COPYRIGHT © 2019 SISTERS IN COMMON
Client Billing Dashbord
Client Name & DOB | |
| Elfalan | David |
| Date of Birth: | June 21, 1959 |
Address & Contact Info | |
| 15150 140th way SE | |
| unit K102 | |
| Renton | WA |
| 98058 | United States |
| Phone: 2065120079 | Email: davidelfalan@gmail.com |
Insurance Information | |
| Insurance Provider: | MOLINA |
| Policy Number: 5678w90-289 | Group Number: 5467834 |
Consent | |
| Has client given consent for healthcare services : Yes | Does client have a support system: Yes, I have a strong support system |
| Service Encounter | |
| Date: | August 25, 2024 |
| Client ID: | drx2062024 |
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| Goals | |
| Goal 1: | Increase client’s understanding of the benefits to her health and safety of creating a safe shower environment. |
| Goal 2: | Encourage the client to consider using or installing railings and a shower bench in her shower. |
| Progress Toward Goals:
still in progress but completed goal 1 |
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| Peer Support Services Provided | |
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Provider Signature:  |
Date: August 27, 2024 |
Supervisor Signature:  |
Date: August 28, 2024 |