WINDOWS


Home Address
Address 1 400_Glen_Oaks_Road____________
Address 2 ______________________________
City/State/Zip Matthews____________ NC 28172 - 1234
Phone Number 704-567-1234
FAX Number 704-567-1299
Primary Contact Helen Cox_____________________
F=11 Retrieve Person Data

NOTES
• F11 pulls address data from the Person 1 Number.
• Phone Number is either the number coded wita a 'H' or 'W' code.
Fax Number Number is the number coded with a 'F' code.


Admission Preferences
Racial * W_ White
Racial * B_ Afro-African
Racial * __
Gender B M=Male, F=Female, B=Both
Age Range _13_ to _19_
Preferred Age _15_


School Districts 
Primary School * ABL Amy Bradley School
Middle School * AL_ Alderman School 
High School * CFA Cape Fear Academy


Inspection
Inspection Type * SI_ Site Inspections
Date Scheduled 4/13/97
Last Inspected 3/18/97


License Data
License Number 123456
License Status * 1 APPROVED
Date Approved * 3/13/97
Date Expires * 9/30/97
Date Renewed * 0/00/00
Last Visit * 3/11/97
Next Visit * 6/15/97
*F8=Lookup




IDs/Numbers
Facility ID A234198
Agency Case Number _________
Federal Tax ID 57-3456789

NOTES
• Facility ID is the six-character code that appears on the 5094 form.
It is not the same ID as the placement system uses.
• Agency Case Number is the County Case Number for the agency parents.


Status
Date Available........ _3/13/97
Date Closed........... _0/00/00
Status Code........... O OPEN
Date Status Changed... 00/00/00
Date Created.......... 3/13/97
Creating User......... CWS
Date Last Maintained.. 3/13/97
User ID............... CWS

NOTES
• Date Available is the date the home is available for placement.
Date Closed is the date the home stopped accepting placements.
A home may be closed but still licensed.

• Valid Status Codes are O=Open and C=Closed.
Change Status Code to 'O' when Date Available is updated.
You must key the Date Closed when you change Status Code to 'C'.
Date Status Changed is the system-date when the code changed.