Free HSRS Family Support Program Module Deskcard - Wisconsin

2009 HSRS FAMILY SUPPORT PROGRAM MODULE DESKCARD
MODULE TYPE 5 CLOSING REASON (FIELD 10)
06 36 37 38 40 42 43 44 45 46 Death of child Insufficient funds to provide needed services Child at home but family doesn't need services Family no longer wants service Temporary interruption in Family Support services Family referred to other program(s) Family relocated Child placed in alternate care Child no longer meets eligibility Child transitions to adult living arrangement

CLIENT CHARACTERISTICS (FIELD 12)
07 08 32 79 09 85 86 02 03 19 23 25 26 27 28 61 62 63 Blind / visually impaired Hard of hearing Blind / deaf Deaf Physical disability / mobility impaired Severe health impairments Severe emotional disturbance Mental illness - excluding SPMI Serious and persistent mental illness (SPMI) Developmental disability - brain trauma Developmental disability - cerebral palsy Developmental disability ­ autism spectrum Developmental disability - mental retardation Developmental disability - epilepsy Developmental disability - other or unknown CHIPS - abuse and neglect CHIPS - abuse CHIPS - neglect

TARGET GROUP (FIELD 33)
01 Developmental disability 31 Mental health 57 Physical or sensory disability

SOS DESK (608) 266-9198 8:00 - 11:30 A.M. and 12:30 - 4:00 P.M. or leave a voice mail message. E-mail address: [email protected] Fax (608) 267-2437 HSRS Handbook and Terminal Operator's Guide: http://www.dhs.wisconsin.gov/HSRS/index.htm WI Department of Health Services Division of Enterprise Services F-20468I (Rev. 01/2009)