<?xml version="1.0" encoding="UTF-8"?>
<PreEncounter>
	<SenderData ProviderName="My Org" ProviderETIN="94203283999" BatchNumber="20060504-007"/>
	<DocumentFunction DocumentNumber="20060504-007-001" DocumentFunction="6" DMHID="700106">
		<EpisodeCare Division="ADA" EnrollingProviderSiteName="Eldon" EnrollingProviderSiteID="408" AdmissionDateTime="2006-03-23 12:00">
			<ProgramAssignment Program="ADACSTARGen " ProgramFromDate="2006-04-10" ProgramFromTime="12:00 PM" Status="5" ProgramToDate="2006-05-04" ProgramToTime="08:00">
				<ADAProgramClosure DateInfoReceivedfromConsumer="2006-05-04" CodependentIndicator="0" MethodoneUsePlan="0" NumArrestsInTreatment="0" HIVTest="3" ServiceCounty="033" PsychologicalProblemIndicator="0" DevelopmentProblemIndicator="0" TuberculosisTreatmentIndicator="0" VeteranStatusIndicator="1" EnrolledInSchool="1" PriorDetox="3" PriorResidential="0" PriorOutpatient="1" NumberofArrests="0" NumberofDUIArrests="0" IncomeSource="2" PrimarySourcePayment="07" WeeklyIncomeCode="Over" MonthlyIncomeAmt="6000" LegalStatus="1" LivingArrangement="09" Education="19" SpecialEducation="19" PrimarySubstanceAbused="1101" PrimarySAFrequency="0" PrimarySARoute="1" PrimarySAAgeFirstUsed="25"/>
				<ADAProgClosureSocialSupportRecovery SocialSupportRecoveryActivities="OTHER"/>
				<ADAProgClosureSocialSupportRecovery SocialSupportRecoveryActivities="RELIGIOUS"/>
				<ADAProgClosureSocialSupportRecovery SocialSupportRecoveryActivities="INTERACTION"/>
				<ADAProgClosurePubAsst PublicAssistance="21"/>
				<ADAProgClosurePubAsst PublicAssistance="36"/>
				<ADAProgClosureMeds MedicationPrescribed="10"/>
				<ADAProgClosureMeds MedicationPrescribed="11"/>
			</ProgramAssignment>
		</EpisodeCare>
	</DocumentFunction>
</PreEncounter>
