| Updated On | [date-and-time] | Updated By | [User Name] [View History] |
|---|---|---|---|
| Effective Date of Change | [Date] | ||
| Approval Requested | [True] | Approval Status | [Approved] [View History] |
[View History]Living Arrangement Details
| Household Member | [Full Name] |
|---|
| Arrangement Type | [field-value] | Arrangement Status | [field-value] |
|---|---|---|---|
| Start Date | [Date] | End Date | [Date] |
| Probable End Date | [Date] | Number of Meals per Day | [field-value] |
| Addicted to Drugs or Alcohol | [True] |
Facility Details
| Facility Participant | [Full Name] |
|---|
Comments
| [Comments] |