Conservatorship / Court Status: Lanterman-Petris-Short Special Population: Governor's Homeless Initiative (GHI) service(s) Legal Class: Voluntary County School: 013323 Number of Dependents Less than 18YO: 1 Number of Dependents Over 18YO: 2 CSI Ethnicity: UnknownNotReported CSI Race: WhiteOrCaucasian CSI Race: HawaiianNative Testing Domain: Financial Eligibility Note: Financial Eligibility is established when operation is performed. Step # 9: Operation: GetClientFinEligibility Scenario: Retrieve Client’s existing Financial Eligibility record that was created through the operation. Data Attribute: Values to be entered Client ID: (Enter the Client ID returned in Step #2) Episode ID: 1 Output Data Attribute: Expected Values Enter any Comment for Discrepancy Discrepancy (DMH Use Only) Acknowledgement: Process completed successfully. Client ID: Client ID returned in Step #2 Episode ID: 1 Coverage Effective Date: 2017-01-01 Subscriber Name: Client First Name entered in Step # 2 <space>MiddleInitial (if any)<space>Suffix (if any)<space>Prefix (if any) Subscriber Last Name: Client Last Name entered in Step # 2 Subscriber Address: 123 Some Place Lane Subscriber Address 2: Suite 10 Subscriber Zip: 90005-4545 Subscriber City: LOS ANGELES Subscriber CA Subscriber Date of Birth: 1985-10-15 Subscriber Assignment of Benefits: Yes Subscriber Release of Information: Yes, Provider Has Signed Statement Permitting Release Coordination of Benefits: Yes Subscriber Social Security Number: 88855666P Subscriber Gender: F Guarantor Name: LA County Guarantor Order: 1
Conservatorship / Court Status: Lanterman-Petris-Short Special Population: Governor's Homeless Initiative (GHI) service(s) Legal Class: Voluntary County School: 013323 Number of Dependents Less than 18YO: 1 Number of Dependents Over 18YO: 2 CSI Ethnicity: UnknownNotReported CSI Race: WhiteOrCaucasian CSI Race: HawaiianNative Testing Domain: Financial Eligibility Note: Financial Eligibility is established when operation is performed. Step # 9: Operation: GetClientFinEligibility Scenario: Retrieve Client’s existing Financial Eligibility record that was created through the operation. Data Attribute: Values to be entered Client ID: (Enter the Client ID returned in Step #2) Episode ID: 1 Output Data Attribute: Expected Values Enter any Discrepancy Comment for Discrepancy (DMH Use Only) Acknowledgement: Process completed successfully. Client ID: Client ID returned in Step #2 Episode ID: 1 Coverage Effective Date: 2017-01-01 Subscriber Name: Client First Name entered in Step # 2 <space>MiddleInitial (if any)<space>Suffix (if any)<space>Prefix (if any) Subscriber Last Name: Client Last Name entered in Step # 2 Subscriber Address: 123 Some Place Lane Subscriber Address 2: Suite 10 Subscriber Zip: 90005-4545 Subscriber City: LOS ANGELES Subscriber CA Subscriber Date of Birth: 1985-10-15 Subscriber Assignment of Benefits: Yes Subscriber Release of Information: Yes, Provider Has Signed Statement Permitting Release Coordination of Benefits: Yes Subscriber Social Security Number: 88855666P Subscriber Gender: F Guarantor Name: LA County Guarantor Order: 1