| # | Name | Location | Type | Details | Index | Description |
|---|---|---|---|---|---|---|
| .01 | name(+) | 0;1 | POINTER | 2 | B | This field is used for the patient's name. |
| .02 | file entry date(+) | 0;2 | DATE-TIME | This field is used to show date the data was entered. | ||
| .022 | source of referral | 0;21 | FREE TEXT | This field is used to show where the source of referral was made from. | ||
| .0221 | source of information(+) | 18;1 | FREE TEXT | This field is used to show where the source of information was received from. | ||
| .023 | referral date(+) | 0;24 | DATE-TIME | This field is used to show the date referral was made. | ||
| .03 | primary social worker(+) | 0;3 | POINTER | 200 | C | This field is used to show what social worker first entered data on a patient. |
| .031 | primary case number(+) | 0;12 | POINTER | 650 | This field is used to show first case number for patient. | |
| .04 | supervisor(+) | 0;13 | POINTER | 200 | E | This field is used to show the social worker's supervisor. |
| .05 | surrogate | 0;14 | POINTER | 200 | AC | This is the surrogate supervisor for another supervisor. |
| 1 | other financial resources | 1;0 | WORD-PROCESSING | This field is used to enter description of other financial resources of veteran. | ||
| 2 | employ/financial assessment | 2;0 | WORD-PROCESSING | This field is used to enter employment and financial assessments of veteran. | ||
| 2.1 | is income sufficient ? | 0;20 | SET OF CODES | 1:YES 2:NO 0:UNKNOWN | This field is used to show if reported income is sufficient to meet veteran's needs. | |
| 2.3 | potential employability | 0;22 | SET OF CODES | 1:YES 2:NO U:UNKNOWN | This field is used to show if veteran has any employability potential. | |
| 3 | special training/skills | 3;0 | WORD-PROCESSING | This field is used to enter any special training or skills of the veteran. | ||
| 4 | educational assessment | 4;0 | WORD-PROCESSING | This field is used to enter educational assessment of the veteran. | ||
| 4.1 | highest level of education | 0;23 | SET OF CODES | 1:LESS THAN 6 2:6 - 12 3:12 - 16 4:MORE THAN 16 | This field is used to show highest level of education attained. | |
| 4.2 | educational program/school? | 0;4 | BOOLEAN | 1:YES | This field is used to show if veteran is currently enrolled in a educational program/trade. | |
| 5 | military assessment | 5;0 | WORD-PROCESSING | This field is used to enter military assessment of the veteran. | ||
| 5.1 | military adjustment | 0;19 | FREE TEXT | This field is used to enter military assessment of veteran. | ||
| 6 | spouse's name | 6;1 | FREE TEXT | This field is used to enter the name of the veteran's spouse. This information is recommended to be entered if the spouse is not listed as the primary next of kin. | ||
| 6.1 | address 1 | 6;2 | FREE TEXT | This field is used to enter the address of the spouse. | ||
| 6.2 | address 2 | 6;3 | FREE TEXT | This field is used to enter a second line for the address. | ||
| 6.3 | city | 6;4 | FREE TEXT | This field is used to enter the name of the city in which the spouse lives. | ||
| 6.4 | state | 6;5 | POINTER | 5 | This field is used to show what state the spouse resides. | |
| 6.5 | zip | 6;6 | FREE TEXT | This field is used to enter the zip code of the spouse. | ||
| 6.6 | phone number | 6;7 | FREE TEXT | This field is used to enter the phone number of the spouse. | ||
| 7 | children's name | 7;0 | MULTIPLE | 655.28 | This multiple field is used to enter the name(s) of veterans's children if there are any. | |
| 9 | mother | 9;1 | FREE TEXT | This field is used to enter name of the veteran's mother. | ||
| 9.1 | father | 9;2 | FREE TEXT | This field is used to enter the name of the veteran's father. | ||
| 9.2 | siblings | 9;3 | FREE TEXT | This field is used to enter the siblings of the veteran. | ||
| 10 | initial plan of action | 10;0 | WORD-PROCESSING | This field is used to enter plan of action as related to problems entered. | ||
| 11 | caregiver | 11;0 | MULTIPLE | 655.32 | This sub field is used to enter potential caregivers for the veteran. | |
| 12 | comments | 12;0 | WORD-PROCESSING | This field is used to enter comments about the social/family assessment. | ||
| 13 | social support system | 13;0 | WORD-PROCESSING | This field is used to enter social support system. | ||
| 14 | use of community resources | 14;0 | WORD-PROCESSING | This field is used to enter Use of Available Community Resources. | ||
| 15 | current living arrangements | 0;15 | SET OF CODES | 1:ALONE 2:SPOUSE 3:RELATIVES 4:NON-RELATIVES 5:GROUP QUARTERS, NOT HEALTH RELATED 6:GROUP QUARTERS, HEALTH RELATED | This field is used to enter living arrangements of the veteran. | |
| 16 | social/family assessment | 16;0 | WORD-PROCESSING | This field is used to enter Social and Family Assessments. | ||
| 17 | preliminary problems | 17;0 | MULTIPLE | 655.38 | This sub file is used to enter preliminary problems of veterans. | |
| 17.1 | progress note date(+) | 18;2 | DATE-TIME | This field is used to enter date that progress note was entered/edited. | ||
| 18 | notes section | 23;0 | MULTIPLE | 655.218 | This section of file #655.2 will contain notes about the patients. | |
| 29.1 | durable power of attorney | 22;1 | SET OF CODES | 1:YES 0:N0 | This field is used to show if there is a power of attorney. | |
| 29.2 | living will | 22;2 | BOOLEAN | 1:YES 0:NO | This field is used to show there is a Living Will. | |
| 29.3 | guardianship | 22;3 | BOOLEAN | 1:YES 0:NO | This field is used to show guardianship if applicable. | |
| 29.4 | attorney's name | 22;4 | FREE TEXT | This field is used to show the name of the Power of Attorney. | ||
| 29.5 | address | 22;5 | FREE TEXT | This field is used to show the address of the attorney. | ||
| 29.6 | address 2 | 22;6 | FREE TEXT | This field is used to enter a second address. | ||
| 29.7 | city | 22;7 | FREE TEXT | This field is used to show what city the attorney resides. | ||
| 29.8 | state | 22;8 | POINTER | 5 | This field is used to show what state the attorney resides. | |
| 29.9 | zip | 22;9 | FREE TEXT | This field is used to enter the zip code. | ||
| 29.91 | phone number | 22;10 | FREE TEXT | This field is used to enter the phone number of the attorney. | ||
| 29.92 | guardian's name | 22;11 | FREE TEXT | This field is used to enter the name of the veteran's guardian. | ||
| 29.93 | address | 22;12 | FREE TEXT | This field is used to enter the address of the guardian. | ||
| 29.94 | address 2 | 25;1 | FREE TEXT | This field is used to enter a second line for address. | ||
| 29.95 | city | 25;2 | FREE TEXT | This field is used to show what city the guardian resides. | ||
| 29.96 | state | 25;3 | POINTER | 5 | This field is used to show what state the guardian resides. | |
| 29.97 | zip | 25;4 | FREE TEXT | This field is used to show the zip code of the guardian. | ||
| 29.98 | phone number | 25;5 | FREE TEXT | This field is used to show the phone number of the guardian. | ||
| 30 | legal assessment | 15;0 | WORD-PROCESSING | This field is used to enter any legal assessment. | ||
| 31 | current substance abuse | 0;25 | SET OF CODES | 1:YES 2:NO U:UNKNOWN | This field is used to indicate if there is any known substance abuse problem. | |
| 31.1 | substance abuse comment | 8;0 | WORD-PROCESSING | This field is used to enter comments about any known substance abuse problems. | ||
| 32 | psycho-social assessment | 19;0 | WORD-PROCESSING | This sub file is used to enter overall impressions of the psycho-social assessment of the veteran. |
Not Referenced