McCrory Center

Created At	Client ID #	Last Name	Evaluation Date	Psych Assess Administer Date	Clinical Work Date	Parent Feedback & Casework Date	Parent Feedback Attestation	Examiner	AR Status
Today 09:00 am	01644280	Jace	Feb 28	Feb 28	Mar 06	Mar 07	Parent feedback uploaded to DWIHN	Hale & Co	Parent Feedback Updated	View Edit Remove Assign To Me Assign To User
Today 10:15 am	01644281	Olivia	Mar 01	Mar 01	Mar 07	Mar 08	Parent feedback document uploaded	Trudy Hale LLP	Parent Feedback Updated	View Edit Remove Assign To Me Assign To User
Today 11:30 am	01644282	Liam	Mar 02	Mar 02	Mar 08	Mar 09	Parent feedback completed	Hale & Co	Parent Feedback Updated	View Edit Remove Assign To Me Assign To User
Today 12:45 pm	01644283	Emma	Mar 03	Mar 03	Mar 09	Mar 10	Parent feedback in review	Trudy Hale LLP	Parent Feedback Updated	View Edit Remove Assign To Me Assign To User
Today 01:15 pm	01644284	Noah	Mar 04	Mar 04	Mar 10	Mar 11	Parent feedback uploaded successfully	Hale & Co	Parent Feedback Updated	View Edit Remove Assign To Me Assign To User
Today 02:30 pm	01644285	Lucas	Mar 05	Mar 05	Mar 11	Mar 12	Parent feedback approved	Trudy Hale LLP	Parent Feedback Updated	View Edit Remove Assign To Me Assign To User
Today 03:45 pm	01644286	Ava	Mar 06	Mar 06	Mar 12	Mar 13	Parent feedback verified	Hale & Co	Parent Feedback Updated	View Edit Remove Assign To Me Assign To User
Today 04:00 pm	01644287	Elijah	Mar 07	Mar 07	Mar 13	Mar 14	Parent feedback uploaded successfully	Trudy Hale LLP	Parent Feedback Updated	View Edit Remove Assign To Me Assign To User
Today 05:15 pm	01644288	Charlotte	Mar 08	Mar 08	Mar 14	Mar 15	Parent feedback finalized	Hale & Co	Parent Feedback Updated	View Edit Remove Assign To Me Assign To User

Account Information

Account

Demetrius

Client ID #

01644029

First Name

Demetrius

Last Name

Cassity

Clinical Information

Is this consumer high risk for SIB, Feeding Issues or PICA?

None

Diagnostic Code(s)/Diagnosis

F84.0, F88.0, F80.9

Re-Evaluation

Three Year Recommended

Evaluation Information

Examiner

Tamika Davis-Moore MA LLP

Evaluation Supervisor

Dr. Darryl Warner PH.D LP

Physical protocols used

ADOS-2, BAYLEY

Testing Location

7800 West Outer Dr Ste LL30

Location Code

11-Office

Case Consultations and contacts made with other service providers?

Primary Care Provider DWIHN Records Review Supervisor Guardian

Assessment portion completed

Behavioral Evaluation Psychological Assessment Parent Feedback

Behavioral Evaluation

Evaluation Date (ADOS-2, or Other, ADI-R, PI, DD-GAS, etc)

Feb 27

Evaluation Start & Stop Time

1:30pm-2:30pm

Evaluation Report writing date

Mar 06

ADOS-2, etc Eval Report Start and Stop Time

10am-12pm

Psychological Assessment

Psych Assess Administer Date

Feb 27

Psych Admin Start and Stop Time

12:30pm-1:30pm

Psych Assess Scoring Date

Feb 27

Psych Assess Score Start and Stop Time

8pm-9pm

Clinical Work For Psy Reporting Writing, Consult, Etc. Date

Mar 06

Clinical Work Start and Stop Time

12:30pm-2:30pm

Other Dates/Times

Other dates/times

None

Parent Feedback

Parent Feedback & Casework Date

Mar 07

Start and Stop Time

4pm-4:45pm

Location

Audio-Telehealth

Parent Feedback Response

Parent was receptive of feedback Examiner reviewed results and provided parent with the opportunity to ask questions Examiner interpreted meaning of results and provided treatment recommendation

Parent Feedback & Casework Note

Provided information for obtaining an IEP, Early On and parent training. Explained ABA and applying for SSA.

Report Upload

Upload Report

MC BH Report Demetrius C.signed.pdf

Quality Assurance

I completed the case transfer form (if applicable)

The report is completed, signed and uploaded to DWIHN

I attest the information is accurate and assume liabilities for any inaccuracies

Providers certify that a claim is true, accurate, and contains no false or erroneous information.