UD 90 Reports Intake Transaction UD 90 si Bie Other A Cancel SaD Finish Consent Referral and Wait List Revoking a Consent Revocation A client may revoke a consent prior to its expiration For the Consent you wish to revoke click the Review hyperlink next to the appropriate consent You will see a Revoke button at the bottom of the Client Disclos
25. s a Client Waiting List Calis Home Page Agency gt Client List Client Profile Non Episode Contact Activity List Intake Tx Team Screening Assessments gt Admission Notes Treatment Outcomes Discharge Consent Referrals Episode List System Administration My Settings gt Reports User Kelly2 Maureen EY Loc Westat Testing Agency Westat Outpatient Facility Client Client Wait List for Jetson Jane Agency WWestat Testing Agency Facility Westat Outpatient Facility select Provan Select Staff v Modality Wait Start Date 5 4 2005 Wait End Date Added to Wait List By Kelly2 Maureen o v Dually Diagnosed v Assistance Needed to Place This Client Patient is Injecting Mo Referred to Interim Services Patient is Pregnant Yes Due Date 8 14 2005 HIV Positive No Removed From Wait List By Reason v Comments Admit Client Cancel Save Finish Microsoft Internet Explorer User Kelly2 Maureen a Loc Westat Testing Agency Westat Outpatient Facility Client TI S SS aaa Client Waiting List Jetson Womens Yes 814 2005 No Jane Mo No Yes No 7 6 2004 Outpatient Jetson Adult Lapin outpatient Yes 814 2005 Mo No 811 2004
26. sclosed To Entity Non System Agency Test agen Purpose For Disclosure Teste Consent Expires Upon C Discharge UD Days C Date Signed DS Days C Other Event OE Exp C Crim Just Cond CJC Exp Description Comments Yes Yes No Yes Yes Yes No Yes No Disclosure Selection Admission UD 90 Behavioral Health Assessment UD 90 CASI Scores UD 90 Client Information Profile UD 90 Client Screening UD 90 DENS ASI Assessment UD 90 Discharge Client s 18th Birthday 5 4 2006 GPRA Assessment UD 90 Intake Transaction UD 90 Other Disclosures Fish Revoke E Client Referrals List Microsoft Internet Explorer Consent Referral User Kelly2 Maureen ik 8 a n d W a it L i St Gal Widi S EE Westat Testing Agency Mie Ova M ity Home Page TUE Name Referred To Agency Referred To Facility Non System Agency Referred To Modality Referral Status Actions scant Jetson FEI Development dut intensive OP interim Weiting List Placed Accepted R e fe r r a Client Profile Jane Agency Non Episode Contact m oe ibid iibris Ni Inpatient jii F RSA ane gency npatie reatme reated Pending pute i Jetson FH Development a duit intensive OP Interim VVaiting List naama A 22 Entry Steps Client Profile Client Intake RM sene Agency creseapendng Tx Team Jane Renee Test Created Pending a i Screening Jetson Westat Testin Substance amp buse
27. stat Testing Agency Westat Outpatient Facility Client Print Report PrintMew Help Client Disclosure Agreement Entities with Disclosure Agreements Disclosed To Agency Disclosed To Entity Non System Agency Consent Date Has the client signed the paper agreement form Client Information Options Non System Agency v Consent Expires Upon Disclosure Selection Admission AK Status Review ATR Interview Behavioral Health Assessment CASI Scores Client Information Profile Client Screening DENS ASI Assessment DENS ASI Lite Discharge GPRA Assessment c Discharge LD Days C Date Signed DS Days Other Event OE Expl c C Cri Just Cond cud Expl Descriptio Comments Other i Note This date will drive reports which show how long clients are on waitlists for various programs so be careful if changing the date 2i Client Disclosure Agreement Microsoft Internet Explorer SEE Consent Referral a J e a Vy TS Testing Agency Westat Outpatient Facility R Fe Client Print Report Printdew Help 2l a d Wait Li st Home Page Client Disclosure Agreement Agency gt ote Consented information m jot b Client List J Client Profile Non Episode Contact Entities with Disclosure O n S e n Activity List Agreements Intake Disclosed To Agency Non System Agency Wait List Disclosed To Entity Test
28. t Description TAP Assessment TCU Drug Screen j Disclosure Selection Admission UD 90 AK Status Rewiew UD 90 Behavioral Health Assessment UD 90 Client Information Profile UD 20 Discharge Client s 18th Birthday 5420068 Client Information Options ATR Interviews Consent Expires Upon Discharge UC Days Date Signed DS Days Other Eventi OE ExpiSi4 2006 GPRA Assessment Crim Just Cond Intake Transaction CJC Expl Mental Status Report Description e 18th Birthday TCU Intake Interview Consent Referral and Wait List Consent De Selection In this example the client has de selected DENS ASI Lite They may also reset the expiration date if desired Client Disclosure Agreement Microsoft Internet Explorer er Kelly2 Mauree Jf z iG a ij Wi is Testing AUS Westat Outpatient Facility E E t Jetson Jane Case 1 Print Report PrintMew Help Logout Home Page Client Disclosure Agreement Create Referral Using this Disclosure Agreement Agency Client List Client Profile Hote Consented information may not be redisclosed Client Hame Jetson Jane Client ID F1190530467100 Disclosed From Agency estat Testing Agency Non Episode Contact Entities with Disclosure a Activity List Agreements Intake Disclosed To Agency Non System Agency wv Wait List Tx Team
29. tient CreatediPending 1 20 2005 Relationships Announcements Referrals Referrals In E Referrals Microsoft Internet Explorer IE User Kelly2 Maureen Gal Widi Jus Loc Client i E eC cle IR HR Au b To a LSLS Referral Created Pending Westat Testing Agency Westat Outpatient Fac lity Home Page Pens Name Referred To Agency Referred To Facility Hon System Agency Referred To Modality Referral Status Agency List v Jetson FEI Development Mental Health Mental Health Inpatient Referral 8 31 2004 Agency Profile Jane Agency Inpatient Treatment Created Pending Aliases Jetson FEI Development 4 intensive OP Interim Weiting List Referral gw ang Contacts Jane Agency Created Pending Doe Referral ae John Created Pending ceeds Relationships Jetson Referral Announcements Jane Rence Test Created Pending 12 9 2004 Referrals v Jetson Westat Testing i Substance Abuse Referral Referras in Jane Agency Adolescent Services Outpatient CreatediPending 12 24 2004 Referrals Out Jetson Referral Wait ist Jane peer eee Created Pending parus Consent Referral and Wait List LE ETT ae User Kelly2 M Gal Wiis Loc i We at Testing AREE Westat Outpatient Facility 3 e g Client an ase 1 EM Home Page ai Referrals for Westat Outpatient Facility Referral CreatediPending Y A R f E Hame Referred From Agency Referred From Facility Referred To Modality Referral Status
30. ure Agreement screen Click the Revoke button The status of the consent will change to Revoked in the Activity List Revocation is not retro active Whatever was already shared between agencies prior to revocation is not subject to non disclosure E Client C Gay WIS Home Page Agency gt Client List Client Profile Mon Episode Contact Activity List Intake Wait List Tx Team Screening Assessments gt Admission gt pnsent List Micr s a Client Disclosure Ag psoit Internet Explorer User Kelly2 Maureen i Loc Westat Testing Agang iris ias Facility Client Client Consent List 7 7 2004 FEI Development Agency 8 3 2004 Administrative Agency 12 7 2004 FEI Dev Child Agency 12 9 2004 Renee Test 12 9 2004 Renee Test 2 3 2005 Reports_Triggerpoint 2 3 2005 test 4 2005 Starbucks 5 4 2005 Test Agency reement Microsoft Internet Explorer ex vM PES Home Page Agency Client List Client Profile Non Episode Contact Activity List Intake Wait List Tx Team Screening Assessments gt Admission Notes Treatment Outcomes gt Discharge Referrals Episode List System Administration My Settings Reports Client Consent List Tr 004 Bisi2004 12772004 12 9 2004 12 9 2004 2312005 2312005 4n 2005 S205 FEl Development Agency Revoked Administrative Agency Active FEl Dev Child Agency Active Renee Test Active Renee Test
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