case note record

Instructions - Case Note Record – DE WONDER Program

of 5

Case Note Record – DE WONDER PROGRAM

Description

This form allows you to provide information about case management services provided to a DE

WONDER participant. This form also launches the Barrier Reduction Services form where information

about barrier reduction services provided to a participant can be entered.

Both the forms allow you to enter the information for multiple participants at a time.

During a data entry session, you can navigate back and forth among all the participant data you enter.

Data Entry Steps

Navigation buttons

to move between

the data entered

Click to save the current

participant’s information

in the spreadsheet

Click to add a blank

participant’s record to the

form

Click to cancel

the data entry

and close the

form

Click to print the data

entry form as seen

on screen

Click to launch

the Barrier

Reduction

Services form


of 5

When the form is opened you will be presented with blank boxes (data fields) to enter data into. When

you use the navigation buttons to move between previously entered data, the boxes will be filled in with

the entered data.

Please note that depending on your computer’s screen resolution, the form may resize and you have to

scroll up or down using the scroll bar to access all the data fields.

Following are the descriptions and instructions for each data field:

1. WonderID – This “unique” value is a combination of the first three letters of the Participant’s

Last Name and the last five digits of their Social Security Number.

2. First Name – Participant’s first name

3. Last Name – Participant’s last name

4. Date of Birth – Date that the Participant was born in the format mm/dd/yyyy (example:

02/09/2016 for February 9, 2016)

The participant is identified in our system by the above values and are an absolute must on every

entry

5. Case Location - Select the case location from the list

6. Reason for contact – Select a reason for contact from the standardized list. The values and the

definitions are:

1. Intake/Enrollment – enrollment in EPIS or WONDER, completion of intake paperwork

2. Assessment – completion or update of core life functioning assessment

3. Barrier Reduction Request – discussion or processing of barrier reductions

4. Develop/Review Job/Career Plan – creation or review/update of Job/Career Plan

document

5. Attempt to re-engage participant – phone, mail or in-person attempts to locate

participants who have missed appointments/training sessions/days of work, etc.

6. Follow-up/check-in with active participant – phone or in-person contact to check on

status/progress of participants currently involved with any training/education program,

community resources, and/or their employment

7. Employment search support – phone or in-person assistance with job search (can

include contacts with potential employers on behalf of participants

8. Employment retention support – phone or in-person assistance provided to participants

to support them in maintaining employment

9. Intervention to prevent disruption of training - phone or in-person contacts with

participants and/or provider representatives to advocate or mediate to preserve the

participant’s status in the training program

10. Intervention to prevent disruption of employment - phone or in-person contacts with

participants and/or employer representatives to advocate or mediate to preserve the

participant’s employment


of 5

11. Skill Building Interaction –one on one coaching or skill building activities (e.g. mock

interviews, resume writing, application process, etc.)

12. Employer Contact – phone or in-person contact with the participant’s employer without

the participant’s presence

13. Provider Contact – phone or in person contact with the participant’s provider without

the participant’s presence

14. Crisis Response – phone on in-person assistance to alleviate a crisis (e.g. participant who

reports suicidal ideation, need to immediately leave a domestic violence situation,

unexpected homelessness, etc.)

7. Contact type – how the participant was contacted to provide this service. Please register even if

an attempt was made to contact the participant. The available standardized options are:

1. Phone Contact

2. Voicemail left

3. In-person contact

4. Mailed documents

5. Email

6. Sent Text

8. Session Date - Enter the session date, in mm/dd/yyyy format.

9. Start Time - Select from the drop-down menu a start time of the contact.

10. End Time - Select from the drop-down menu an end time of the contact.

Note: If the total phone or in-person contact was 7 minutes or less, please select the same time

as start time and end time, indicating 0 minutes. If it was over 7 minutes, then choose the time in

15 minute increments.

11. Accident/Incident Report Completed – if this was a crisis and if there was an incident report

completed, please indicate here

12. Notes on transportation in a State vehicle - Provide location and purpose if you personally

transported a participant in a state vehicle

13. Completed Core Life Functioning Assessment – Indicates the status of “Core Life Functioning”

assessment – if the reason for contact is “Assessment”

14. Review of Core Life Functioning Assessment – Indicates the status of “Core Life Functioning”

assessment – if the reason for contact is “Assessment”

15. Job/Career Plan Status – Choose the status of the participant’s job/career plan

16. Referrals Accepted - Provide a short summary of referrals accepted

17. Referrals Declined - Provide a short summary of referrals declined

18. D.A.P. Participant Contact Record - Provide a summary of D.A.P responses for participant.

19. New Identified Issues – if any new issues have been identified during this contact session, please

indicate what they are from the standardized list – check all that apply. Please only identify new

issues and not those previously identified

Once the above fields are filled in, click the button labeled “Save” to add them to the spreadsheet.


of 5

If you would like to add services provided to another participant click the button labeled “New” and

proceed as above.

You can click the button labeled “Print” to print the information on the current data entry form as you

see it on the screen.

Barrier Reduction Services

If you have provided any Barrier Reduction Services to a participant, click on the button labeled “Barrier

Reduction Services” to launch the form where you can enter the information – this form accepts data for

any participant, not just for the participant for whom a case note record is being entered.

Following are the descriptions for the data fields you need to provide in this form:

1. First Name – Participant’s first name

2. Last Name – Participant’s last name

Click to save the

current participant’s

information in the

spreadsheet

Click to add a new

blank record

Click to close the

form

Click to print the

form as seen on the

screen

Navigation buttons

to move between

the data entered


of 5

3. WonderID – This “unique” value is a combination of the first three letters of the Participant’s

Last Name and the last five digits of their Social Security Number.

4. Date of Birth – Date that the Participant was born in the format mm/dd/yyyy (example:

02/09/2016 for February 9, 2016)

The participant is identified in our system by the above values and are an absolute must on every

entry

5. Provider – This field is filled in automatically, you do not need to edit this

6. Service Type – select the type of service provided from the standardized list.

7. Date Received – Provide the date the service was provided, in the format mm/dd/yyyy

8. Service Description – In this area, provide any additional information about the service provided

9. Additional Comments – Provide any additional comments

10. Amount Paid (in $) – enter the cost / amount of the services provided in dollars

11. Gas Card Type (if provided) – Choose the type of Gas Card provided, if any.

Note:

When you open the spreadsheet, if the data entry form does not launch automatically and you see any

of the following warnings:

Please click on the button labeled “Enable Content”.

Also, if you open the spreadsheet directly from the email (or depending on your system, the very first

time you open it) you may get the following warning:

Please click on the button labeled “Enable Editing”.

If the data entry form does not launch automatically after clicking the above button, or you accidentally

close it after it launches, you can click on the button labeled “Case Note Record Form” or click on the

data entry area in the spreadsheet to launch it manually.

case note record

Documents