Appendix D, Service Record for CRS Data Reporting System

For more information please refer to the Data Reporting System User Guide.

Required InformationDescription
Facility NameProvider name
Facility NumberReHabWorks/Contract number
CRS ID Case NumberCRS assigned id case number
Facility case numberFacility assigned case or medical record number. If facility does not have such a number, repeat CRS ID case number in this field
Participant First NameParticipant first name
Participant Last NameParticipant last name
Service Authorization number (ID purchase order)Id purchase order (same as service authorization) number
PABI SettingResidential or Non Residential
Service TypeSee Service list
Service DescriptionSee Service List
Service LocationSee Location list
Service Location Other (Specify)If other, specify
Service Start DateService date of therapy
Provided bySee Provider Type List
Total Number of TherapistsNumber of therapists delivering service
Number of 15 Minute Units DeliveredNumber of 15 minute units delivered
Setting type – “Individual”, “Group”, or TeamIndividual, Group or Team
If Group, Enter # of ParticipantsIf group, number of participants