Restoration House In-Person Screening

General Notes

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Currently employed?

Yes
No

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Currently in school?

Yes
No

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Able to work?

Yes
No

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Where did you stay last night?

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Physical Limitations?

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Receiving disability?

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Needs high needs bed?

Yes
No

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Able to stand, sit, and walk?

Yes
No

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Defiant or resistant?

Yes
No

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Needs bed for a short time?

Yes
No

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Level of Motivation?

Closing Tasks

Intake Decision(Required)*

Planned to accept the applicant?

If so, you have not answered all required questions.

Press the Previous button and unselect “End Interview” or the Disqualifying question and finish the interview.

The applicant must meet the following criteria in order to be a CH Candidate. The applicant’s answers are in the right column.

CRITERIA	CH CANDIDATE	APPLICANT
Defiant or Resistant?	No	Applicant’s Answer
Needs a bed for a short time?	No	Applicant’s Answer
Level of Motivation	≥ 4	Applicant’s Answer
Major Physical Limitations?	No	Applicant’s Answer
Needs High Needs Bed?	No	No
Stand, Sit, Walk?	Yes	Yes
Currently Employed?	No	Applicant’s Answer
Currently in School?	No	Applicant’s Answer
Last Night Stay?	Not Long-term care facility or nursing home AND Not Psychiatric Hospital or Other Psychiatric Facility	Applicant’s Answer
Able to Work? and Receiving Disability?	Yes and No OR No and Receiving Disability	Applicant’s Answer and

Is the applicant a CH Candidate?

Auto selects based on the applicant’s‘s answers. Update if you disagree based on your assessment.

CH Candidate

Is the applicant a CH Candidate?

Auto selects based on the applicant’s‘s answers. Update if you disagree based on your assessment.

CH Candidate

Is the applicant a CH Candidate?

Auto selects based on the applicant’s‘s answers. Update if you disagree based on your assessment.

CH Candidate

You’ve accepted The applicant 🎉!

Communicate to The applicant where to go until Intake and Orientation.

Take the Client’s Photo for their ID Badge

1. Make sure the Logitech webcam is plugged in.
2. Open the Camera App on your laptop.
3. Aim the Logitech camera at the new client.
4. Click the take photo button in the Camera App.
5. After the screening is completed, upload the file to the client’s files in Salesforce.

Done!

Denial Reason(Required)*

Select the reason the applicant was denied entry

, thank you for your interest in staying at Atlanta Mission. Due to the information you shared, , we are unable to serve you within our facility at this time.

Because we are unable to help, there may be another facility that could better assist you, I will send that information to your email/phone.

**The applicant is a mother. When viewing referrals, ensure all referrals offered to mothers with her specific circumstances are checked.

Applicant Email

Applicant Phone Number

SMS/Text Opt-In

I agree to receive text messages (SMS) from Atlanta Mission regarding important updates, appointments, and other operational information related to the services provided to me.

Referrals(Required)*

Please only click the Submit button once. It may take a few moments to process the submission.

restoration house

In-Person Screening

General Info

Observed Behaviors

Medications

Search Google for the generic and brand names of any additional medications not mentioned in the phone screening to confirm they are not banned.

Mental/Behavioral Health

Physical Health

Recovery

Closing Tasks

Take the Client’s Photo for their ID Badge