Good Client refused Fair Data not collected DISABLING CONDITION Clients] No Client doesn’t know Client refused Yes Data not collected PHYSICAL DISABILITY required for SSVF] No Client doesn’t know Client refused Yes Data not collected IF TO PHYSICAL DISABILITY SPECIFY “YES” – No Client doesn’t know Expected to be of long-continued and indefinite duration Client refused and substantially impairs ability to live independently? Yes Data not collected DEVELOPMENTAL DISABILITY required for SSVF] No Client doesn’t know Client refused Yes Data not collected IF TO DEVELOPMENTAL DISABILITY SPECIFY “YES” – No Client know Expected to substantially impair ability to live Client refused independently? Yes Data not collected CHRONIC HEALTH CONDITION required for SSVF] No Client know Client refused Yes Data not collected IF TO CHRONIC HEALTH CONDITION SPECIFY “YES” – No Client doesn’t know Expected to be of long-continued and indefinite duration Client refused and substantially impairs ability to live independently? Yes Data not collected HIV-AIDS required for SSVF] No Client doesn’t know Client refused Yes Data not collected
Good Client refused Fair Data not collected DISABLING CONDITION Clients] No Client doesn’t know Yes Client refused Data not collected PHYSICAL DISABILITY required for SSVF] No Client doesn’t know Yes Client refused Data not collected IF “YES” TO PHYSICAL DISABILITY – SPECIFY Expected to be of long-continued and indefinite duration and substantially impairs ability to live independently? No Client doesn’t know Yes Client refused Data not collected DEVELOPMENTAL DISABILITY required for SSVF] No Client doesn’t know Yes Client refused Data not collected IF “YES” TO DEVELOPMENTAL DISABILITY – SPECIFY Expected to substantially impair ability to live independently? No Client know Yes Client refused Data not collected CHRONIC HEALTH CONDITION required for SSVF] No Client know Yes Client refused Data not collected IF “YES” TO CHRONIC HEALTH CONDITION – SPECIFY Expected to be of long-continued and indefinite duration and substantially impairs ability to live independently? No Client doesn’t know Yes Client refused Data not collected HIV-AIDS required for SSVF] No Client doesn’t know Yes Client refused Data not collected
VA-Combined-Project-Exit-HMIS-2017-rev07May2018.docx