<PreEncounter>
	<SenderData ProviderName="ProviderName" ProviderETIN="12345678" BatchNumber="00001"/>
	<DocumentFunction DocumentNumber="0000001" DocumentFunction="0" DMHID="987654">
		<ConsumerData>
			<Name LastName="LastName" FirstName="FirstName" MiddleName="MiddleName" Prefix="DR" Suffix="Jr" Credential="CPA"/>
			<Demographics Gender="2" DateOfBirth="1999-05-31" HearingStatus="145" PreferredLanguage="1" MaritalStatus="1" EmploymentStatus="1" Occupation="1"/>
			<Address Street1="AnyStreet" Street2="Street2" City="City" State="State" County="51" Zip="55555" Country="US"/>
			<Race White="1" Black_AfricanAmerican="1" Asian="1" NativeHawiian_PacificIslander="1" AmIndian_NativeAlaskan="1" OtherRace="1" OtherRaceDesc="OtherRace" NotOfHispanicOrigin="1" Hispanic_Mexican="1" Hispanic_Cuban="1" Hispanic_PuertoRican="1" OtherHispanic="1" OtherHispanicDesc="OtherHispanicDesc"/>
			<StandardMeansTest FromDate="2006-03-01" MonthlyAbilityToPayAmt="59" PreparedBy="John Doe"/>
		</ConsumerData>
		<EpisodeCare Division="CPS" EnrollingProviderSiteName="EnrollingProviderSite" EnrollingProviderSiteID="112" AdmissionDateTime="2006-03-01 14:30" AdmissionReason="1" ReferralSource="1" ReferralOffice="22244" LocalChartNumber="999998999" FamilySize="4" NumberOfChildrenInCare="2" DischargeReason="DischargeReason" DischargeDateTime="2006-04-15 12:00" DischargeDiagnosisCode="1111" TypeofFollowUp="1">
			<Diagnosis Axis="1" DiagnosisDateTime="2006-03-01 14:30" DiagnosticianName="DiagnosticianName" DiagnosisCodeSet="ICD-9" DiagnosisCode="50001" Status="Admission" Severity="Mild" Principal="0" Primary="0" StressorCategory="1" Chronicity="Acute" CurrentGAF="33"/>
			<Commitments CommitmentType="100" CommitmentFromDate="2006-03-01" CommitmentToDate="2006-04-15" CommitmentCounty="193" PrimaryIndicator="0"/>
			<ProgramAssignment Program="ADACPSAD" ProgramFromDate="2006-03-01" ProgramFromTime="02:30 PM" Status="1" LivingArrangement="1" ProgramToDate="2006-04-01" ProgramToTime="12:00 PM" ProgramLevel="1" ProgramLevelFromDate="2006-03-01" ProgramLevelFromTime="02:30 PM">
				<ADAProgramAssignment DateInfoReceivedfromConsumer="2006-03-01" PrimarySubstanceAbused="1401" PrimarySAFrequency="1" PrimarySARoute="1" PrimarySAAgeFirstUsed="01" SecondarySubstanceAbused="9996" SecondarySAFrequency="NA" SecondarySARoute="NA" SecondarySAAgeFirstUsed="NA" TertiarySubstanceAbused="9996" TertiarySAFrequency="NA" TertiarySARoute="NA" TertiarySAAgeFirstUsed="NA" ServiceCounty="59" PsychologicalProblemIndicator="0" DevelopmentProblemIndicator="0" TuberculosisTreatmentIndicator="0" CurrentPregnant="0" VeteranStatusIndicator="0" EnrolledInSchool="0" PriorDetox="0" PriorResidential="0" PriorOutpatient="0" NumberofArrests="10" NumberofDUIArrests="06" IncomeSource="15" PrimarySourcePayment="1" WeeklyIncomeCode="99" MonthlyIncomeAmt="19" LegalStatus="1" LivingArrangement="1" Education="10" SpecialEducation="12" GradePointAverage="9" PrimaryHealthInsurance="21"/>
				<ADAProgAssignSocialSupportRecovery SocialSupportRecoveryActivities="INTERACTION"/>
				<ADAProgAssignPubAsst PublicAssistance="11"/>
				<ADAProgAssignMeds MedicationPrescribed="0"/>
				<ADAProgramClosure DateInfoReceivedfromConsumer="2006-04-15" NumArrestsInTreatment="997" HIVTest="2" PrimarySubstanceAbused="1" PrimarySAFrequency="1" PrimarySARoute="1" PrimarySAAgeFirstUsed="21" SecondarySubstanceAbused="1608" SecondarySAFrequency="08" SecondarySARoute="0" SecondarySAAgeFirstUsed="43" TertiarySubstanceAbused="9996" TertiarySAFrequency="NA" TertiarySARoute="NA" TertiarySAAgeFirstUsed="NA" ServiceCounty="27" PsychologicalProblemIndicator="0" DevelopmentProblemIndicator="0" TuberculosisTreatmentIndicator="0" CurrentPregnant="0" VeteranStatusIndicator="0" EnrolledInSchool="0" PriorDetox="0" PriorResidential="0" PriorOutpatient="0" NumberofArrests="997" NumberofDUIArrests="04" IncomeSource="21" PrimarySourcePayment="7" WeeklyIncomeCode="99" MonthlyIncomeAmt="42" LegalStatus="5" LivingArrangement="6" Education="6" SpecialEducation="10" GradePointAverage="10" PrimaryHealthInsurance="21"/>
				<ADAProgClosureSocialSupportRecovery SocialSupportRecoveryActivities="RELIGIOUS"/>
				<ADAProgClosurePubAsst PublicAssistance="11"/>
				<ADAProgClosureMeds MedicationPrescribed="4"/>
			</ProgramAssignment>
		</EpisodeCare>
	</DocumentFunction>
</PreEncounter>
