Field is calculated based on information entered in the UNITS report form. Providers may not edit this field. Enter the SAM Level if VR Counselor or VR SAM LEVEL DROP DOWN Contractor has pre-authorized SAM Level for the service. SUMMARY OF Enter a summary of the issue that was worked on that TEXT specific date. ISSUE(S)/CONCERN(S) Enter documentation of the type of contact or what CONTACTS & SUMMARY OF STEPS TAKEN TEXT actions were taken to resolve the issue on that specific TO RESOLVE ISSUE(S)/CONCERN(S) date. Enter the initials of the Provider Staff who provided STAFF INTIALS TEXT direct service to the Individual on the date. VOCATIONAL EVALUATION INVOICE SECTION SERVICE DESCRIPTION (UOS SERVICES) SERVICE TOTAL $0.00 SERVICE AREA MODIFIER (SAM) TOTAL $0.00 INVOICE TOTAL FIELD ENTRY INFORMATION TYPE Use this field for If the “Vocational Evaluation”. Bilingual Supplement has been approved and authorized SERVICE DESCRIPTION DROP for the case select the Vocational “Bilingual Evaluation” (UOS SERVICES) DOWN option. This field will load the associated rates, individual and/or group, as applicable. SERVICE AREA MODIFIER Field is calculated based on information entered in the report form. Providers may not edit this field. TOTAL Field is calculated based on information entered in the INVOICE TOTAL report form. Providers may not edit this field. INTEREST TEST(S) ADMINISTERED SUMMARY OF TEST RESULTS FIELD ENTRY INFORMATION TYPE Enter the name of any standardized vocational tests that were used to measure this characteristic. If no INTEREST TEST(S) TEXT ADMINISTERED standardized tests were used to collect data explain how the conclusion was derived. Enter a summary of the information and explain how that SUMMARY OF TEST it was used to formulate the identified vocational goal(s) TEXT RESULTS as realistic and viable (e.g. within the Individuals interests, abilities, and capabilities.)
UNITS Field is calculated based on information entered in the report form. Providers may not edit this field. SAM LEVEL DROP DOWN Enter the SAM Level if VR Counselor or VR Contractor has pre-authorized SAM Level for the service. SUMMARY OF ISSUE(S)/CONCERN(S) TEXT Enter a summary of the issue that was worked on that specific date. CONTACTS & SUMMARY OF STEPS TAKEN TO RESOLVE ISSUE(S)/CONCERN(S) TEXT Enter documentation of the type of contact or what actions were taken to resolve the issue on that specific date. STAFF INTIALS TEXT Enter the initials of the Provider Staff who provided direct service to the Individual on the date. VOCATIONAL EVALUATION INVOICE SECTION SERVICE DESCRIPTION (UOS SERVICES) SERVICE TOTAL $0.00 SERVICE AREA MODIFIER (SAM) TOTAL $0.00 INVOICE TOTAL FIELD ENTRY TYPE INFORMATION SERVICE DESCRIPTION (UOS SERVICES) DROP DOWN Use this field for “Vocational Evaluation”. If the Bilingual Supplement has been approved and authorized for the case select the “Bilingual Vocational Evaluation” option. This field will load the associated rates, individual and/or group, as applicable. SERVICE AREA MODIFIER TOTAL Field is calculated based on information entered in the report form. Providers may not edit this field. INVOICE TOTAL Field is calculated based on information entered in the report form. Providers may not edit this field. INTEREST TEST(S) ADMINISTERED SUMMARY OF TEST RESULTS FIELD ENTRY TYPE INFORMATION INTEREST TEST(S) ADMINISTERED TEXT Enter the name of any standardized vocational tests that were used to measure this characteristic. If no standardized tests were used to collect data explain how the conclusion was derived. SUMMARY OF TEST RESULTS TEXT Enter a summary of the information and explain how that it was used to formulate the identified vocational goal(s) as realistic and viable (e.g. within the Individuals interests, abilities, and capabilities.)
VR%20Provider%20Manual%20-%20Effective%20010118.docx