<PreEncounter>
	<SenderData ProviderName="MyOrg Name" ProviderETIN="xxxxxxxxxxx" BatchNumber="20151203_1"/>
	<DocumentFunction DocumentNumber="20151203_1_1" DocumentFunction="A" DMHID="xxxxxx">
		<EpisodeCare Division="ADA" EnrollingProviderSiteName="MyOrg Site Name" EnrollingProviderSiteID="xxxx" AdmissionDateTime="2015-11-01 08:00 AM">
			<Assessments>
				<AssessmentDLA AssessmentDLAType="AD" AssessmentDate="2015-11-20" RaterLastName="Daffy" RaterFirstName="Duck">
					<AssessmentDLAAnswer Question="1" Score="1"/>
					<AssessmentDLAAnswer Question="2" Score="0"/>
					<AssessmentDLAAnswer Question="3" Score="3"/>
					<AssessmentDLAAnswer Question="4" Score="4"/>
					<AssessmentDLAAnswer Question="5" Score="1"/>
					<AssessmentDLAAnswer Question="6" Score="6"/>
					<AssessmentDLAAnswer Question="7" Score="7"/>
					<AssessmentDLAAnswer Question="8" Score="1"/>
					<AssessmentDLAAnswer Question="9" Score="2"/>
					<AssessmentDLAAnswer Question="10" Score="1"/>
					<AssessmentDLAAnswer Question="11" Score="4"/>
					<AssessmentDLAAnswer Question="12" Score="5"/>
					<AssessmentDLAAnswer Question="13" Score="6"/>
					<AssessmentDLAAnswer Question="14" Score="7"/>
					<AssessmentDLAAnswer Question="15" Score="1"/>
					<AssessmentDLAAnswer Question="16" Score="1"/>
					<AssessmentDLAAnswer Question="17" Score="3"/>
					<AssessmentDLAAnswer Question="18" Score="4"/>
					<AssessmentDLAAnswer Question="19" Score="5"/>
					<AssessmentDLAAnswer Question="20" Score="6"/>
				</AssessmentDLA>
				<AssessmentCPSStatusReport DrugUsage="0" DrinkingThinkShouldCutBack="0" DrinkingMoreThanMeant="2" MoreThanStandardDrinks="0" TobaccoUse="0" NumberOfArrestsLast30Days="00" PartTimeEstWeeklyHour="10" CPSEmploymentStatus="PART" CPSEducationLevel="GRAD" CPSEducationAttendanceStatus="UNKN" CPSResidentialStatus="RESCARE" CPSAssessmentType="ADMIT" ModifiedGAFScore="10" ReportingDate="2015-12-06"/>
			</Assessments>
		</EpisodeCare>
	</DocumentFunction>
	<DocumentFunction DocumentNumber="20151203_1_2" DocumentFunction="A" DMHID="xxxxxx">
		<EpisodeCare Division="ADA" EnrollingProviderSiteName="MyOrg Site Name" EnrollingProviderSiteID="xxxx" AdmissionDateTime="2015-12-11 08:00 AM">
			<Assessments>
				<AssessmentCPSStatusReport DrugUsage="0" DrinkingThinkShouldCutBack="0" DrinkingMoreThanMeant="2" MoreThanStandardDrinks="0" TobaccoUse="0" NumberOfArrestsLast30Days="00" PartTimeEstWeeklyHour="10" CPSEmploymentStatus="PART" CPSEducationLevel="GRAD" CPSEducationAttendanceStatus="UNKN" CPSResidentialStatus="RESCARE" CPSAssessmentType="ADMIT" ModifiedGAFScore="10" ReportingDate="2015-12-09"/>
				<AssessmentDLA AssessmentDLAType="AD" AssessmentDate="2015-12-12" RaterLastName="Daffy" RaterFirstName="Duck">
					<AssessmentDLAAnswer Question="1" Score="1"/>
					<AssessmentDLAAnswer Question="2" Score="4"/>
					<AssessmentDLAAnswer Question="3" Score="3"/>
					<AssessmentDLAAnswer Question="4" Score="4"/>
					<AssessmentDLAAnswer Question="5" Score="1"/>
					<AssessmentDLAAnswer Question="6" Score="6"/>
					<AssessmentDLAAnswer Question="7" Score="7"/>
					<AssessmentDLAAnswer Question="8" Score="1"/>
					<AssessmentDLAAnswer Question="9" Score="2"/>
					<AssessmentDLAAnswer Question="10" Score="1"/>
					<AssessmentDLAAnswer Question="11" Score="4"/>
					<AssessmentDLAAnswer Question="12" Score="5"/>
					<AssessmentDLAAnswer Question="13" Score="6"/>
					<AssessmentDLAAnswer Question="14" Score="7"/>
					<AssessmentDLAAnswer Question="15" Score="1"/>
					<AssessmentDLAAnswer Question="16" Score="1"/>
					<AssessmentDLAAnswer Question="17" Score="3"/>
					<AssessmentDLAAnswer Question="18" Score="4"/>
					<AssessmentDLAAnswer Question="19" Score="5"/>
					<AssessmentDLAAnswer Question="20" Score="6"/>
				</AssessmentDLA>
			</Assessments>
		</EpisodeCare>
	</DocumentFunction>
</PreEncounter>
