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Hey guys and girls, this is a first stab at an online note page. This program does not allow me to make a table with all open ended notes so you will find a box for each visit. Let me know if this will work. Play around with phony data, I can delete it when we start.
 
 
 
Who are you?
 
Nelson Grit
 
Susan Steinke
 
John Weir
 
Other
 
 
 
 
First Visit Date:
   
 
 
 
Participant Name:
   
 
 
 
Participant Address:
   
 
 
 
Waiver Agent:
 
A&D Home Health
 
AAA of Western Michigan
 
Area Agency on Aging 1B
 
Blue Water CIL
 
Detroit Area Agency on Aging
 
Disability Advocates of Kent County
 
Disability Connection of West Michigan DC
 
Disability Connections Jackson DCJ
 
Disability Network Lakeshore DN/L
 
Disability Network Mid-Michigan DN/MM
 
Disability Network Southwest DN/SW
 
Disability Network Wayne County-Detroit DN/WCD
 
HHS, Inc.
 
MORC
 
Northern Lakes CMH
 
Region 11
 
Region 2 Area Agency on Aging
 
Region 3B Area Agency on Aging
 
Region 9 Area Agency on Aging
 
Area Agency on Aging IV
 
Region VII Area Agency on Aging
 
Senior Resources
 
Senior Services, Inc.
 
Superior Alliance for Independent Living (SAIL)
 
The Disability Network, Flint (TDN)
 
The Information Center
 
The Senior Alliance
 
Tri-county Office on Aging
 
Valley Area Agency on Agin
 
 
 
Issue:
   
 
 
 
Outcome:
   
 
 
 
Date
   
Time
   
Notes ((include title/descriptor with names)
   
 
 
 
Date
   
Time
   
Notes ((include title/descriptor with names)
   
 
 
 
Date
   
Time
   
Notes ((include title/descriptor with names)
   
 
 
 
Date
   
Time
   
Notes ((include title/descriptor with names)
   
 
 
 
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