| HCBS Case Mix & Budget Tool (CASE MIX)|
| Q15. SPECIAL NURSING
| <*Answer_8550*>
| Q16. NEUROMUSCULAR DIAGNOSIS"
| <*Answer_8551*>
| COMMENTS
| <*Answer_8552*>
| SOURCES
| <*Answer_8553*>
| Date Given: <.Date_Given.>| Clinician: <.Staff_Ordered_By.>| Location: <.Location.>
| | Veteran: <.Patient_Name_Last_First.>| SSN: <.Patient_SSN.>| DOB: <.Patient_Date_Of_Birth.> (<.Patient_Age.>)
| Gender: <.Patient_Gender.>|
| Type of Evaluation: <*Answer_8580*>
| Anticipated Start Date: <*Answer_8581*>
| Anticipated Length of Service: <*Answer_8582*>|
| <*Answer_7771*>
| Questions and Answers:|<*Answer_7772*>
|
