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Waiting Placement (121)
Pending Placement (15)
Recently Placed (27)

Waiting Placement
Member	Member ID	Admission ID	City	Start Date	Stop Date	ROC	Service Coordinator	Actions
Thomas Jefferson DoB: 04/17/1743	1234567	87654321	Portland	01/01/2020	01/01/2021	-	-	Add Placement
Thomas Jefferson DoB: 04/17/1743	1234567	87654321	Portland	01/01/2020	01/01/2021	-	-	Add Placement
Thomas Jefferson DoB: 04/17/1743	1234567	87654321	Portland	01/01/2020	01/01/2021	-	-	Add Placement
Thomas Jefferson DoB: 04/17/1743	1234567	87654321	Portland	01/01/2020	01/01/2021	-	-	Add Placement
Thomas Jefferson DoB: 04/17/1743	1234567	87654321	Portland	01/01/2020	01/01/2021	-	-	Add Placement
Thomas Jefferson DoB: 04/17/1743	1234567	87654321	Portland	01/01/2020	01/01/2021	-	-	Add Placement
Thomas Jefferson DoB: 04/17/1743	1234567	87654321	Portland	01/01/2020	01/01/2021	-	-	Add Placement
Thomas Jefferson DoB: 04/17/1743	1234567	87654321	Portland	01/01/2020	01/01/2021	-	-	Add Placement
Thomas Jefferson DoB: 04/17/1743	1234567	87654321	Portland	01/01/2020	01/01/2021	-	-	Add Placement
Thomas Jefferson DoB: 04/17/1743	1234567	87654321	Portland	01/01/2020	01/01/2021	-	-	Add Placement

1 - 10 of 121

Pending Placement
Member	Member ID	Admission ID	City	Start Date	Stop Date	Broadcast	Request Sent	Response Expected	Status	Service Coordinator	Actions
Thomas Jefferson DoB: 04/17/1743	1234567	87654321	Portland	01/01/2020	01/01/2021	Northeast Home Services TIN: 1234567	02/20/2020 07:57:07 AM	02/25/2020 07:57:07 AM	No answer	-	View Placement Add 30 min Cancel Request
Thomas Jefferson DoB: 04/17/1743	1234567	87654321	Portland	01/01/2020	01/01/2021		02/20/2020 07:57:07 AM	02/25/2020 07:57:07 AM	Pending	-	View Placement Add 30 min Cancel Request
Thomas Jefferson DoB: 04/17/1743	1234567	87654321	Portland	01/01/2020	01/01/2021	Northeast Home Services TIN: 1234567	02/20/2020 07:57:07 AM	02/25/2020 07:57:07 AM	Pending	-	View Placement Add 30 min Cancel Request
Thomas Jefferson DoB: 04/17/1743	1234567	87654321	Portland	01/01/2020	01/01/2021	Northeast Home Services TIN: 1234567	02/20/2020 07:57:07 AM	02/25/2020 07:57:07 AM	Denied	-	View Placement Add 30 min Cancel Request
Thomas Jefferson DoB: 04/17/1743	1234567	87654321	Portland	01/01/2020	01/01/2021	Northeast Home Services TIN: 1234567	02/20/2020 07:57:07 AM	02/25/2020 07:57:07 AM	Denied	-	View Placement Add 30 min Cancel Request
Thomas Jefferson DoB: 04/17/1743	1234567	87654321	Portland	01/01/2020	01/01/2021		02/20/2020 07:57:07 AM	02/25/2020 07:57:07 AM	Needs more time	-	View Placement Add 30 min Cancel Request
Thomas Jefferson DoB: 04/17/1743	1234567	87654321	Portland	01/01/2020	01/01/2021	Northeast Home Services TIN: 1234567	02/20/2020 07:57:07 AM	02/25/2020 07:57:07 AM	No answer	-	View Placement Add 30 min Cancel Request
Thomas Jefferson DoB: 04/17/1743	1234567	87654321	Portland	01/01/2020	01/01/2021	Northeast Home Services TIN: 1234567	02/20/2020 07:57:07 AM	02/25/2020 07:57:07 AM	Needs more time	-	View Placement Add 30 min Cancel Request
Thomas Jefferson DoB: 04/17/1743	1234567	87654321	Portland	01/01/2020	01/01/2021	Northeast Home Services TIN: 1234567	02/20/2020 07:57:07 AM	02/25/2020 07:57:07 AM	Needs more time	-	View Placement Add 30 min Cancel Request
Thomas Jefferson DoB: 04/17/1743	1234567	87654321	Portland	01/01/2020	01/01/2021	Northeast Home Services TIN: 1234567	02/20/2020 07:57:07 AM	02/25/2020 07:57:07 AM	Denied	-	View Placement Add 30 min Cancel Request

1 - 10 of 15

Recently Placed
Member	Member ID	Admission ID	City	Start Date	Stop Date	Provider	Request Sent	Service Coordinator
Thomas Jefferson DoB: 04/17/1743	1234567	87654321	Portland	01/01/2020	01/01/2021	Northeast Home Services TIN: 1234567	02/20/2020 07:57:07 AM	-
Thomas Jefferson DoB: 04/17/1743	1234567	87654321	Portland	01/01/2020	01/01/2021	Northeast Home Services TIN: 1234567	02/20/2020 07:57:07 AM	-
Thomas Jefferson DoB: 04/17/1743	1234567	87654321	Portland	01/01/2020	01/01/2021	Northeast Home Services TIN: 1234567	02/20/2020 07:57:07 AM	-
Thomas Jefferson DoB: 04/17/1743	1234567	87654321	Portland	01/01/2020	01/01/2021	Northeast Home Services TIN: 1234567	02/20/2020 07:57:07 AM	-
Thomas Jefferson DoB: 04/17/1743	1234567	87654321	Portland	01/01/2020	01/01/2021	Northeast Home Services TIN: 1234567	02/20/2020 07:57:07 AM	-
Thomas Jefferson DoB: 04/17/1743	1234567	87654321	Portland	01/01/2020	01/01/2021	Northeast Home Services TIN: 1234567	02/20/2020 07:57:07 AM	-
Thomas Jefferson DoB: 04/17/1743	1234567	87654321	Portland	01/01/2020	01/01/2021	Northeast Home Services TIN: 1234567	02/20/2020 07:57:07 AM	-
Thomas Jefferson DoB: 04/17/1743	1234567	87654321	Portland	01/01/2020	01/01/2021	Northeast Home Services TIN: 1234567	02/20/2020 07:57:07 AM	-
Thomas Jefferson DoB: 04/17/1743	1234567	87654321	Portland	01/01/2020	01/01/2021	Northeast Home Services TIN: 1234567	02/20/2020 07:57:07 AM	-
Thomas Jefferson DoB: 04/17/1743	1234567	87654321	Portland	01/01/2020	01/01/2021	Northeast Home Services TIN: 1234567	02/20/2020 07:57:07 AM	-

1 - 10 of 27

Broadcast (4) for Thomas Jefferson

Broadcasted Providers for Thomas Jefferson
Provider	TIN	NPI	Agency Type	Status
Northeast Home Services	1234567	87654321	Home Care	Active
Northeast Home Services	1234567	87654321	Home Care	Inactive
Northeast Home Services	1234567	87654321	Home Care	Inactive
Northeast Home Services	1234567	87654321	Home Care	Active