| # | Name | Location | Type | Details | Index | Description |
|---|---|---|---|---|---|---|
| .01 | name of home(+) | 0;1 | FREE TEXT | B | This field is used to enter the name of the Residential Care Home. | |
| 1 | home id(+) | 0;2 | FREE TEXT | This is the home identification. | ||
| 2 | station number(+) | 0;3 | FREE TEXT | This field is used to enter the station number of the residential care home. | ||
| 3 | case worker(+) | 0;4 | POINTER | 200 | This field is used to enter the name of the social worker assigned to this residential care home. | |
| 4 | address 1(+) | 0;5 | FREE TEXT | This is the primary address of the residential care home. | ||
| 4.5 | address 2 | 0;14 | FREE TEXT | Optional address for RCH or to be used if Address 1 field is not large enough. | ||
| 5 | city(+) | 0;6 | FREE TEXT | This field indicates the city in which this residential care home resides. | ||
| 6 | state(+) | 0;7 | POINTER | 5 | This field is used to indicate in which state the residential care home is located. | |
| 7 | zip(+) | 0;8 | FREE TEXT | This field is used for the zip code. | ||
| 8 | telephone #1(+) | 0;9 | FREE TEXT | This field is used to enter the primary telephone number of the residential care home. | ||
| 8.1 | telephone #2 | 0;15 | FREE TEXT | This field is use to enter a secondary or optional telephone number. | ||
| 9 | licensed by state(+) | 0;10 | BOOLEAN | Y:YES N:NO | This field is used to indicate whether or not the residential home is licensed by the state in which the home is located. | |
| 10 | number of beds(+) | 0;11 | NUMERIC | This field is used to indicate the number of beds in a residential care home. | ||
| 11 | veterans only(+) | 0;12 | BOOLEAN | Y:YES N:NO | This field is used to indicate whether or not the residential care home is for veterans only. | |
| 12 | date of last assessment | 0;13 | DATE-TIME | This field is used to indicate the date the residential care home was last assessed. | ||
| 13 | transmit name | 1;1 | FREE TEXT | This field will be used to store the abbreviated name that is transmitted to Austin when submitting the RCS 10-0173 AMIS data. For example, if the name of the home is "Mrs. T. L. Suggs Residential Care Home, Inc.", the name would probably be abbreviated in the form of, "MRS T L SUGGS RCHI". More information can be found in Circular 10-83-8, dated Jan. 17, 1983. | ||
| 14 | addition(+) | 1;2 | BOOLEAN | 1:YES 0:NO | This field will be used to indicate if the RCH is a new addition for the current reporting period. If the RCH is new for the reporting period 'yes' will have to be entered so that the RCH will be accepted in Austin for the RCS 10-0173 AMIS report. After this new RCH is transmitted this field will automatically be set to NO. Refer to Circular 10-83-8. |
Not Referenced