Overview

To collect general demographic data along with information about residential history, education information, work experience, skills, and preferences. The form is to be updated at least once a year and is generally reviewed along with the Individual Assessment. Individual Assessment

Applicable Staff

Directors/Supervisors, ID Staff, and Nursing may complete the form. All Avatar users may view the form.

Usage

The IDS Individual Information Sheet is client and episode based and can be accessed from the Home View, within a client's chart, or following the menu path Avatar CWS/Mercy Modeled Clinical Forms/Mercy ID Forms/IDS Individual Information Sheet (MIDS).

Basic Information Section

This section is partially filled in from previous general information collected during admission. The Date of Completion is a required field. Additional information consists of housing information, birth place, languages spoken, distinguishing features, legal status (competency), and a photograph of the client. Allergies and Vitals can be accessed directly from the appropriate link in the side bar.

Basic Information Section Continued:

Insurance and Medical Information Section

The Insurance portion records insurance type and number. Medical Information portion records allergies, disabilities, medications, level of retardation, any special communication needs, limitations including hearing, vision, ambulatory, and diet. Diagnosis information is pre-populated from other forms. Allergies and Vitals can be entered directly into new forms through the links in the sidebar.

Insurance and Medical Information Continued:

Emergency Contact Information Section

Emergency Contact information begins with recording the client's physician and/or dentist information.

Continue to scroll down the form to view the client's therapist information, family contact/relationship information, and Substitute Decision Maker information. The Mercy Substitute Decision Maker information is listed as well, if necessary.

Further down theform enter transportation needs to the DAY Program (if required), Independent Support Coordinator, OVR Counselor, referral information, funding type, and financial information.

The final information in the Emergency Contact section describes the client's independence in the community and information about arrival to work and home.

Residential History Section

The Residential History Section is a multiple iteration table that allows adding new entries and viewing, editing, and deleting previous entries. Data entry fields are free text so information can be entered in any format. For more information about using multiple iteration tables, see this article. Using a Form

To Edit a previous row of data, select the desired row first and click Edit Selected Item. If the following error appears, acknowledge and select the desired row:

Friends and Family Contacts Section

The Friend and Family Section is a multiple iteration table that functions identically to the Residential History table. Add as many contacts as required.

Educational Information Section

The Educational Information Section is a multiple iteration table that functions identically to the Residential History table. Add as many programs as required.

Work Experience Section

This section also consists of a multiple iteration table to capture detailed work experience data. If the following error appears, acknowledge it and click the Add New Item button:

After selecting Add New Item, fill in all desired information fields below to populate the table.

Performance Skills Section

This section details the client's skills in a variety of areas. In the first portion of the form, Vocational and Performance skills are covered. The fields are free text fields and information can be entered in any format. The Text Editor and Search functions are available.