Name
phone#
GenderMaleFemale
DOB
Social Security #
Medicaid #
Tabs ID
Address
Ethnicity
Language
Diagnosis/Disability
Allergies
Parent/Guardian/Caregiver Name
Telephone
List Services provided by JHS, OPWDD
Consenting statusYesNo
Self advocate YesNo
Self-Determining YesNo
Voting StatusYesNo
Registered to vote YesNo
Shows interest in voting process YesNo
Self-preserving YesNo