{"text_format":"1","workbook":"xlsx","n_sheets":26,"sheets":["Cover sheet","Printing Instructions","WORK_MFEI info","Tips","Member Information","Residency Information","Health and Safety Information","Diagnosis Information","Bathing & Personal Hygiene","Dressing","Prosthetic, Orthotic, Other Dev","Toileting","Eating","Other ADLs","Medication Management","Meal Support","Shopping","Housekeeping","Laundry","Transportation","Money Management","Other IADLs","Supported Employment","Total Hrs Supprt & Alloc Req","Additional WORK Services","Signature Page"],"not_rendered":{"charts":0,"images":4,"macros":1,"external_links":0,"defined_names":9,"comments":0,"pivot_tables":0},"unopened":[],"bounds":{"document_bytes":16777216,"sheet_cells":100000,"rows_first":2000,"rows_last":500,"rows_between":2000,"halvings":0,"cell_chars":16384,"cell_head_chars":4096},"cells_cut":0,"cells_raw":0,"read":"whole","date_system":"1900"}

{"sheet":"Cover sheet","index":0,"n_rows":38,"n_cols":2,"rows_kept":38,"cut":false,"hidden":false,"merged":[[35,1,35,35],[36,1,36,35],[37,1,37,35],[33,1,33,35],[31,1,31,33],[32,1,32,33],[18,1,18,35],[19,1,19,35],[20,1,20,35],[21,1,21,35],[34,1,34,35],[22,1,27,35],[28,1,28,33],[29,1,29,33]]}
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[null,"Work Opportunities Reward Kansans (WORK)"]
[null,"Kansas Personal Assistance Program for Employed Persons with Disabilities"]
[]
[]
[null,"WORK Assessment and Allocation Instrument"]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[null,"Kansas Department of Health and Environment"]
[null,"Kansas Working Healthy Program"]
[null,"900 SW Kansas, Suite 900N"]
[null,"Topeka, KS   66612"]

{"sheet":"Printing Instructions","index":1,"n_rows":15,"n_cols":2,"rows_kept":15,"cut":false,"hidden":true,"merged":[[11,1,11,9],[12,1,12,9],[14,1,14,9],[0,0,0,9],[5,0,5,9],[6,1,6,9],[10,0,10,9]]}
["How to print the whole workbook (the workbook consists of all pages from all the sheets)?"]
[1,"Select print"]
[2,"Under \"Print What\" select \"Entire Workbook\""]
[3,"Then print"]
[]
["How to print just the Consumer Agreement and the Emergency Backup Plan?"]
[1,"Using the sheet tabs at the bottom of the screen, select either the Consumer Agreement or Emergency Backup Plan"]
[2,"Select print"]
[3,"Then print. This will print all the pages contained in that sheet."]
[]
["How to print just the Assessment?"]
[1,"Using the sheet tabs at the bottom of the screen, select the first tab you want to print. Example: Cover sheet. "]
[2,"Then hold down the Ctrl button and select all the other sheet tabs you want to print. Example: Information sheet, Previous Support, Personal Hygiene and grooming, etc."]
[3,"Select print"]
[4,"Then print. This will print all the sheets that you selected. This is the only way to print just the Assessment pages."]

{"sheet":"WORK_MFEI info","index":2,"n_rows":36,"n_cols":35,"rows_kept":36,"cut":false,"hidden":false,"merged":[[0,0,5,25],[0,26,1,51],[3,28,3,51],[6,28,6,51],[7,0,8,25],[7,28,9,51],[9,7,10,17],[9,18,10,25],[10,28,12,51],[11,7,19,7],[2,26,2,51],[11,14,19,14],[11,15,19,15],[11,16,19,16],[11,17,19,17],[11,8,19,8],[20,0,20,6],[21,0,21,6],[11,23,19,23],[11,24,19,24],[11,25,19,25],[11,18,19,18],[11,19,19,19],[11,20,19,20],[11,21,19,21],[11,22,19,22],[11,13,19,13],[11,9,19,9],[11,10,19,10],[11,11,19,11],[11,12,19,12],[18,0,19,6],[24,0,24,6],[25,34,26,51],[25,0,25,6],[22,34,22,51],[26,0,27,6],[27,34,28,51],[28,0,28,6],[29,34,30,51],[29,0,29,6],[34,0,34,6],[35,0,35,6],[9,0,17,6],[16,29,17,51],[29,27,29,32],[31,27,31,32],[30,0,30,6],[31,34,31,51],[31,0,31,6],[32,0,32,6],[33,0,33,6],[22,0,22,6],[23,34,24,51],[23,0,23,6],[5,26,5,51],[22,27,22,32],[23,27,23,32],[25,27,25,32],[27,27,27,32],[19,26,19,51],[20,26,21,51],[13,29,13,51],[14,29,15,51]]}
["The ADL and IADL support categories on the following pages contain information to connect the WORK Allocation Instrument to the forthcoming Kansas Medicaid Functional Eligibility Instrument (MFEI). The categories and coding contained within the MFEI are referenced throughout the WORK Allocation Instrument both to improve the instrument now and to create consistency across these instruments in the future. The following information and definitions are provided for future reference and noted herein with an asterisk (*).",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Performance and Capacity"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Guidance for Performance (b, \"How did you get this done in the last 3 days?\"):"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"•","Consider all tasks within each category over the last 3-days."]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Guidance for Capacity (c, \"How much/what aspects of these tasks can you do safely on your own?\"):   "]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"•","Code based on presumed ability to carry out activity safely."]
["WORK Allocation Instrument/MFEI Crosswalk",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"•"," Capacity requires some \"discretion\" by the assessor, taking into account what is reported for “Performance,\" direct observation of consumer in home setting and/or reports from representatives or people close to the consumer on a daily basis, with the exception of paid attendants."]
[]
["WORK Allocation Instrument ",null,null,null,null,null,null,"MFEI ADL Categories",null,null,null,null,null,null,null,null,null,null,"MFEI IADL Categories"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"•","Capacity should be considered in determining time allocations - not just performance. In a majority of instances performance and capacity will be similar. However Capacity & Performance may differ in the following situations:  "]
[null,null,null,null,null,null,null,"a. Bathing","b. Personal hygiene","c. Dressing upper body","d. Dressing lower body","e. Walking","f. Locomotion","g. Transfer toilet","h. Toilet use","i. Bed mobility","j. Eating","k. Transfer","a.Meal preparation","b. Ordinary housework","c. Managing finances","d. Managing medications","e.Phone use","f.Stairs","g. Shopping","h. Transportation"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1,"The person has the capacity to complete the task, but someone is performing it for him or her."]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,2,"The task is not currently being performed because no one is available to perform it, but the person does not have the capacity to complete the task safely and does need help to perform it."]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,3,"The person is currently performing the task, but is not doing so safely and truly needs assistance with it."]
[]
["ADL Categories"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"MFEI Numeric Coding Guidance:"]
["1. Bathing & Personal hygiene",null,null,null,null,null,null,"✓","✓",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"These values will be provided in Section G: Functional Status in the forthcoming MFEI. Here in the WORK Allocation Instrument you will see them referenced at the top of each page. "]
["2. Dressing",null,null,null,null,null,null,null,null,"✓","✓"]
["3. Prosthetic, Orthotic, Other ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"0 =  Independent",null,null,null,null,null,"=","No physical assistance, setup, or supervsion."]
["4.Tolieting",null,null,null,null,null,null,null,null,null,null,null,null,"✓","✓",null,null,null,null,null,null,null,null,null,null,null,null,"1 = Set-up help only",null,null,null,null,null,"=","Article or devise provided or placed within reach, but not physical assistance or supervision."]
["5. Eating",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"✓"]
["6. Other ADLs",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"✓",null,"✓",null,null,null,null,null,null,null,null,null,"3 = Limited assistance",null,null,null,null,null,"=","Guided maneuvering of limbs, physical guidance without taking weight, or help on some occassions."]
[" IADL Categories"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"4 =Extensive assistance",null,null,null,null,null,"=","Weight-bearing support (including lifting limbs) and help throughout task(s) but person still performs 50% or more of the task on his/her own."]
["7. Medication Management",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"✓"]
["8. Meal plan/prep/clean",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"✓",null,null,null,null,null,null,null,null,"5 = Max assistance",null,null,null,null,null,"=","Weight-bearing support (including lifting limbs) and person performs less than 50% of the task on his/her own."]
["9. Shopping",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"✓"]
["10. Housekeeping",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"✓",null,null,null,null,null,null,null,"6 = Total dependence",null,null,null,null,null,"=","Full performance by other person(s) throughout entire task."]
["11. Laundry",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"✓"]
["12. Transportation",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"✓"]
["13. Money management",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"✓"]
["14. Other IADLs",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"✓"]

{"sheet":"Tips","index":3,"n_rows":15,"n_cols":2,"rows_kept":15,"cut":false,"hidden":false,"merged":[[3,0,4,0],[5,0,6,0]]}
["Tips for operating this tool"]
["Function","Directions"]
["Sizing pages","If the page is overflowing onto the page to the right you can resize the page to fit. Go to the tool bar and select Page Layout. Then go to Scale to Fit. You can scale up or down to adjust the page without adjusting columns etc. The reason this can change is because of the settings on different computers. "]
["Expanding cells","Cell that require you to type in a narritive should now expand. Example, Employment info on the member info page, sections of the residency form, sections of the health and safety info page, the notes column on the diagnosis page, sections B, C, and D on the ADLs, IADLs, and Supported Employment pages, etc."]
[null,"When you type in these cells, they will now auto expand. You will need to double click in the cell after you have typed what you want and hit enter for force the cell to resize. If you are removing something from an expanded cell you may need to double click in the cell then hit enter to force it to collapse. "]
["Drop down boxes","It may not look like there are any drop-down boxes in this document but there are. When you see a cell that says, for example, \"Select\" but you don't see the drop-down button. If you click on the cell the button will appear. Then you just need to click on the button and you will get a list of options to chose from. Make your selection and click on to something else. "]
[null,"When you expand cells on a page with these new drop-down boxes, the drop-down boxes will move with the appropriate row. "]
["To print the full doc","Make sure to click on Print Entire Workbook."]
[null,"There is information next to the member info page and total hours supports page. This info will not print. It states that these sections will not print directly next to this informaiton. "]
["View","If the page does not look right check view to see if you are viewing \"page layout\""]
["Auto Population","There are sections throughout this workbook that will grab information you enter in other sections to auto populate other sections of this workbook. For example, when you enter how many hours a member works per week, this info will cause time to auto pop on the Supported Employment page telling you how much time a member has. Make sure that you complete all sections. If you come across a section that is not auto populating the info you expect to see go back and make sure you didn't miss something."]
[null,"The Residency page will cause Other ADLs, and all the IADLs to remind you about the informal support policy application."]
[null,"When you answer questions about home delivered meals the time for grocery shopping will auto populate with the max time allowed for that member based on HDM."]
[null,"When you answer the question about if a member has a driver's license, a message will pop up telling you if the member is not eligible for transportation."]
[null,"On the Total Hours of Support page you will need to identify any members who have 2 person transfers. Once you have identified this and how much time the tool will tell you how much max time the member can have per month. The tool will tell you to stop if you have gone over this time and continue if you are below the max."]

{"sheet":"Member Information","index":4,"n_rows":47,"n_cols":39,"rows_kept":47,"cut":false,"hidden":false,"merged":[[12,10,12,28],[27,1,27,9],[15,10,15,28],[25,10,25,28],[29,10,29,13],[30,10,30,13],[30,18,30,22],[29,18,29,22],[32,19,32,28],[32,13,32,17],[17,10,17,28],[20,1,20,9],[19,10,20,28],[17,1,17,9],[19,1,19,9],[2,15,2,19],[1,11,1,14],[4,1,4,6],[4,21,4,22],[4,23,4,27],[4,7,4,20],[28,1,28,9],[26,10,26,28],[12,1,12,9],[13,1,13,9],[14,1,14,9],[15,1,15,9],[25,1,25,9],[26,1,26,9],[10,10,11,28],[9,1,9,28],[24,10,24,28],[6,1,6,9],[7,1,7,9],[8,1,8,9],[10,1,10,9],[11,1,11,9],[7,10,7,28],[8,10,8,28],[0,1,0,28],[32,10,32,12],[34,10,34,28],[5,1,5,28],[16,1,16,28],[28,10,28,28],[30,1,30,9],[32,1,32,9],[33,1,33,9],[13,10,13,28],[14,10,14,28],[6,10,6,28],[1,23,1,28],[2,7,2,10],[2,20,2,22],[2,23,2,28],[1,1,1,6],[2,1,2,6],[1,7,1,10],[1,20,1,22],[3,1,3,6],[3,7,3,28],[1,15,1,19],[2,11,2,14],[46,3,46,12],[43,1,43,3],[43,4,43,12],[22,1,22,9],[35,1,36,12],[38,1,38,5],[38,6,38,12],[35,13,36,28],[39,1,40,2],[37,3,37,12],[42,3,42,12],[41,3,41,12],[45,9,45,11],[44,9,44,11],[39,3,40,12],[22,10,22,28],[23,1,23,9],[37,1,37,2],[43,13,46,28],[41,14,41,17],[37,13,37,28],[44,3,44,8],[45,3,45,8],[29,1,29,9],[42,14,42,28],[29,14,29,16],[30,14,30,16],[29,23,29,26],[30,23,30,26],[27,10,27,16],[41,18,41,28],[38,22,38,28],[21,1,21,9],[21,10,21,28],[31,10,31,28],[34,1,34,9],[23,10,23,28],[33,10,33,28],[24,35,24,62],[29,35,29,37],[30,35,30,37],[29,38,29,62],[30,38,30,62],[25,38,25,62],[26,38,26,62],[25,35,25,37],[26,35,26,37],[27,35,28,37],[27,38,28,62]]}
[null,"Assessment Information"]
[null,"Assessment Date:",null,null,null,null,null,null,null,null,null,"Budget Period Start Date:",null,null,null,null,null,null,null,null,"End Date:",null,null,null,null,null,null,null,null,"Select"]
[null,"Revised Assessment Date:",null,null,null,null,null,null,null,null,null,"Revision Start Date:",null,null,null,null,null,null,null,null,"End Date:",null,null,null,null,null,null,null,null,"Aetna"]
[null,"Reason for Revision",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Sunflower",null,null,{"$f":"H4","v":0}]
[null,"Assessor Name:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"MCO",null,"Sunflower",null,null,null,null,null,"United"]
[null,"Member Information Section"]
[null,"First Name:"]
[null,"Middle Name:"]
[null,"Last Name:"]
[null,"Physical Home Address: This is where the member physically lives"]
[null,"Street Address:"]
[null,"Suite or Apartment Number:"]
[null,"City:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Select"]
[null,"State:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Home"]
[null,"Zip:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Cell"]
[null,"County:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Work"]
[null,"Mailing Address: This is where mailings of any kind will be sent to if different from Physical Home address (can't be ILC)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Other"]
[null,"Name (if other than member):"]
[null,"Relation to member if not member:"]
[null,"Street Address:"]
[null,"Suite or Apartment Number:"]
[null,"City:"]
[null,"State:"]
[null,"Zip:"]
[null,"Other Member Information",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"This information will not print"]
[null,"Email:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Gender Identity Selection ",null,null,null,null,null,"Female",null,null,"Born biologically female and identifies as female."]
[null,"Birth Date:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Female",null,null,null,null,null,"Male",null,null,"Born biologically male and identifies as male."]
[null,"Gender:",null,null,null,null,null,null,null,null,"Gender Identity Selection ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Male",null,null,null,null,null,"Non-binary",null,null,"An adjective describing a person who does not identify exclusively as a man or a woman. Non-binary people may identify as being both a man and a woman, somewhere in between, or as falling completely outside these categories."]
[null,"Medicaid ID Number:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Non-binary"]
[null,"Main Phone:",null,null,null,null,null,null,null,null,0,null,null,null,"Select",null,null,null,0,null,null,null,null,"Select",null,null,null,null,null,"Trans-femme",null,null,null,null,null,"Trans-femme",null,null,"A term used to describe those who were assigned male at birth, but identify as more female than male."]
[null,"Alternative Phone:",null,null,null,null,null,null,null,null,0,null,null,null,"Select",null,null,null,0,null,null,null,null,"Select",null,null,null,null,null,"Trans-masc",null,null,null,null,null,"Trans-masc",null,null,"A term used to describe those who were assigned female at birth, but identify as more male than female."]
[null,"Employment Information"]
[null,"Number of hours of paid employment PER WEEK: ",null,null,null,null,null,null,null,null,0,null,null,"Formatted for numbers only",null,null,null,null,null,"(If there are multiple jobs put total number of hours per week for all jobs.)"]
[null,"Place of employment (Name only):",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"K34","v":0}]
[null,"Type of employment and list of relevant job tasks:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"B35","v":"Type of employment and list of relevant job tasks:"},{"$f":"K35","v":0}]
[null,"Guardian/WORK Representative Contact Information                  (Note: This person may not be a paid provider of PAS)",null,null,null,null,null,null,null,null,null,null,null,"Who attended this WORK Assessment?                                                     (PCAs & other Providers can't participate in assessment.)"]
[]
[null,"Name:",null,null,null,null,null,null,null,null,null,null,null,"Representative present at this assessment meeting:"]
[null,"Relation to Member:",null,null,null,null,null,null,null,null,null,null,null,null,"Yes",null,"No"]
[null,"Street Address:",null,null,null,null,null,null,null,null,null,null,null,"Who else is present at this meeting?"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"Please check the appropriate box below"]
[null,"City:",null,null,null,null,null,null,null,null,null,null,null,null,"IL Counselor Name:"]
[null,"State:",null,null,null,null,null,null,null,null,null,null,null,null,"Other (name, relation to consumer):"]
[null,"Zip Code:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"N44","v":0}]
[null,"Phone:",null,0,null,null,null,null,null,"Select"]
[null,"Phone:",null,0,null,null,null,null,null,"Select"]
[null,"Email:"]

{"sheet":"Residency Information","index":5,"n_rows":46,"n_cols":23,"rows_kept":46,"cut":false,"hidden":false,"merged":[[45,0,45,16],[29,13,29,16],[30,13,30,16],[29,7,29,8],[30,7,30,8],[42,9,42,16],[29,3,29,4],[40,9,40,16],[41,9,41,16],[40,3,40,4],[41,3,41,4],[39,3,39,4],[30,3,30,4],[32,3,32,4],[44,0,44,16],[32,7,32,8],[42,3,42,4],[36,3,37,4],[36,9,37,16],[34,2,34,16],[39,9,39,16],[38,9,38,16],[38,3,38,4],[37,5,37,8],[35,3,35,16],[36,5,36,8],[32,5,32,6],[32,13,32,16],[31,3,31,4],[12,13,12,16],[13,13,13,16],[26,9,26,12],[20,4,20,16],[28,7,28,8],[16,4,16,16],[17,4,17,16],[18,4,18,16],[19,4,19,16],[21,4,21,16],[14,13,14,16],[13,3,13,4],[14,3,14,4],[12,7,12,8],[11,13,11,16],[11,3,11,4],[12,3,12,4],[24,3,24,16],[13,5,13,6],[13,7,13,8],[14,5,14,6],[14,7,14,8],[27,13,27,16],[25,7,25,8],[31,13,31,16],[25,3,26,4],[25,13,26,16],[27,3,27,4],[28,3,28,4],[31,7,31,8],[28,13,28,16],[29,5,29,6],[27,7,27,8],[27,5,27,6],[25,9,25,12],[30,5,30,6],[31,5,31,6],[28,5,28,6],[5,3,5,16],[9,13,9,16],[10,3,10,4],[10,13,10,16],[6,3,7,4],[6,13,7,16],[9,3,9,4],[6,9,6,12],[8,3,8,4],[8,13,8,16],[10,5,10,6],[8,5,8,6],[8,7,8,8],[9,5,9,6],[9,7,9,8],[0,0,0,16],[23,2,23,16],[4,2,4,16],[2,2,2,16],[26,7,26,8],[25,5,25,6],[26,5,26,6],[10,7,10,8],[11,5,11,6],[11,7,11,8],[12,5,12,6],[7,9,7,12],[6,5,6,6],[6,7,6,8],[7,5,7,6],[7,7,7,8]]}
["Please put an \"X\" in the below box to indicate the member's living situation. If you put an \"X\" in more than one section you will get an error on other pages."]
[]
[null,null,"WORK consumer lives alone.",null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"COUNTIFS(B3,\"x\")","v":0},{"$f":"AND(R3)","v":false}]
[]
[null,null,"WORK consumer lives in separate apartment within the family home or on family estate/property.",null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"COUNTIFS(B5,\"x\")","v":0},{"$f":"AND(R5)","v":false}]
[null,null,null,"List information on all members of the household."]
[null,null,null,"Name",null,"Relation",null,"Age",null,"SSA Disability",null,null,null,"Notes - Is this person a PCA"]
[null,null,null,null,null,null,null,null,null,"Please put an \"X\" in the appropriate box"]
[null,null,null,null,null,null,null,null,null,null,"Yes",null,"No",null,null,null,null,null,{"$f":"D9","v":0},{"$f":"F9","v":0},{"$f":"N9","v":0}]
[null,null,null,null,null,null,null,null,null,null,"Yes",null,"No",null,null,null,null,null,{"$f":"D10","v":0},0,{"$f":"N10","v":0}]
[null,null,null,null,null,null,null,null,null,null,"Yes",null,"No",null,null,null,null,null,0,0,0]
[null,null,null,null,null,null,null,null,null,null,"Yes",null,"No",null,null,null,null,null,0,0,0]
[null,null,null,null,null,null,null,null,null,null,"Yes",null,"No",null,null,null,null,null,0,0,0]
[null,null,null,null,null,null,null,null,null,null,"Yes",null,"No",null,null,null,null,null,0,0,0]
[null,null,null,null,null,null,null,null,null,null,"Yes",null,"No",null,null,null,null,null,0,0,0]
[null,null,null,"Below please put an x in all that apply"]
[null,null,null,null,"Separate apartment has it's own outside entrance."]
[null,null,null,null,"Separate apartment has it's own fully functioning kitchen with sink and appliances including refrigerator, stove, etc."]
[null,null,null,null,"Separate apartment has it's own living space (living room) from the rest of the home."]
[null,null,null,null,"Separate apartment has it's own laundry facility separate from the rest of the home."]
[null,null,null,null,"Separate apartment has it's own bathroom separate from the rest of the home. "]
[null,null,null,null,"Separate apartment in a separate stand alone building that is uses only for the member's living space."]
[]
[null,null,"WORK consumer lives with family members. ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"COUNTIFS(B24,\"x\")","v":0},{"$f":"AND(R24)","v":false}]
[null,null,null,"List information on all members of the household."]
[null,null,null,"Name",null,"Relation",null,"Age",null,"SSA Disability",null,null,null,"Notes - Is this person a PCA"]
[null,null,null,null,null,null,null,null,null,"Please put an x in the appropriate box"]
[null,null,null,null,null,null,null,null,null,null,"Yes",null,"No",null,null,null,null,null,{"$f":"D28","v":0},{"$f":"F28","v":0},{"$f":"N28","v":0}]
[null,null,null,null,null,null,null,null,null,null,"Yes",null,"No",null,null,null,null,null,0,0,0]
[null,null,null,null,null,null,null,null,null,null,"Yes",null,"No",null,null,null,null,null,0,0,0]
[null,null,null,null,null,null,null,null,null,null,"Yes",null,"No",null,null,null,null,null,0,0,0]
[null,null,null,null,null,null,null,null,null,null,"Yes",null,"No",null,null,null,null,null,0,0,0]
[null,null,null,null,null,null,null,null,null,null,"Yes",null,"No",null,null,null,null,null,{"$f":"D33","v":0},0,0]
[]
[null,null,"WORK consumer lives with roommate(s), do not list blood relatives or in-laws as roommate(s).",null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"COUNTIFS(B35,\"x\")","v":0},{"$f":"AND(R35)","v":false}]
[null,null,null,"List information on all roommate(s)."]
[null,null,null,"Name",null,"SSA Disability",null,null,null,"Notes - Is this person a PCA"]
[null,null,null,null,null,"Please put an x in the appropriate box"]
[null,null,null,null,null,null,"Yes",null,"No",null,null,null,null,null,null,null,null,null,{"$f":"D39","v":0},null,null,{"$f":"J39","v":0}]
[null,null,null,null,null,null,"Yes",null,"No",null,null,null,null,null,null,null,null,null,{"$f":"D40","v":0},null,null,{"$f":"J40","v":0}]
[null,null,null,null,null,null,"Yes",null,"No",null,null,null,null,null,null,null,null,null,0,null,null,{"$f":"J41","v":0}]
[null,null,null,null,null,null,"Yes",null,"No",null,null,null,null,null,null,null,null,null,0,null,null,{"$f":"J42","v":0}]
[null,null,null,null,null,null,"Yes",null,"No",null,null,null,null,null,null,null,null,null,0,null,null,{"$f":"J43","v":0}]
[]
["Any additional notes:"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"D46","v":0}]

{"sheet":"Health and Safety Information","index":6,"n_rows":51,"n_cols":31,"rows_kept":51,"cut":false,"hidden":false,"merged":[[0,16,0,25],[1,16,2,25],[50,0,51,25],[49,0,49,25],[48,1,48,25],[39,16,39,25],[41,16,42,25],[29,16,31,25],[19,16,19,25],[20,16,20,25],[16,16,16,25],[17,16,17,25],[21,16,21,25],[22,16,22,25],[23,16,23,25],[11,16,11,25],[12,16,12,25],[13,16,13,25],[14,16,14,25],[15,16,15,25],[6,16,6,25],[7,16,7,25],[8,16,8,25],[9,16,9,25],[10,16,10,25],[43,16,43,25],[44,16,44,25],[45,16,45,25],[46,16,46,25],[25,0,25,13],[29,0,29,13],[34,0,34,13],[40,0,40,13],[46,0,46,13],[25,16,25,25],[26,16,26,25],[27,16,27,25],[32,16,32,25],[33,16,33,25],[36,1,37,13],[42,1,43,13],[4,1,4,10],[2,1,2,10],[3,1,3,10],[3,16,3,25],[4,16,4,25],[5,16,5,25],[5,1,5,10],[6,1,6,10],[7,1,7,10],[8,1,8,10],[9,1,9,10],[12,1,12,10],[13,1,13,10],[14,1,14,10],[15,1,15,10],[16,1,16,10],[19,1,19,10],[20,1,20,10],[21,1,21,10],[24,16,24,25],[34,16,34,25],[35,16,35,25],[36,16,36,25],[37,16,37,25],[38,16,38,25]]}
["Please put an \"X\" in the appropriate box.",null,null,null,null,null,null,null,null,null,null,null,null,null,null,9,"Does your home have the following?"]
[1,"Place of residence",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"1 = Does not have, 2 = Not working,                   3 = working (indicate the code that applies)"]
[null,"House / Town House"]
[null,"Apartment / Condominium",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Electricity"]
[null,"Duplex",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Gas/Propane"]
[null,"Assisted Living",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Piped water, hot/cold"]
[null,"Congregated / Group Living Facility",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Air conditioner/fan"]
[null,"Trailer Home",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Telephone"]
[null,"Nursing Facility",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Laundry facilities"]
[null,"Homeless",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Smoke detector"]
["Please put an \"X\" in the appropriate box.",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Carbon monoxide detector"]
[2,"Client's residence is:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Refrigerator"]
[null,"Owned (or being purchased)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Stove"]
[null,"Rented, private",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Heating system"]
[null,"Rented, subsidized",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Flush toilet"]
[null,"Rent free (e.g. family, friends)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Tub/shower"]
[null,"other",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Radio/television"]
["Please put an \"X\" in the appropriate box.",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Microwave"]
[3,"Client's residence location",null,null,null,null,null,null,null,null,null,null,null,null,null,"Please put an \"X\" in the appropriate box."]
[null,"Rural (less that 20,000)",null,null,null,null,null,null,null,null,null,null,null,null,null,10,"Are there health or physical safety"]
[null,"Town (20,000 - 100,000)",null,null,null,null,null,null,null,null,null,null,null,null,null,null," problems? (Check all that apply)"]
[null,"Urban (greater than 100,000)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Dirt/garbage"]
["Please put an \"X\" in the appropriate box for all Yes/No questions.",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Furnishings/rugs"]
[4,"Do you feel safe inside your home?",null,null,null,null,null,null,null,null,"Yes",null,"No",null,null,null,"House/Basement"]
[null,"If no, why?",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Yard/Storage Buildings"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Animals/Pets",null,null,null,null,null,null,null,null,null,null,{"$f":"A26","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Poor lighting"]
[5,"Do you feel safe in your neighborhood?",null,null,null,null,null,null,null,null,null,"Yes",null,"No",null,null,"Other"]
[null,"If no, why?",null,null,null,null,null,null,null,null,null,null,null,null,null,"Please put an \"X\" in the appropriate box."]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,11,"Do you have any difficulty getting into your home or any room in your home? (Check all that apply)",null,null,null,null,null,null,null,null,null,null,{"$f":"A30","v":0}]
[]
[6,"Do you feel safe outside of your neighborhood?"]
[null,null,null,"Yes",null,"No",null,null,null,null,null,null,null,null,null,null,"Entrance(s)"]
[null,"If no, why?",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Living/Family Room"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Bathing Facility/tub",null,null,null,null,null,null,null,null,null,null,{"$f":"A35","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Laundry"]
[7,"Is there anything inside or outside of your home that you worry about or are uncomfortable about?",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Bedroom"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Toilet Facility"]
[null,null,null,"Yes",null,"No",null,null,null,null,null,null,null,null,null,null,"Kitchen"]
[null,"If yes, why?",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"No Difficulty"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Please put an \"X\" in the appropriate box.",null,null,null,null,null,null,null,null,null,null,null,{"$f":"A41","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,12,"Is this dwelling a suitable candidate for weatherization?"]
[8,"Are there any neglect, abuse or exploitation issues that should be reported to help you?"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Yes"]
[null,null,null,"Yes",null,"No",null,null,null,null,null,null,null,null,null,null,"No"]
[null,"If yes, why?",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Already completed"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Above income guidelines",null,null,null,null,null,null,null,null,null,null,{"$f":"A47","v":0}]
[]
[13,"Recommended changes to environment:"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"A50","v":0}]
["Special Note: Assessor's must have access to the home to verify that there are no health and safety risks. Failure to allow this access will result in a failure to cooperate and closure of WORK services. "]

{"sheet":"Diagnosis Information","index":7,"n_rows":35,"n_cols":31,"rows_kept":35,"cut":false,"hidden":false,"merged":[[7,0,7,6],[8,0,8,6],[9,0,9,6],[10,0,10,6],[11,0,11,6],[12,0,12,6],[2,0,2,25],[3,0,3,25],[5,7,6,9],[5,10,6,12],[4,7,4,12],[4,0,6,6],[4,13,6,27],[7,13,7,27],[8,13,8,27],[9,13,9,27],[10,13,10,27],[11,13,11,27],[12,13,12,27],[0,23,0,26],[0,18,0,22],[0,0,0,4],[1,0,1,5],[1,6,1,26],[0,5,0,17],[32,0,32,6],[33,0,33,6],[34,0,34,6],[7,7,7,9],[8,7,8,9],[9,7,9,9],[10,7,10,9],[11,7,11,9],[12,7,12,9],[25,0,25,6],[26,0,26,6],[27,0,27,6],[28,0,28,6],[29,0,29,6],[30,0,30,6],[19,0,19,6],[20,0,20,6],[21,0,21,6],[13,0,13,6],[14,0,14,6],[15,0,15,6],[23,7,23,9],[24,7,24,9],[13,7,13,9],[14,7,14,9],[15,7,15,9],[16,7,16,9],[17,7,17,9],[18,7,18,9],[31,0,31,6],[16,0,16,6],[17,0,17,6],[18,0,18,6],[15,10,15,12],[16,10,16,12],[17,10,17,12],[18,10,18,12],[31,7,31,9],[26,10,26,12],[27,10,27,12],[28,10,28,12],[29,10,29,12],[30,10,30,12],[19,10,19,12],[20,10,20,12],[21,10,21,12],[22,10,22,12],[23,10,23,12],[24,10,24,12],[22,0,22,6],[23,0,23,6],[24,0,24,6],[32,7,32,9],[33,7,33,9],[34,7,34,9],[7,10,7,12],[8,10,8,12],[9,10,9,12],[10,10,10,12],[11,10,11,12],[12,10,12,12],[25,7,25,9],[26,7,26,9],[27,7,27,9],[28,7,28,9],[29,7,29,9],[30,7,30,9],[19,7,19,9],[20,7,20,9],[21,7,21,9],[22,7,22,9],[31,10,31,12],[32,10,32,12],[33,10,33,12],[34,10,34,12],[25,10,25,12],[13,10,13,12],[14,10,14,12],[19,13,19,27],[20,13,20,27],[21,13,21,27],[22,13,22,27],[23,13,23,27],[24,13,24,27],[13,13,13,27],[14,13,14,27],[15,13,15,27],[16,13,16,27],[17,13,17,27],[18,13,18,27],[31,13,31,27],[32,13,32,27],[33,13,33,27],[34,13,34,27],[25,13,25,27],[26,13,26,27],[27,13,27,27],[28,13,28,27],[29,13,29,27],[30,13,30,27]]}
["Primary Diagnosis:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Waiver Eligibility:",null,null,null,null,"Select",null,null,null,null,"Select"]
["Source of Information:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"BI/TBI"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"I/DD"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"PD"]
["Health Conditions",null,null,null,null,null,null,"Please put an \"X\" in the appropriate box",null,null,null,null,null,"Notes: List diagnosis and impairments. Example, if paralyzed, to what extend does the paralysis limits the member's function. "]
[null,null,null,null,null,null,null,"Primary Condition",null,null,"Secondary Condition"]
[]
["Alcoholism/Drug use",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"A8","v":"Alcoholism/Drug use"},{"$f":"N8","v":0}]
["Alzheimer's Disease, other memory loss conditions (specify)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"A9","v":"Alzheimer's Disease, other memory loss conditions (specify)"},{"$f":"N9","v":0}]
["Arthritis (specify)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"A10","v":"Arthritis (specify)"},{"$f":"N10","v":0}]
["Cancer/Leukemia",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Cancer/Leukemia",{"$f":"N11","v":0}]
["Circulation Problems (Swelling limbs, blood cot problems, etc.)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Circulation Problems (Swelling limbs, blood cot problems, etc.)",0]
["Diabetes",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Diabetes",0]
["GI Tract Problems (Ulcer, Colitis, etc.)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"A14","v":"GI Tract Problems (Ulcer, Colitis, etc.)"},0]
["Head Injury (include date of onset)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Head Injury (include date of onset)",0]
["Hearing Problem",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Hearing Problem",0]
["Heart Problems",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Heart Problems",0]
["High Blood Pressure",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"High Blood Pressure",0]
["Infectious Diseases (specify)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Infectious Diseases (specify)",0]
["Kidney/Bladder Problems",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Kidney/Bladder Problems",0]
["Lung/Breathing Problems (specify)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Lung/Breathing Problems (specify)",0]
["Intellectual/Developmental Disability (specify)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Intellectual/Developmental Disability (specify)",0]
["Behavioral Health (specify)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Behavioral Health (specify)",0]
["Missing Limb (specify)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Missing Limb (specify)",0]
["Open Wounds, Bed Sores",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Open Wounds, Bed Sores",0]
["Osteoporosis",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Osteoporosis",0]
["Paralysis (specify)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Paralysis (specify)",0]
["Neurological Disease (such as Parkinson's) or mobility problems",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Neurological Disease (such as Parkinson's) or mobility problems",0]
["Seizures",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Seizures",0]
["Significant Weight Loss/Gain, Obesity or Under Weight (specify)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Significant Weight Loss/Gain, Obesity or Under Weight (specify)",0]
["Speech Problem",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Speech Problem",0]
["Stroke",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Stroke",0]
["Uses Wheelchair, Walker, or other aid",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Uses Wheelchair, Walker, or other aid",0]
["Vision Problems (Glaucoma, Cataracts, etc.)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Vision Problems (Glaucoma, Cataracts, etc.)",0]
["Other (Specific)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Other (Specific)",0]

{"sheet":"Bathing & Personal Hygiene","index":8,"n_rows":36,"n_cols":25,"rows_kept":36,"cut":false,"hidden":false,"merged":[[16,0,16,10],[16,12,16,13],[16,15,16,16],[16,18,16,19],[16,21,16,22],[14,0,14,10],[14,12,14,13],[14,15,14,16],[14,18,14,19],[14,21,14,22],[15,0,15,10],[15,12,15,13],[15,15,15,16],[15,18,15,19],[15,21,15,22],[12,0,12,10],[12,12,12,13],[12,15,12,16],[12,18,12,19],[12,21,12,22],[13,0,13,10],[13,12,13,13],[13,15,13,16],[13,18,13,19],[13,21,13,22],[9,12,9,13],[9,15,9,16],[9,18,9,19],[9,21,9,22],[10,12,10,13],[10,15,10,16],[10,18,10,19],[10,21,10,22],[11,12,11,13],[11,15,11,16],[11,18,11,19],[11,21,11,22],[5,21,5,22],[7,12,7,13],[7,15,7,16],[7,18,7,19],[7,21,7,22],[6,1,6,22],[8,12,8,13],[8,15,8,16],[8,18,8,19],[8,21,8,22],[33,20,33,22],[1,0,1,10],[1,11,1,13],[1,14,1,16],[1,17,1,19],[1,20,1,22],[2,0,2,10],[2,11,2,13],[2,14,2,16],[2,17,2,19],[2,20,2,22],[3,0,3,10],[3,12,3,13],[3,15,3,16],[3,18,3,19],[3,21,3,22],[4,12,4,13],[4,15,4,16],[4,18,4,19],[4,21,4,22],[5,0,5,10],[5,12,5,13],[5,15,5,16],[5,18,5,19],[33,4,33,6],[33,8,33,10],[33,12,33,14],[33,16,33,18],[34,0,34,2],[34,4,34,6],[34,8,34,10],[34,12,34,14],[34,16,34,18],[35,7,35,8],[35,13,35,15],[35,18,35,19],[35,20,35,22],[35,2,35,4],[35,0,35,1],[18,1,18,11],[18,12,18,20],[26,1,26,11],[26,12,26,20],[32,0,32,22],[28,1,28,22],[29,0,29,14],[29,15,29,18],[29,19,29,22],[30,0,30,10],[30,11,30,14],[23,1,23,22],[24,1,24,22],[27,0,27,22],[20,1,20,22],[21,1,21,22],[34,20,34,22],[33,0,33,2]]}
["1) Bathing and Personal Hygiene (MFEI a&b*)"]
["Time per Task Guide:",null,null,null,null,null,null,null,null,null,null,"(6)*",null,null,"(4-5)*",null,null,"(3)*",null,null,"(1-2)*"]
[null,null,null,null,null,null,null,null,null,null,null,"Total Assist",null,null,"Medium Assist",null,null,"Light Assist",null,null,"Cue/Prompt"]
["Locomotion to & from facilities (both ways)",null,null,null,null,null,null,null,null,null,null,10,"minutes",null,8,"minutes",null,5,"minutes",null,"NA","minutes"]
[null,"(e.g. hoyer lift, push manual wheelchair, etc.)"]
["Bathing: Tub/Shower/Sponge Bath (1 bath per day, exception for 2 with justification)",null,null,null,null,null,null,null,null,null,null,"31 to 60","minutes",null,"16 to 30","minutes",null,"5 to 15","minutes",null,"5 to 10","minutes"]
[null,"You can use the time on the row above or you can use the times below to better account for the member's needs)"]
[null,"Transfer in/out (step over tub edge)",null,null,null,null,null,null,null,null,null,"8 to 10","minutes",null,"5 to 7","minutes",null,5,"minutes",null,5,"minutes"]
[null,"Transfer in/out (transfer board/chair)",null,null,null,null,null,null,null,null,null,"8 to 10","minutes",null,"5 to 7","minutes",null,5,"minutes",null,5,"minutes"]
[null,"Transfer in/out (Hoyer lift)",null,null,null,null,null,null,null,null,null,"11 to 15","minutes",null,"6 to 10","minutes",null,5,"minutes",null,"NA","minutes"]
[null,"Wash/condition hair",null,null,null,null,null,null,null,null,null,10,"minutes",null,8,"minutes",null,5,"minutes",null,5,"minutes"]
[null,"Wash/rinse total body",null,null,null,null,null,null,null,null,null,"20 to 35","minutes",null,"12 to 19","minutes",null,"5 to 11","minutes",null,5,"minutes"]
["Oral Care: Brush Teeth/Floss/Denture Care",null,null,null,null,null,null,null,null,null,null,10,"minutes",null,8,"minutes",null,5,"minutes",null,"NA","minutes"]
["Hair Care: Comb/Brush (no hair cuts, shaving head, color, etc.)",null,null,null,null,null,null,null,null,null,null,"16 to 20","minutes",null,"11 to 15","minutes",null,"5 to 10","minutes",null,"5 to 10","minutes"]
["Skin Care: Dry Off, Inspect Skin, Apply Lotion, Deodorant",null,null,null,null,null,null,null,null,null,null,"16 to 20","minutes",null,"11 to 15","minutes",null,"5 to 10","minutes",null,"5 to 10","minutes"]
["Shaving (no shaving head/hair cut)",null,null,null,null,null,null,null,null,null,null,15,"minutes",null,10,"minutes",null,5,"minutes",null,5,"minutes"]
["Inspect/Clean/Trim Nails (once per week, no mani/pedi)",null,null,null,null,null,null,null,null,null,null,15,"minutes",null,10,"minutes",null,5,"minutes",null,5,"minutes"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Yes","No"]
["A.","Can you perform this task without any support?",null,null,null,null,null,null,null,null,null,null,"Please put an \"X\" in the appropriate box."]
[]
["B.","In the last 3 days, how did you get this done?"]
["  Performance  ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"B22","v":0}]
[]
["C.","How much or what aspects of these tasks are you able to do safely on your own?"]
["Capacity  ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"B25","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Yes","No"]
["D.","Are any hours of support needed for this task?",null,null,null,null,null,null,null,null,null,null,"Please put an \"X\" in the appropriate box."]
["If support is needed, list each task, describe the amount and frequency of support needed and include an estimate of the weekly hours of support needed. (Thorough justification of time greater than examples above is required.)"]
["Time per task breakdown  ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"B29","v":0}]
["Total Weekly hours needed for this activity",null,null,null,null,null,null,null,null,null,null,null,null,null,null,0,null,null,null,"hours"]
["Total Monthly hours",null,null,null,null,null,null,null,null,null,null,{"$f":"PRODUCT(P30,4.33)","v":0},null,null,null,"(Weekly hours X 4.33 = Monthly hrs.)"]
[]
["Time Conversion Chart and Calculation Tool"]
["5m = .08 h",null,null,null,"15m = .25h",null,null,null,"25m = .42h",null,null,null,"35m = .58h",null,null,null,"45m = .75h",null,null,null,"55m = .92h"]
["10m = .17h",null,null,null,"20m = .33h",null,null,null,"30m = .5h",null,null,null,"40m = .67h",null,null,null,"50m = .83h",null,null,null,"60m = 1.0h"]
["* No rounding ",null,"Number of Minutes",null,null,0,"=",{"$f":"ROUND(F36/60,2)","v":0},null,"Number of Hours",null,null,"or","Number of Hours",null,null,0,"=",{"$f":"ROUND(Q36*60,2)","v":0},null,"Number of Minutes"]

{"sheet":"Dressing","index":9,"n_rows":30,"n_cols":25,"rows_kept":30,"cut":false,"hidden":false,"merged":[[24,14,24,22],[22,1,22,22],[23,0,23,14],[23,15,23,18],[23,19,23,22],[24,0,24,9],[24,10,24,13],[8,12,8,13],[8,15,8,16],[8,18,8,19],[8,21,8,22],[21,0,21,22],[14,1,14,22],[20,12,20,20],[15,1,15,22],[17,1,17,22],[10,15,10,16],[10,18,10,19],[10,21,10,22],[20,1,20,11],[7,18,7,19],[7,21,7,22],[5,12,5,13],[5,15,5,16],[5,18,5,19],[1,0,1,10],[1,11,1,13],[1,14,1,16],[1,17,1,19],[1,20,1,22],[2,17,2,19],[3,18,3,19],[12,1,12,11],[12,12,12,20],[2,20,2,22],[2,0,2,10],[2,11,2,13],[2,14,2,16],[3,21,3,22],[9,12,9,13],[9,15,9,16],[9,18,9,19],[9,21,9,22],[4,12,4,13],[4,15,4,16],[4,18,4,19],[3,0,3,10],[3,12,3,13],[7,0,7,10],[18,1,18,22],[5,0,5,10],[5,21,5,22],[6,12,6,13],[6,15,6,16],[6,18,6,19],[6,21,6,22],[10,0,10,10],[10,12,10,13],[3,15,3,16],[4,21,4,22],[7,12,7,13],[7,15,7,16],[26,0,26,22],[27,0,27,2],[27,4,27,6],[27,8,27,10],[27,12,27,14],[27,16,27,18],[27,20,27,22],[28,20,28,22],[29,0,29,1],[29,2,29,4],[29,13,29,15],[29,18,29,19],[29,20,29,22],[28,0,28,2],[28,4,28,6],[28,8,28,10],[28,12,28,14],[28,16,28,18],[29,7,29,8]]}
["2) Dressing (MFEI c&d*)"]
["Time per Task Guide:",null,null,null,null,null,null,null,null,null,null,"(6)*",null,null,"(4-5)*",null,null,"(3)*",null,null,"(1-2)*"]
[null,null,null,null,null,null,null,null,null,null,null,"Total Assist",null,null,"Medium Assist",null,null,"Light Assist",null,null,"Cue/Prompt"]
["Locomotion to & from facilities (both ways)",null,null,null,null,null,null,null,null,null,null,10,"minutes",null,8,"minutes",null,5,"minutes",null,"NA","minutes"]
[null,"(e.g. hoyer lift, push manual wheelchair, etc.)"]
["Setting out clothes ( 5 min. max per day)",null,null,null,null,null,null,null,null,null,null,5,"minutes",null,5,"minutes",null,5,"minutes",null,5,"minutes"]
[null,"If total assistance to dress is needed then this does not apply."]
["Dressing: (70 min max per day with max transfer time)",null,null,null,null,null,null,null,null,null,null,"31 to 70","minutes",null,"16 to 30","minutes",null,"5 to 15","minutes",null,"5 to 10","minutes"]
[null,"Transfer",null,null,null,null,null,null,null,null,null,"8 to 10","minutes",null,"5 to 7","minutes",null,5,"minutes",null,"NA","minutes"]
[null,"Get Dressed/undressed",null,null,null,null,null,null,null,null,null,"16 to 25","minutes",null,"10 to 15","minutes",null,"5 to 9","minutes",null,"5 to 10","minutes"]
["Clothing Appropriateness (including matching)",null,null,null,null,null,null,null,null,null,null,5,"minutes",null,5,"minutes",null,5,"minutes",null,5,"minutes"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Yes","No"]
["A.","Can you perform this task without any support?",null,null,null,null,null,null,null,null,null,null,"Please put an \"X\" in the appropriate box."]
[]
["B.","In the last 3 days, how did you get this done?"]
["  Performance  ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"B16","v":0}]
[]
["C.","How much or what aspects of these tasks are you able to do safely on your own?"]
["Capacity ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"B19","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Yes","No"]
["D.","Are any hours of support needed for this task?",null,null,null,null,null,null,null,null,null,null,"Please put an \"X\" in the appropriate box."]
["If support is needed, list each task, describe the amount and frequency of support needed and include an estimate of the weekly hours of support needed. (Thorough justification of time greater than examples above is required.)"]
["Time per task breakdown ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"B23","v":0}]
["Total Weekly hours needed for this activity",null,null,null,null,null,null,null,null,null,null,null,null,null,null,0,null,null,null,"hours"]
["Total Monthly hours",null,null,null,null,null,null,null,null,null,{"$f":"PRODUCT(P24,4.33)","v":0},null,null,null,"(Weekly hours X 4.33 = Monthly hrs.)"]
[]
["Time Conversion Chart and Calculation Tool"]
["5m = .08 h",null,null,null,"15m = .25h",null,null,null,"25m = .42h",null,null,null,"35m = .58h",null,null,null,"45m = .75h",null,null,null,"55m = .92h"]
["10m = .17h",null,null,null,"20m = .33h",null,null,null,"30m = .5h",null,null,null,"40m = .67h",null,null,null,"50m = .83h",null,null,null,"60m = 1.0h"]
["* No rounding ",null,"Number of Minutes",null,null,0,"=",{"$f":"ROUND(F30/60,2)","v":0},null,"Number of Hours",null,null,"or","Number of Hours",null,null,0,"=",{"$f":"ROUND(Q30*60,2)","v":0},null,"Number of Minutes"]

{"sheet":"Prosthetic, Orthotic, Other Dev","index":10,"n_rows":40,"n_cols":25,"rows_kept":40,"cut":false,"hidden":false,"merged":[[34,0,34,9],[34,10,34,13],[34,14,34,22],[33,15,33,18],[33,19,33,22],[22,1,22,11],[22,12,22,20],[30,1,30,11],[30,12,30,20],[27,1,27,22],[28,1,28,22],[33,0,33,14],[13,21,13,22],[24,1,24,22],[25,1,25,22],[19,12,19,13],[19,15,19,16],[19,18,19,19],[19,21,19,22],[18,12,18,13],[18,15,18,16],[18,18,18,19],[18,21,18,22],[17,12,17,13],[17,15,17,16],[17,18,17,19],[17,21,17,22],[15,21,15,22],[20,12,20,13],[20,15,20,16],[20,18,20,19],[20,21,20,22],[9,21,9,22],[12,12,12,13],[12,15,12,16],[12,18,12,19],[12,21,12,22],[10,12,10,13],[10,15,10,16],[10,18,10,19],[10,21,10,22],[11,12,11,13],[11,15,11,16],[11,18,11,19],[11,21,11,22],[2,20,2,22],[4,21,4,22],[8,12,8,13],[8,15,8,16],[8,18,8,19],[8,21,8,22],[5,12,5,13],[5,15,5,16],[5,18,5,19],[5,21,5,22],[38,16,38,18],[1,0,1,22],[4,0,4,10],[4,12,4,13],[15,12,15,13],[15,15,15,16],[15,18,15,19],[4,15,4,16],[4,18,4,19],[9,12,9,13],[9,15,9,16],[9,18,9,19],[13,12,13,13],[13,15,13,16],[13,18,13,19],[3,0,3,10],[3,11,3,13],[3,14,3,16],[3,17,3,19],[3,20,3,22],[2,0,2,10],[2,11,2,13],[2,14,2,16],[2,17,2,19],[39,7,39,8],[39,0,39,1],[39,2,39,4],[39,13,39,15],[39,18,39,19],[39,20,39,22],[16,12,16,13],[16,15,16,16],[16,18,16,19],[16,21,16,22],[37,20,37,22],[31,0,31,22],[32,1,32,22],[38,20,38,22],[36,0,36,22],[37,0,37,2],[37,4,37,6],[37,8,37,10],[37,12,37,14],[37,16,37,18],[38,0,38,2],[38,4,38,6],[38,8,38,10],[38,12,38,14]]}
["3) Prosthetic, Orthotic and Other Assistive Devices (under c&d [Dressing] in MFEI*)"]
["Examples of such devices include: limbs, shoes, lifts, braces, wheelchairs, walkers, canes, helmets, splints, CPAP, hearing aids, maintenance of glucose meter, communication / tech devices, and other devices that assist an individual to perform ADLs. "]
["Time per Task Guide:",null,null,null,null,null,null,null,null,null,null,"(6)*",null,null,"(4-5)*",null,null,"(3)*",null,null,"(1-2)*"]
[null,null,null,null,null,null,null,null,null,null,null,"Total Assist",null,null,"Medium Assist",null,null,"Light Assist",null,null,"Cue/Prompt"]
["Putting on and removing devices",null,null,null,null,null,null,null,null,null,null,15,"minutes",null,10,"minutes",null,5,"minutes",null,5,"minutes"]
[null,"(e.g. artificial limbs, ted hose, braces/splints, etc.)"]
["Maintenance and cleaning of devices: Time may vary depending on type of device(s). "]
["Daily times can be used or can be \"as needed\" several times per week. Below are examples."]
[null,"Clean wheelchair (max of 70 min per week)",null,null,null,null,null,null,null,null,null,10,"minutes",null,8,"minutes",null,5,"minutes",null,5,"minutes"]
[null,"Clean Hoyer lift (max of 70 min per week)",null,null,null,null,null,null,null,null,null,10,"minutes",null,8,"minutes",null,5,"minutes",null,5,"minutes"]
[null,"Clean walker/cane (max of 35 min per week)",null,null,null,null,null,null,null,null,null,5,"minutes",null,5,"minutes",null,5,"minutes",null,5,"minutes"]
[null,"Clean glasses (max of 35 min per week)",null,null,null,null,null,null,null,null,null,5,"minutes",null,5,"minutes",null,5,"minutes",null,5,"minutes"]
[null,"CPAP (daily cleaning/wipe down) ",null,null,null,null,null,null,null,null,null,5,"minutes",null,5,"minutes",null,5,"minutes",null,5,"minutes"]
[null,"CPAP (Weekly disinfecting/deep cleaning)",null,null,null,null,null,null,null,null,null,"16 to 20","minutes",null,"9 to 15","minutes",null,"5 to 10","minutes",null,5,"minutes"]
[null,null,"(A member can have up to 6 daily CPAP cleanings and 1 weekly CPAP cleaning)"]
[null,"Cleaning of Nebulizer"]
[null,null,"Heat methods (including boiling, dishwasher or electric sterilizer)",null,null,null,null,null,null,null,null,15,"minutes",null,10,"minutes",null,5,"minutes",null,5,"minutes"]
[null,null,"Cold soak method",null,null,null,null,null,null,null,null,20,"minutes",null,15,"minutes",null,10,"minutes",null,5,"minutes"]
[null,"Wiping down/disinfecting artificial limbs",null,null,null,null,null,null,null,null,null,10,"minutes",null,8,"minutes",null,5,"minutes",null,5,"minutes"]
[null,"Hand washing Ted Hose ",null,null,null,null,null,null,null,null,null,5,"minutes",null,5,"minutes",null,5,"minutes",null,5,"minutes"]
[null,"Wiping down/disinfecting braces",null,null,null,null,null,null,null,null,null,5,"minutes",null,5,"minutes",null,5,"minutes",null,5,"minutes"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Yes","No"]
["A.","Can you perform this task without any support?",null,null,null,null,null,null,null,null,null,null,"Please put an \"X\" in the appropriate box."]
[]
["B.","In the last 3 days, how did you get this done?"]
["  Performance  ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"B26","v":0}]
[]
["C.","How much or what aspects of these tasks are you able to do safely on your own?"]
["Capacity ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"B29","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Yes","No"]
["D.","Are any hours of support needed for this task?",null,null,null,null,null,null,null,null,null,null,"Please put an \"X\" in the appropriate box."]
["If support is needed, list each task, describe the amount and frequency of support needed and include an estimate of the weekly hours of support needed. (Thorough justification of time greater than examples above is required.)"]
["Time per task breakdown ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"B33","v":0}]
["Total Weekly hours needed for this activity",null,null,null,null,null,null,null,null,null,null,null,null,null,null,0,null,null,null,"hours"]
["Total Monthly hours",null,null,null,null,null,null,null,null,null,{"$f":"PRODUCT(P34,4.33)","v":0},null,null,null,"(Weekly hours X 4.33 = Monthly hrs.)"]
[]
["Time Conversion Chart and Calculation Tool"]
["5m = .08 h",null,null,null,"15m = .25h",null,null,null,"25m = .42h",null,null,null,"35m = .58h",null,null,null,"45m = .75h",null,null,null,"55m = .92h"]
["10m = .17h",null,null,null,"20m = .33h",null,null,null,"30m = .5h",null,null,null,"40m = .67h",null,null,null,"50m = .83h",null,null,null,"60m = 1.0h"]
["* No rounding ",null,"Number of Minutes",null,null,0,"=",{"$f":"ROUND(F40/60,2)","v":0},null,"Number of Hours",null,null,"or","Number of Hours",null,null,0,"=",{"$f":"ROUND(Q40*60,2)","v":0},null,"Number of Minutes"]

{"sheet":"Toileting","index":11,"n_rows":46,"n_cols":25,"rows_kept":46,"cut":false,"hidden":false,"merged":[[8,1,8,22],[9,0,9,10],[9,12,9,13],[9,15,9,16],[9,18,9,19],[9,21,9,22],[10,6,10,11],[13,0,13,10],[1,11,1,13],[1,14,1,16],[1,17,1,19],[7,0,7,10],[7,12,7,13],[7,15,7,16],[7,18,7,19],[1,20,1,22],[2,11,2,13],[2,14,2,16],[2,17,2,19],[2,20,2,22],[4,0,4,10],[4,12,4,13],[4,15,4,16],[4,18,4,19],[6,21,6,22],[7,21,7,22],[4,21,4,22],[6,0,6,10],[6,12,6,13],[6,15,6,16],[6,18,6,19],[38,1,38,22],[30,1,30,22],[24,12,24,13],[24,15,24,16],[24,18,24,19],[24,21,24,22],[25,0,25,10],[25,12,25,13],[25,15,25,16],[25,18,25,19],[25,21,25,22],[24,1,24,10],[28,1,28,11],[28,12,28,20],[36,1,36,11],[36,12,36,20],[37,0,37,22],[33,1,33,22],[34,1,34,22],[31,1,31,22],[39,0,39,14],[42,0,42,22],[43,20,43,22],[44,20,44,22],[43,16,43,18],[44,16,44,18],[43,12,43,14],[44,12,44,14],[43,8,43,10],[44,8,44,10],[40,11,40,14],[40,0,40,10],[39,15,39,18],[39,19,39,22],[43,4,43,6],[44,4,44,6],[43,0,43,2],[44,0,44,2],[23,0,23,10],[23,12,23,13],[23,15,23,16],[23,18,23,19],[23,21,23,22],[22,1,22,10],[19,12,19,13],[19,15,19,16],[18,1,18,10],[19,1,19,2],[20,1,20,2],[19,3,19,10],[20,3,20,10],[22,21,22,22],[15,12,15,13],[15,15,15,16],[15,18,15,19],[15,21,15,22],[13,12,13,13],[13,15,13,16],[13,18,13,19],[13,21,13,22],[14,0,14,10],[12,1,12,5],[12,6,12,10],[10,1,10,5],[15,1,15,10],[16,1,16,10],[22,12,22,13],[22,15,22,16],[22,18,22,19],[45,7,45,8],[45,0,45,1],[45,2,45,4],[45,13,45,15],[45,18,45,19],[45,20,45,22],[21,2,21,12],[0,0,0,22],[19,18,19,19],[19,21,19,22],[20,12,20,13],[20,15,20,16],[20,18,20,19],[20,21,20,22],[16,12,16,13],[16,15,16,16],[16,18,16,19],[16,21,16,22],[11,0,11,10],[11,12,11,13],[11,15,11,16],[11,18,11,19],[11,21,11,22],[17,0,17,10]]}
["4) Toileting"]
["Time per Task Guide:",null,null,null,null,null,null,null,null,null,null,"(6)*",null,null,"(4-5)*",null,null,"(3)*",null,null,"(1-2)*"]
[null,null,null,null,null,null,null,null,null,null,null,"Total Assist",null,null,"Medium Assist",null,null,"Light Assist",null,null,"Cue/Prompt"]
[]
["Locomotion to & from facilities (both ways)",null,null,null,null,null,null,null,null,null,null,10,"minutes",null,8,"minutes",null,5,"minutes",null,"NA","minutes"]
[null,"(e.g. Hoyer lift, push manual wheelchair, etc.)",null,null,null,null,null,null,null,null,null,"Up to ",15,"extra minutes could be needed when using a Hoyer lift."]
["Bed pan/Commode/Toilet (includes transfer)",null,null,null,null,null,null,null,null,null,null,"15 to 30","minutes",null,"8 to 14","minutes",null,"5 to 7","minutes",null,"NA","minutes"]
["Bowel program = max of once per day",null,null,null,null,null,null,null,null,null,null,"60 to 90","minutes",null,"30 to 59","minutes",null,"5 to 29","minutes",null,"NA","minutes"]
[null,"(includes digital/suppository stimulation, time to take effect, and clean up.)"]
["Clean self after urination (includes straightening/clothing change)",null,null,null,null,null,null,null,null,null,null,10,"minutes",null,8,"minutes",null,5,"minutes",null,5,"minutes"]
[null,"Average = 6 to 7 times per 24 hrs",null,null,null,null,"High frequency = up to 10 times per 24hrs"]
["Clean self after bowel movement (includes straightening/ clothing change)",null,null,null,null,null,null,null,null,null,null,15,"minutes",null,10,"minutes",null,5,"minutes",null,5,"minutes"]
[null,"Average = 1 to 2 times per 24 hrs",null,null,null,null,"High frequency = 2 to 3 times per 24hrs"]
["Changing of incontinence products only",null,null,null,null,null,null,null,null,null,null,10,"minutes",null,8,"minutes",null,5,"minutes",null,5,"minutes"]
["Ostomy Care (non-medical assistance)"]
[null,"Emptying the Ostomy Appliance (1 to 3 times per 24 hrs)",null,null,null,null,null,null,null,null,null,10,"minutes",null,8,"minutes",null,5,"minutes",null,5,"minutes"]
[null,"Changing the Ostomy Appliance (Change pouch every 4 to 7 days)",null,null,null,null,null,null,null,null,null,15,"minutes",null,10,"minutes",null,5,"minutes",null,5,"minutes"]
["Urostomy/Catheter Care (non-medical assistance)"]
[null,"Emptying the Urostomy bag "]
[null,"Daytime:",null,"High frequency = 2 to 3 hrs, Normal = 4 to 6 hrs",null,null,null,null,null,null,null,10,"minutes",null,8,"minutes",null,5,"minutes",null,5,"minutes"]
[null,"Nighttime:",null,"High frequency = 3 to 4 hrs, Lower frequency = 6 to 8 hrs",null,null,null,null,null,null,null,10,"minutes",null,8,"minutes",null,5,"minutes",null,5,"minutes"]
[null,null,"Many individuals do not require the urostomy bag be changed during the sleep hours."]
[null,"Changing the Urostomy Appliance (Change bag every 4 to 7 days)",null,null,null,null,null,null,null,null,null,15,"minutes",null,10,"minutes",null,5,"minutes",null,5,"minutes"]
["Feminine hygiene & related needs",null,null,null,null,null,null,null,null,null,null,10,"min/day",null,8,"min/day",null,5,"min/day",null,5,"min/day"]
[null,"Time is for 7 days or one week per month. Dived by 4.33 for weekly hrs.",null,null,null,null,null,null,null,null,null,{"$f":"ROUND(PRODUCT(10,7)/4.33,2)","v":16.170000000000002},"min/week",null,{"$f":"ROUND(PRODUCT(8,7)/4.33,2)","v":12.93},"min/week",null,{"$f":"ROUND(PRODUCT(5,7)/4.33,2)","v":8.08},"min/week",null,{"$f":"ROUND(PRODUCT(5,7)/4.33,2)","v":8.08},"min/week"]
["Establish/maintain toileting schedule",null,null,null,null,null,null,null,null,null,null,10,"minutes",null,8,"minutes",null,5,"minutes",null,5,"minutes"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Yes","No"]
["A.","Can you perform this task without any support?",null,null,null,null,null,null,null,null,null,null,"Please put an \"X\" in the appropriate box."]
[]
["B.","In the last 3 days, how did you get this done?"]
["  Performance  ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"B32","v":0}]
[]
["C.","How much or what aspects of these tasks are you able to do safely on your own?"]
["Capacity  ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"B35","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Yes","No"]
["D.","Are any hours of support needed for this task?",null,null,null,null,null,null,null,null,null,null,"Please put an \"X\" in the appropriate box."]
["If support is needed, list each task, describe the amount and frequency of support needed and include an estimate of the weekly hours of support needed. (Thorough justification of time greater than examples above is required.)"]
["Time per task breakdown ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"B39","v":0}]
["Total Weekly hours needed for this activity",null,null,null,null,null,null,null,null,null,null,null,null,null,null,0,null,null,null,"hours"]
["Total Monthly hours",null,null,null,null,null,null,null,null,null,null,{"$f":"PRODUCT(P40,4.33)","v":0},null,null,null,"(Weekly hours X 4.33 = Monthly hrs.)"]
[]
["Time Conversion Chart and Calculation Tool"]
["5m = .08 h",null,null,null,"15m = .25h",null,null,null,"25m = .42h",null,null,null,"35m = .58h",null,null,null,"45m = .75h",null,null,null,"55m = .92h"]
["10m = .17h",null,null,null,"20m = .33h",null,null,null,"30m = .5h",null,null,null,"40m = .67h",null,null,null,"50m = .83h",null,null,null,"60m = 1.0h"]
["* No rounding ",null,"Number of Minutes",null,null,0,"=",{"$f":"ROUND(F46/60,2)","v":0},null,"Number of Hours",null,null,"or","Number of Hours",null,null,0,"=",{"$f":"ROUND(Q46*60,2)","v":0},null,"Number of Minutes"]

{"sheet":"Eating","index":12,"n_rows":31,"n_cols":25,"rows_kept":31,"cut":false,"hidden":false,"merged":[[13,1,13,11],[13,12,13,20],[9,0,9,10],[9,12,9,13],[9,15,9,16],[9,18,9,19],[10,12,10,13],[10,15,10,16],[10,18,10,19],[25,0,25,9],[25,10,25,13],[25,14,25,22],[15,1,15,22],[16,1,16,22],[22,0,22,22],[23,1,23,22],[24,0,24,14],[24,15,24,18],[24,19,24,22],[18,1,18,22],[19,1,19,22],[21,1,21,11],[21,12,21,20],[29,12,29,14],[29,16,29,18],[29,20,29,22],[27,0,27,22],[28,0,28,2],[28,4,28,6],[28,8,28,10],[28,12,28,14],[28,16,28,18],[28,20,28,22],[29,0,29,2],[29,4,29,6],[29,8,29,10],[8,21,8,22],[11,12,11,13],[11,15,11,16],[11,18,11,19],[11,21,11,22],[8,12,8,13],[9,21,9,22],[10,21,10,22],[8,0,8,10],[11,0,11,10],[4,12,4,13],[4,15,4,16],[4,18,4,19],[8,15,8,16],[8,18,8,19],[7,0,7,10],[6,12,6,13],[6,15,6,16],[6,18,6,19],[4,21,4,22],[7,12,7,13],[7,15,7,16],[7,18,7,19],[7,21,7,22],[5,12,5,13],[5,15,5,16],[5,18,5,19],[5,21,5,22],[6,21,6,22],[3,21,3,22],[1,0,1,10],[1,11,1,13],[1,14,1,16],[1,17,1,19],[1,20,1,22],[2,20,2,22],[2,0,2,10],[2,11,2,13],[2,14,2,16],[2,17,2,19],[3,0,3,10],[3,12,3,13],[3,15,3,16],[3,18,3,19],[30,0,30,1],[30,2,30,4],[30,13,30,15],[30,18,30,19],[30,20,30,22],[30,7,30,8]]}
["5) Eating (MFEI j*)"]
["Time per Task Guide:",null,null,null,null,null,null,null,null,null,null,"(6)*",null,null,"(4-5)*",null,null,"(3)*",null,null,"(1-2)*"]
[null,null,null,null,null,null,null,null,null,null,null,"Total Assist",null,null,"Medium Assist",null,null,"Light Assist",null,null,"Cue/Prompt"]
["Locomotion to & from dining location (both ways)",null,null,null,null,null,null,null,null,null,null,10,"minutes",null,8,"minutes",null,5,"minutes",null,"NA","minutes"]
[null,"(e.g. hoyer lift, push manual wheelchair, etc.)"]
["Remind/Coax to begin and cease eating/drinking per meal",null,null,null,null,null,null,null,null,null,null,"NA","minutes",null,"NA","minutes",null,"NA","minutes",null,5,"minutes"]
["Reminders to slow down and take smaller bites per meal",null,null,null,null,null,null,null,null,null,null,"NA","minutes",null,"NA","minutes",null,"NA","minutes",null,5,"minutes"]
["Cutting plated food per meal (separate from meal prep) ",null,null,null,null,null,null,null,null,null,null,5,"minutes",null,5,"minutes",null,5,"minutes",null,"NA","minutes"]
["Direct feeding by mouth per meal",null,null,null,null,null,null,null,null,null,null,15,"minutes",null,10,"minutes",null,5,"minutes",null,"NA","minutes"]
["Direct supervision to eat based on Severe Dysphagia",null,null,null,null,null,null,null,null,null,null,20,"minutes",null,15,"minutes",null,10,"minutes",null,"NA","minutes"]
[null,"(Must have supporting medical documentation from PCP)"]
["Nourishment, other means, per meal (tube feeding, parenteral nutrition)",null,null,null,null,null,null,null,null,null,null,"30 to 60","minutes",null,"15 to 29","minutes",null,"5 to 14","minutes",null,"NA","minutes"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Yes","No"]
["A.","Can you perform this task without any support?",null,null,null,null,null,null,null,null,null,null,"Please put an \"X\" in the appropriate box."]
[]
["B.","In the last 3 days, how did you get this done?"]
["  Performance  ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"B17","v":0}]
[]
["C.","How much or what aspects of these tasks are you able to do safely on your own?"]
[" Capacity  ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"B20","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Yes","No"]
["D.","Are any hours of support needed for this task?",null,null,null,null,null,null,null,null,null,null,"Please put an \"X\" in the appropriate box."]
["If support is needed, list each task, describe the amount and frequency of support needed and include an estimate of the weekly hours of support needed. (Thorough justification of time greater than examples above is required.)"]
["Time per task breakdown ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"B24","v":0}]
["Total Weekly hours needed for this activity",null,null,null,null,null,null,null,null,null,null,null,null,null,null,0,null,null,null,"hours"]
["Total Monthly hours",null,null,null,null,null,null,null,null,null,{"$f":"PRODUCT(P25,4.33)","v":0},null,null,null,"(Weekly hours X 4.33 = Monthly hrs.)"]
[]
["Time Conversion Chart and Calculation Tool"]
["5m = .08 h",null,null,null,"15m = .25h",null,null,null,"25m = .42h",null,null,null,"35m = .58h",null,null,null,"45m = .75h",null,null,null,"55m = .92h"]
["10m = .17h",null,null,null,"20m = .33h",null,null,null,"30m = .5h",null,null,null,"40m = .67h",null,null,null,"50m = .83h",null,null,null,"60m = 1.0h"]
["* No rounding ",null,"Number of Minutes",null,null,0,"=",{"$f":"ROUND(F31/60,2)","v":0},null,"Number of Hours",null,null,"or","Number of Hours",null,null,0,"=",{"$f":"ROUND(Q31*60,2)","v":0},null,"Number of Minutes"]

{"sheet":"Other ADLs","index":13,"n_rows":35,"n_cols":25,"rows_kept":35,"cut":false,"hidden":false,"merged":[[8,1,8,11],[28,15,28,18],[34,20,34,22],[33,0,33,2],[33,4,33,6],[33,8,33,10],[33,12,33,14],[33,16,33,18],[33,20,33,22],[17,1,17,22],[29,14,29,22],[28,19,28,22],[25,10,25,22],[23,1,23,9],[27,1,27,22],[11,1,11,11],[6,21,6,22],[7,0,7,10],[7,12,7,13],[6,12,6,13],[6,15,6,16],[6,18,6,19],[4,12,4,13],[4,15,4,16],[4,18,4,19],[4,21,4,22],[5,12,5,13],[5,15,5,16],[5,18,5,19],[5,21,5,22],[2,17,2,19],[2,20,2,22],[3,0,3,10],[3,12,3,13],[3,15,3,16],[3,18,3,19],[3,21,3,22],[2,0,2,10],[2,11,2,13],[2,14,2,16],[1,0,1,10],[1,11,1,13],[1,14,1,16],[1,17,1,19],[1,20,1,22],[11,12,11,20],[19,1,19,11],[19,12,19,20],[22,15,22,18],[22,1,22,14],[20,0,20,22],[21,1,21,22],[16,1,16,22],[13,1,13,22],[14,1,14,22],[21,0,29,0],[23,10,23,13],[22,19,22,22],[23,14,23,22],[24,1,24,22],[26,15,26,22],[34,0,34,1],[34,2,34,4],[34,7,34,8],[34,13,34,15],[34,18,34,19],[29,10,29,13],[29,1,29,9],[28,1,28,14],[31,0,31,22],[32,0,32,2],[32,4,32,6],[32,8,32,10],[32,12,32,14],[32,16,32,18],[32,20,32,22]]}
["6) Other ADLs (MFEI j*)"]
["Time per Task Guide:",null,null,null,null,null,null,null,null,null,null,"(6)*",null,null,"(4-5)*",null,null,"(3)*",null,null,"(1-2)*"]
[null,null,null,null,null,null,null,null,null,null,null,"Total Assist",null,null,"Medium Assist",null,null,"Light Assist",null,null,"Cue/Prompt"]
["Getting in/out of bed and/or chair (max 1 hr per day)",null,null,null,null,null,null,null,null,null,null,10,"minutes",null,8,"minutes",null,5,"minutes",null,"NA","minutes"]
[null,"(includes transferring & repositioning)"]
["Assistance with doctor ordered ROM (max per day)",null,null,null,null,null,null,null,null,null,null,15,"minutes",null,10,"minutes",null,5,"minutes",null,5,"minutes"]
[null,"(for in the home, not outside the home or at the gym)"]
["Night Support (non-medical assistance)",null,null,null,null,null,null,null,null,null,null,480,"minutes",null,"(480 min per night = 8 hrs per night)"]
[null,"Night Support is calculated at $10.62 per hour, up to 8 hours per night."]
[null,"If a member only needs assist with getting up to toilet sometimes, Night Supports are not indicated. Time can be included for this need under the toileting section."]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Yes","No"]
["A.","Can you perform this task without any support?",null,null,null,null,null,null,null,null,null,null,"Please put an \"X\" in the appropriate box."]
[]
["B.","In the last 3 days, how did you get this done?"]
["  Performance  ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"B15","v":0}]
[]
["C.","How much or what aspects of these tasks are you able to do safely on your own?"]
["Capacity ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"B18","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Yes","No"]
["D.","Are any hours of support needed for this task?",null,null,null,null,null,null,null,null,null,null,"Please put an \"X\" in the appropriate box."]
["If support is needed, list each task, describe the amount and frequency of support needed and include an estimate of the weekly hours of support needed. (Thorough justification of time greater than examples above is required.)"]
["Time per task breakdown                                    ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"B22","v":0}]
[null,"Total Weekly hours needed for this activity",null,null,null,null,null,null,null,null,null,null,null,null,null,0,null,null,null,"hours"]
[null,"Total Monthly hours",null,null,null,null,null,null,null,null,{"$f":"PRODUCT(P23,4.33)","v":0},null,null,null,"(Weekly hours X 4.33 = Monthly hrs.)",null,null,null,null,null,null,null,null,{"$f":"IF(AND(X26=FALSE,X27=FALSE),TRUE)","v":true},"   Error. Go back to the Residency Information page and complete page."]
[null,"   ****************************************   NIGHT SUPPORT TIME ONLY   ****************************************",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(AND(X26=TRUE,X27=TRUE),TRUE)","v":false},"   Error. Go back to the Residency Information page and fix page."]
[null,"Does Informal Supports policy apply to this member?",null,null,null,null,null,null,null,null,{"$f":"_xlfn.IFS(X24,Y24,X25,Y25,X26,\"No\",X27,\"Yes\")","v":"   Error. Go back to the Residency Information page and complete page."},null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"OR('Residency Information'!S3)","v":false}]
[null,"Is an exception to the Informal Supports policy being requested?",null,null,null,null,null,null,null,null,null,null,"Yes",null,"No","(Please put an x in the appropriate box)",null,null,null,null,null,null,null,{"$f":"OR('Residency Information'!S5,'Residency Information'!S24,'Residency Information'!S35)","v":false}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"B28","v":0}]
[null,"Total Weekly hours needed for *NIGHT SUPPORT ONLY",null,null,null,null,null,null,null,null,null,null,null,null,null,0,null,null,null,"hours"]
[null,"Total Monthly hours",null,null,null,null,null,null,null,null,{"$f":"PRODUCT(P29,4.33)","v":0},null,null,null,"(Weekly hours X 4.33 = Monthly hrs.)"]
[]
["Time Conversion Chart and Calculation Tool"]
["5m = .08 h",null,null,null,"15m = .25h",null,null,null,"25m = .42h",null,null,null,"35m = .58h",null,null,null,"45m = .75h",null,null,null,"55m = .92h"]
["10m = .17h",null,null,null,"20m = .33h",null,null,null,"30m = .5h",null,null,null,"40m = .67h",null,null,null,"50m = .83h",null,null,null,"60m = 1.0h"]
["* No rounding ",null,"Number of Minutes",null,null,0,"=",{"$f":"ROUND(F35/60,2)","v":0},null,"Number of Hours",null,null,"or","Number of Hours",null,null,0,"=",{"$f":"ROUND(Q35*60,2)","v":0},null,"Number of Minutes"]

{"sheet":"Medication Management","index":14,"n_rows":35,"n_cols":25,"rows_kept":35,"cut":false,"hidden":false,"merged":[[11,21,11,22],[12,12,12,13],[12,15,12,16],[12,18,12,19],[12,21,12,22],[10,21,10,22],[23,1,23,11],[23,12,23,20],[17,1,17,22],[18,1,18,22],[20,1,20,22],[21,1,21,22],[13,21,13,22],[13,0,13,10],[13,12,13,13],[13,15,13,16],[13,18,13,19],[15,1,15,11],[11,12,11,13],[11,15,11,16],[11,18,11,19],[32,16,32,18],[32,20,32,22],[33,0,33,2],[33,4,33,6],[33,8,33,10],[33,12,33,14],[33,16,33,18],[24,0,24,22],[27,1,27,22],[28,0,28,14],[28,15,28,18],[28,19,28,22],[25,9,25,22],[15,12,15,20],[4,12,4,13],[4,15,4,16],[4,18,4,19],[4,21,4,22],[6,21,6,22],[7,21,7,22],[6,12,6,13],[7,12,7,13],[6,15,6,16],[7,15,7,16],[6,18,6,19],[7,18,7,19],[10,12,10,13],[10,15,10,16],[10,18,10,19],[5,0,5,10],[5,12,5,13],[5,15,5,16],[5,18,5,19],[5,21,5,22],[3,0,3,10],[3,12,3,13],[3,15,3,16],[3,18,3,19],[3,21,3,22],[2,11,2,13],[2,14,2,16],[2,17,2,19],[2,20,2,22],[1,0,1,10],[1,11,1,13],[1,14,1,16],[1,17,1,19],[1,20,1,22],[34,20,34,22],[26,15,26,22],[34,0,34,1],[34,2,34,4],[34,7,34,8],[34,13,34,15],[34,18,34,19],[29,0,29,9],[29,10,29,13],[29,14,29,22],[33,20,33,22],[31,0,31,22],[32,0,32,2],[32,4,32,6],[32,8,32,10],[32,12,32,14]]}
["7) Medication Management (MFEI, IADL d*)"]
["Time per Task Guide:",null,null,null,null,null,null,null,null,null,null,"(6)*",null,null,"(4-5)*",null,null,"(3)*",null,null,"(1-2)*"]
[null,"Any need to document is included in the times listed.",null,null,null,null,null,null,null,null,null,"Total Assist",null,null,"Medium Assist",null,null,"Light Assist",null,null,"Cue/Prompt"]
["Ordering medication(s) (10 min/week max)",null,null,null,null,null,null,null,null,null,null,10,"minutes",null,8,"minutes",null,5,"minutes",null,5,"minutes"]
["Setting up medications (med planner per week)",null,null,null,null,null,null,null,null,null,null,15,"minutes",null,10,"minutes",null,5,"minutes",null,5,"minutes"]
["Taking medications (time dependent on # of meds and type of assist)",null,null,null,null,null,null,null,null,null,null,15,"minutes",null,10,"minutes",null,5,"minutes",null,5,"minutes"]
["Take a blood glucose reading (max 5 times per day with PCP order)",null,null,null,null,null,null,null,null,null,null,10,"minutes",null,8,"minutes",null,5,"minutes",null,5,"minutes"]
["Breathing treatment (with PCP order identifying how often per day)",null,null,null,null,null,null,null,null,null,null,20,"minutes",null,15,"minutes",null,10,"minutes",null,5,"minutes"]
["Basic wound care  (A Doctor's order is required and this activity is preformed by a non-medically trained individual.) "]
[null,"(Time can vary depending on the stage of the wound and the size of the affected area. Make sure this is not duplicated under bathing)"]
[null,"Dressing wound (remove dressing and reapply dressing)",null,null,null,null,null,null,null,null,null,10,"minutes",null,8,"minutes",null,5,"minutes",null,5,"minutes"]
[null,"Cleaning wound",null,null,null,null,null,null,null,null,null,10,"minutes",null,8,"minutes",null,5,"minutes",null,5,"minutes"]
[null,"Applying ointment/cream ",null,null,null,null,null,null,null,null,null,5,"minutes",null,5,"minutes",null,5,"minutes",null,5,"minutes"]
["Check compliance (only if there is no time given for taking meds)",null,null,null,null,null,null,null,null,null,null,5,"minutes",null,5,"minutes",null,5,"minutes",null,5,"minutes"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Yes","No"]
["A.","Can you perform this task without any support?",null,null,null,null,null,null,null,null,null,null,"Please put an \"X\" in the appropriate box."]
[]
["B.","In the last 3 days, how did you get this done?"]
["  Performance  ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"B19","v":0}]
[]
["C.","How much or what aspects of these tasks are you able to do safely on your own?"]
["Capacity ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"B22","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Yes","No"]
["D.","Are any hours of support needed for this task?",null,null,null,null,null,null,null,null,null,null,"Please put an \"X\" in the appropriate box.",null,null,null,null,null,null,null,null,null,null,{"$f":"IF(AND(X26=FALSE,X27=FALSE),TRUE)","v":true},"   Error. Go back to the Residency Information page and complete page."]
["If support is needed, list each task, describe the amount and frequency of support needed and include an estimate of the weekly hours of support needed. (Thorough justification of time greater than examples above is required.)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(AND(X26=TRUE,X27=TRUE),TRUE)","v":false},"   Error. Go back to the Residency Information page and fix page."]
[null,"Does Informal Supports policy apply to this member?",null,null,null,null,null,null,null,{"$f":"_xlfn.IFS(X24,Y24,X25,Y25,X26,\"No\",X27,\"Yes\")","v":"   Error. Go back to the Residency Information page and complete page."},null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"OR('Residency Information'!R3)","v":false}]
[null,"Is an exception to the Informal Supports policy being requested?",null,null,null,null,null,null,null,null,null,null,"Yes",null,"No","(Please put an x in the appropriate box)",null,null,null,null,null,null,null,{"$f":"OR('Residency Information'!R5,'Residency Information'!R24,'Residency Information'!R35)","v":false}]
["Time per task breakdown ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"B28","v":0}]
["Total Weekly hours needed for this activity",null,null,null,null,null,null,null,null,null,null,null,null,null,null,0,null,null,null,"hours"]
["Total Monthly hours",null,null,null,null,null,null,null,null,null,{"$f":"PRODUCT(P29,4.33)","v":0},null,null,null,"(Weekly hours X 4.33 = Monthly hrs.)"]
[]
["Time Conversion Chart and Calculation Tool"]
["5m = .08 h",null,null,null,"15m = .25h",null,null,null,"25m = .42h",null,null,null,"35m = .58h",null,null,null,"45m = .75h",null,null,null,"55m = .92h"]
["10m = .17h",null,null,null,"20m = .33h",null,null,null,"30m = .5h",null,null,null,"40m = .67h",null,null,null,"50m = .83h",null,null,null,"60m = 1.0h"]
["* No rounding ",null,"Number of Minutes",null,null,0,"=",{"$f":"ROUND(F35/60,2)","v":0},null,"Number of Hours",null,null,"or","Number of Hours",null,null,0,"=",{"$f":"ROUND(Q35*60,2)","v":0},null,"Number of Minutes"]

{"sheet":"Meal Support","index":15,"n_rows":38,"n_cols":26,"rows_kept":38,"cut":false,"hidden":false,"merged":[[24,0,24,23],[27,1,27,23],[32,0,32,15],[32,16,32,19],[32,20,32,23],[25,10,25,23],[29,0,29,11],[26,16,26,23],[28,16,28,23],[15,1,15,11],[15,12,15,21],[17,1,17,23],[18,1,18,23],[20,1,20,23],[1,0,1,11],[1,12,1,14],[1,15,1,17],[8,22,8,23],[9,22,9,23],[7,13,7,14],[8,13,8,14],[7,16,7,17],[8,16,8,17],[7,19,7,20],[8,19,8,20],[9,13,9,14],[7,22,7,23],[6,19,6,20],[6,22,6,23],[1,18,1,20],[23,1,23,12],[2,0,2,11],[2,12,2,14],[2,15,2,17],[2,18,2,20],[3,0,3,11],[3,13,3,14],[3,16,3,17],[3,19,3,20],[6,13,6,14],[6,16,6,17],[11,13,11,14],[11,16,11,17],[21,1,21,23],[12,13,12,14],[12,16,12,17],[1,21,1,23],[23,13,23,21],[2,21,2,23],[3,22,3,23],[12,19,12,20],[12,22,12,23],[13,13,13,14],[13,16,13,17],[13,19,13,20],[13,22,13,23],[9,16,9,17],[9,19,9,20],[11,19,11,20],[11,22,11,23],[33,0,33,10],[33,11,33,14],[33,15,33,23],[34,0,34,23],[35,0,35,2],[35,4,35,6],[35,8,35,10],[35,13,35,15],[35,17,35,19],[35,21,35,23],[36,21,36,23],[37,0,37,1],[37,2,37,4],[37,7,37,8],[37,14,37,16],[37,19,37,20],[37,21,37,23],[37,12,37,13],[36,0,36,2],[36,4,36,6],[36,8,36,10],[36,13,36,15],[36,17,36,19]]}
["8) Meal planning/preparation/clean-up (MFEI a*)"]
["Time per Task Guide:",null,null,null,null,null,null,null,null,null,null,null,"(6)*",null,null,"(4-5)*",null,null,"(3)*",null,null,"(1-2)*"]
[null,null,null,null,null,null,null,null,null,null,null,null,"Total Assist",null,null,"Medium Assist",null,null,"Light Assist",null,null,"Cue/Prompt"]
["Development of healthy menu ",null,null,null,null,null,null,null,null,null,null,null,20,"minutes",null,15,"minutes",null,10,"minutes",null,5,"minutes"]
[null," (including specialized diet or ordering Home Delivered Meals [HDM])              "]
["Safe preparation of foods"]
[null,"Meals - FULL Meal (up to 3 per day max)",null,null,null,null,null,null,null,null,null,null,"21 to 30","minutes",null,"11 to 20","minutes",null,"5 to 10","minutes",null,5,"minutes"]
[null,"Meals - SMALL Meal (up to 6 per day max)",null,null,null,null,null,null,null,null,null,null,"11 to 15","minutes",null,"8 to 10","minutes",null,"5 to 7","minutes",null,5,"minutes"]
[null,"Snacks (up to 3 per day)",null,null,null,null,null,null,null,null,null,null,10,"minutes",null,8,"minutes",null,5,"minutes",null,5,"minutes"]
[null,"Future meals (prepare & freeze)",null,null,null,null,null,null,null,null,null,null,"21 to 30","minutes",null,"11 to 20","minutes",null,"5 to 10","minutes",null,5,"minutes"]
["Clean up after food preparation/meal"]
[null,"Clean up after FULL meal",null,null,null,null,null,null,null,null,null,null,15,"minutes",null,10,"minutes",null,5,"minutes",null,5,"minutes"]
[null,"Clean up after SMALL meal",null,null,null,null,null,null,null,null,null,null,8,"minutes",null,5,"minutes",null,5,"minutes",null,5,"minutes"]
[null,"Clean up after snack or after home delivered meal (HDM)",null,null,null,null,null,null,null,null,null,null,5,"minutes",null,5,"minutes",null,5,"minutes",null,5,"minutes"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Yes","No"]
["A.","Can you perform this task without any support?",null,null,null,null,null,null,null,null,null,null,"Please put an \"X\" in the appropriate box."]
[]
["B.","In the last 3 days, how did you get this done?"]
["  Performance    ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"B19","v":0}]
[]
["C.","How much or what aspects of these tasks are you able to do safely on your own?"]
["Capacity  ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"B22","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Yes","No"]
["D.","Are any hours of support needed for this task?",null,null,null,null,null,null,null,null,null,null,null,"Please put an \"X\" in the appropriate box.",null,null,null,null,null,null,null,null,null,null,{"$f":"IF(AND(Y26=FALSE,Y27=FALSE),TRUE)","v":true},"   Error. Go back to the Residency Information page and complete page."]
["If support is needed, list each task, describe the amount and frequency of support needed and include an estimate of the weekly hours of support needed. (Thorough justification of time greater than examples above is required.)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(AND(Y26=TRUE,Y27=TRUE),TRUE)","v":false},"   Error. Go back to the Residency Information page and fix page."]
[null,"Does Informal Supports policy apply to this member?",null,null,null,null,null,null,null,null,{"$f":"_xlfn.IFS(Y24,Z24,Y25,Z25,Y26,\"No\",Y27,\"Yes\")","v":"   Error. Go back to the Residency Information page and complete page."},null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"OR('Residency Information'!S3)","v":false}]
[null,"Is an exception to the Informal Supports policy being requested?",null,null,null,null,null,null,null,null,null,null,null,"Yes",null,"No","(Please put an x in the appropriate box)",null,null,null,null,null,null,null,{"$f":"OR('Residency Information'!S5,'Residency Information'!S24,'Residency Information'!S35)","v":false}]
["Time per task breakdown  ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"B28","v":0}]
["Will the member be using time to purchase home delivered meals?",null,null,null,null,null,null,null,null,null,null,null,"Yes",null,null,"No","(Please put an \"X\" in the appropriate box.)",null,null,null,null,null,null,null,{"$f":"COUNTIFS(L29,\"x\")","v":0},{"$f":"AND(Y29)","v":false}]
["How many home delivered meals per day will be purchased?",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"COUNTIFS(O29,\"x\")","v":0},{"$f":"AND(Y30)","v":false}]
["By Purchasing home delivered meals, if the member needs time for grocery shopping, time will be reduced.",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,0]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1]
["Total Weekly hours needed for this activity",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,0,null,null,null,"hours",null,null,null,2]
["Total Monthly hours",null,null,null,null,null,null,null,null,null,null,{"$f":"PRODUCT(Q33,4.33)","v":0},null,null,null,"(Weekly hours X 4.33 = Monthly hrs.)",null,null,null,null,null,null,null,null,3]
["Time Conversion Chart and Calculation Tool",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"0"]
["5m = .08 h",null,null,null,"15m = .25h",null,null,null,"25m = .42h",null,null,null,null,"35m = .58h",null,null,null,"45m = .75h",null,null,null,"55m = .92h"]
["10m = .17h",null,null,null,"20m = .33h",null,null,null,"30m = .5h",null,null,null,null,"40m = .67h",null,null,null,"50m = .83h",null,null,null,"60m = 1.0h"]
["* No rounding ",null,"Number of Minutes",null,null,0,"=",{"$f":"ROUND(F38/60,2)","v":0},null,"Number of Hours",null,null,"or",null,"Number of Hours",null,null,0,"=",{"$f":"ROUND(R38*60,2)","v":0},null,"Number of Minutes"]

{"sheet":"Shopping","index":16,"n_rows":42,"n_cols":26,"rows_kept":42,"cut":false,"hidden":false,"merged":[[7,13,7,14],[7,16,7,17],[7,19,7,20],[38,0,38,23],[39,0,39,2],[39,17,39,19],[39,21,39,23],[31,1,31,23],[35,0,35,15],[35,16,35,19],[35,20,35,23],[36,0,36,10],[36,11,36,14],[36,15,36,23],[39,4,39,6],[39,8,39,10],[12,11,12,12],[12,14,12,15],[11,11,11,12],[11,14,11,15],[10,11,10,12],[10,14,10,15],[13,11,13,12],[13,14,13,15],[39,13,39,15],[28,0,28,23],[4,0,4,11],[4,13,4,14],[4,16,4,17],[4,19,4,20],[4,22,4,23],[6,22,6,23],[5,13,5,14],[5,22,5,23],[6,13,6,14],[6,19,6,20],[6,16,6,17],[7,22,7,23],[3,12,3,14],[3,15,3,17],[3,18,3,20],[3,21,3,23],[5,16,5,17],[5,19,5,20],[2,0,2,11],[2,12,2,14],[2,15,2,17],[2,18,2,20],[2,21,2,23],[41,0,41,1],[41,2,41,4],[41,7,41,8],[9,8,9,12],[9,20,9,22],[29,10,29,23],[19,1,19,11],[19,12,19,21],[27,1,27,12],[27,13,27,21],[32,9,32,23],[21,1,21,23],[22,1,22,23],[24,1,24,23],[25,1,25,23],[40,0,40,2],[41,12,41,13],[41,14,41,16],[41,19,41,20],[41,21,41,23],[40,4,40,6],[40,8,40,10],[40,13,40,15],[40,17,40,19],[40,21,40,23]]}
["9) Shopping (MFEI g*)"]
["This is only for shopping. There is not time for locomotion. If locomotion assistance is needed it will be under the Transportation section."]
["Time per Task Guide:",null,null,null,null,null,null,null,null,null,null,null,"(6)*",null,null,"(4-5)*",null,null,"(3)*",null,null,"(1-2)*"]
[null,null,null,null,null,null,null,null,null,null,null,null,"Total Assist",null,null,"Medium Assist",null,null,"Light Assist",null,null,"Cue/Prompt"]
["Making shopping list ",null,null,null,null,null,null,null,null,null,null,null,15,"minutes",null,10,"minutes",null,5,"minutes",null,5,"minutes"]
["Medication Pick-up",null,null,null,null,null,null,null,null,null,null,null,"16 to 30","minutes",null,"11 to 15","minutes",null,"5 to 10","minutes",null,5,"minutes"]
["Shopping for personal items",null,null,null,null,null,null,null,null,null,null,null,30,"minutes",null,20,"minutes",null,10,"minutes",null,5,"minutes"]
["Grocery shopping (with or without Home Delivered Meals HDM)"]
["The below times cannot be above the \"Total Max Time\" but can be less than this amount of time."]
[null,null,null,null,null,null,null,null,"How many HDM(s) per day",null,null,null,null,null,null,null,null,null,null,null,"Total Max time"]
[null,"Total Assist - with or without home delivered meals",null,null,null,null,null,null,null,null,{"$f":"M34","v":"0"},"HDM = ",null,{"$f":"SUM(D15)","v":120},"min/week",null,"plus",{"$f":"SUM(E15)","v":0},"min/week",null,"=",{"$f":"SUM(N11,R11)","v":120},"min/week"]
[null,"Medium Assist - with or without home delivered meals",null,null,null,null,null,null,null,null,{"$f":"M34","v":"0"},"HDM = ",null,{"$f":"SUM(D16)","v":60},"min/week",null,"plus",{"$f":"SUM(E16)","v":0},"min/week",null,"=",{"$f":"SUM(N12,R12)","v":60},"min/week"]
[null,"Light Assist - with or without home delivered meals",null,null,null,null,null,null,null,null,{"$f":"M34","v":"0"},"HDM = ",null,{"$f":"SUM(D17)","v":30},"min/week",null,"plus",{"$f":"SUM(E17)","v":0},"min/week",null,"=",{"$f":"SUM(N13,R13)","v":30},"min/week"]
[null,"Cue/Prompt - with or without home delivered meals",null,null,null,null,null,null,null,null,{"$f":"M34","v":"0"},"HDM = ",null,{"$f":"SUM(D18)","v":4.9799999999999995},"min/week",null,"plus",{"$f":"SUM(E18)","v":0},"min/week",null,"=",{"$f":"SUM(N14,R14)","v":4.9799999999999995},"min/week"]
[null,{"$f":"K11","v":"0"},{"$f":"3-B15","v":3},{"$f":"C15*40","v":120},{"$f":"B15*10","v":0}]
[null,{"$f":"K12","v":"0"},{"$f":"3-B16","v":3},{"$f":"C16*20","v":60},{"$f":"B16*10","v":0}]
[null,{"$f":"K13","v":"0"},{"$f":"3-B17","v":3},{"$f":"C17*10","v":30},{"$f":"B17*10","v":0}]
[null,{"$f":"K14","v":"0"},{"$f":"3-B18","v":3},{"$f":"C18*1.66","v":4.9799999999999995},{"$f":"B18*1.66","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Yes","No"]
["A.","Can you perform this task without any support?",null,null,null,null,null,null,null,null,null,null,"Please put an \"X\" in the appropriate box."]
[]
["B.","In the last 3 days, how did you get this done?"]
["  Performance  ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"B23","v":0}]
[]
["C.","How much or what aspects of these tasks are you able to do safely on your own?"]
["Capacity  ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"B26","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Yes","No"]
["D.","Are any hours of support needed for this task?",null,null,null,null,null,null,null,null,null,null,null,"Please put an \"X\" in the appropriate box.",null,null,null,null,null,null,null,null,null,null,{"$f":"IF(AND(Y30=FALSE,Y31=FALSE),TRUE)","v":true},"   Error. Go back to the Residency Information page and complete page."]
["If support is needed, list each task, describe the amount and frequency of support needed and include an estimate of the weekly hours of support needed. (Thorough justification of time greater than examples above is required.)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(AND(Y30=TRUE,Y31=TRUE),TRUE)","v":false},"   Error. Go back to the Residency Information page and fix page."]
[null,"Does Informal Supports policy apply to this member?",null,null,null,null,null,null,null,null,{"$f":"_xlfn.IFS(Y28,Z28,Y29,Z29,Y30,\"No\",Y31,\"Yes\")","v":"   Error. Go back to the Residency Information page and complete page."},null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"OR('Residency Information'!S3)","v":false}]
[null,"Is an exception to the Informal Supports policy being requested?",null,null,null,null,null,null,null,null,null,"Yes",null,"No","(Please put an x in the appropriate box)",null,null,null,null,null,null,null,null,null,{"$f":"OR('Residency Information'!S5,'Residency Information'!S24,'Residency Information'!S35)","v":false}]
["Time per task breakdown ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"B32","v":0}]
["Will the member be using time to purchase home delivered meals?",null,null,null,null,null,null,null,null,{"$f":"_xlfn.IFS(Y37,Z37,Y36,Z38,Y33,Z33,Y34,Z34)","v":"    STOP. Must answer this question on the Meal Support page."},null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"'Meal Support'!Z29","v":false},"Yes"]
["How many home delivered meals per day will be purchased?",null,null,null,null,null,null,null,null,null,null,null,{"$f":"Y35","v":"0"},null,null,null,null,null,null,null,null,null,null,null,{"$f":"'Meal Support'!Z30","v":false},"No"]
["By Purchasing home delivered meals, if the member needs time for grocery shopping, time will be reduced.",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"'Meal Support'!Y35","v":"0"}]
["Total Weekly hours needed for this activity",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,0,null,null,null,"hours",null,null,null,{"$f":"_xlfn.IFNA(Y38,TRUE)","v":true}]
["Total Monthly hours",null,null,null,null,null,null,null,null,null,null,{"$f":"PRODUCT(Q36,4.33)","v":0},null,null,null,"(Weekly hours X 4.33 = Monthly hrs.)",null,null,null,null,null,null,null,null,{"$f":"IF(AND(Y33=TRUE,Y34=TRUE),TRUE)","v":false},"   Error. Must check only one box for this question on the Meal Support page."]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"_xlfn.IFS(Y33,FALSE,Y34,FALSE)","v":{"$error":"#N/A"}},"    STOP. Must answer this question on the Meal Support page."]
["Time Conversion Chart and Calculation Tool"]
["5m = .08 h",null,null,null,"15m = .25h",null,null,null,"25m = .42h",null,null,null,null,"35m = .58h",null,null,null,"45m = .75h",null,null,null,"55m = .92h"]
["10m = .17h",null,null,null,"20m = .33h",null,null,null,"30m = .5h",null,null,null,null,"40m = .67h",null,null,null,"50m = .83h",null,null,null,"60m = 1.0h"]
["* No rounding ",null,"Number of Minutes",null,null,0,"=",{"$f":"ROUND(F42/60,2)","v":0},null,"Number of Hours",null,null,"or",null,"Number of Hours",null,null,0,"=",{"$f":"ROUND(R42*60,2)","v":0},null,"Number of Minutes"]

{"sheet":"Housekeeping","index":17,"n_rows":29,"n_cols":25,"rows_kept":29,"cut":false,"hidden":false,"merged":[[1,20,1,22],[2,0,2,10],[2,11,2,13],[2,14,2,16],[2,17,2,19],[2,20,2,22],[4,12,4,13],[1,0,1,10],[1,11,1,13],[1,14,1,16],[1,17,1,19],[17,1,17,11],[17,12,17,20],[4,15,4,16],[4,18,4,19],[4,21,4,22],[6,21,6,22],[7,0,7,10],[7,12,7,13],[7,15,7,16],[7,18,7,19],[7,21,7,22],[5,12,5,13],[5,15,5,16],[5,18,5,19],[5,21,5,22],[4,0,4,10],[12,1,12,22],[14,1,14,22],[15,1,15,22],[9,1,9,11],[9,12,9,20],[6,0,6,10],[6,12,6,13],[6,15,6,16],[6,18,6,19],[11,1,11,22],[18,0,18,22],[21,1,21,22],[22,0,22,14],[22,15,22,18],[22,19,22,22],[19,9,19,22],[25,0,25,22],[26,0,26,2],[26,4,26,6],[26,8,26,10],[27,0,27,2],[27,4,27,6],[27,8,27,10],[28,18,28,19],[28,20,28,22],[20,16,20,22],[28,0,28,1],[28,2,28,4],[28,7,28,8],[28,13,28,15],[26,12,26,14],[26,16,26,18],[26,20,26,22],[27,12,27,14],[27,16,27,18],[27,20,27,22],[23,0,23,9],[23,10,23,13],[23,14,23,22]]}
["10) Housekeeping (MFEI b*)"]
["Time per Task Guide:",null,null,null,null,null,null,null,null,null,null,"(6)*",null,null,"(4-5)*",null,null,"(3)*",null,null,"(1-2)*"]
[null,null,null,null,null,null,null,null,null,null,null,"Total Assist",null,null,"Medium Assist",null,null,"Light Assist",null,null,"Cue/Prompt"]
["HOUSEKEEPING MAX OF 2 TOTAL HOURS PER WEEK TOTAL"]
["Clean bathroom and/or kitchen",null,null,null,null,null,null,null,null,null,null,"20 to 30","minutes",null,"10 to 19","minutes",null,"5 to 9","minutes",null,5,"minutes"]
["Clean floors, carpets, rugs, dusting",null,null,null,null,null,null,null,null,null,null,"30 to 45","minutes",null,"20 to 29","minutes",null,"5 to 19","minutes",null,5,"minutes"]
["Make bed and/or change linens",null,null,null,null,null,null,null,null,null,null,15,"minutes",null,10,"minutes",null,5,"minutes",null,5,"minutes"]
["Remove trash",null,null,null,null,null,null,null,null,null,null,10,"minutes",null,8,"minutes",null,5,"minutes",null,5,"minutes"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Yes","No"]
["A.","Can you perform this task without any support?",null,null,null,null,null,null,null,null,null,null,"Please put an \"X\" in the appropriate box."]
[]
["B.","In the last 3 days, how did you get this done?"]
["  Performance  ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"B13","v":0}]
[]
["C.","How much or what aspects of these tasks are you able to do safely on your own?"]
["Capacity ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"B16","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Yes","No"]
["D.","Are any hours of support needed for this task?",null,null,null,null,null,null,null,null,null,null,"Please put an \"X\" in the appropriate box.",null,null,null,null,null,null,null,null,null,null,{"$f":"IF(AND(X20=FALSE,X21=FALSE),TRUE)","v":true},"   Error. Go back to the Residency Information page and complete page."]
["If support is needed, list each task, describe the amount and frequency of support needed and include an estimate of the weekly hours of support needed. (Thorough justification of time greater than examples above is required.)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(AND(X20=TRUE,X21=TRUE),TRUE)","v":false},"   Error. Go back to the Residency Information page and fix page."]
[null,"Does Informal Supports policy apply to this member?",null,null,null,null,null,null,null,{"$f":"_xlfn.IFS(X18,Y18,X19,Y19,X20,\"No\",X21,\"Yes\")","v":"   Error. Go back to the Residency Information page and complete page."},null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"OR('Residency Information'!S3)","v":false}]
[null,"Is an exception to the Informal Supports policy being requested?",null,null,null,null,null,null,null,null,null,null,null,"Yes",null,"No","(Please put an x in the appropriate box)",null,null,null,null,null,null,{"$f":"OR('Residency Information'!S5,'Residency Information'!S24,'Residency Information'!S35)","v":false}]
["Time per task breakdown ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"B22","v":0}]
["Total Weekly hours needed for this activity",null,null,null,null,null,null,null,null,null,null,null,null,null,null,0,null,null,null,"hours"]
["Total Monthly hours",null,null,null,null,null,null,null,null,null,{"$f":"PRODUCT(P23,4.33)","v":0},null,null,null,"(Weekly hours X 4.33 = Monthly hrs.)"]
[]
["Time Conversion Chart and Calculation Tool"]
["5m = .08 h",null,null,null,"15m = .25h",null,null,null,"25m = .42h",null,null,null,"35m = .58h",null,null,null,"45m = .75h",null,null,null,"55m = .92h"]
["10m = .17h",null,null,null,"20m = .33h",null,null,null,"30m = .5h",null,null,null,"40m = .67h",null,null,null,"50m = .83h",null,null,null,"60m = 1.0h"]
["* No rounding ",null,"Number of Minutes",null,null,0,"=",{"$f":"ROUND(F29/60,2)","v":0},null,"Number of Hours",null,null,"or","Number of Hours",null,null,0,"=",{"$f":"ROUND(Q29*60,2)","v":0},null,"Number of Minutes"]

{"sheet":"Laundry","index":18,"n_rows":34,"n_cols":25,"rows_kept":34,"cut":false,"hidden":false,"merged":[[19,1,19,22],[20,1,20,22],[12,0,12,22],[8,21,8,22],[10,21,10,22],[14,1,14,11],[14,12,14,20],[23,0,23,22],[26,1,26,22],[27,0,27,14],[27,15,27,18],[27,19,27,22],[24,9,24,22],[25,16,25,22],[32,20,32,22],[28,0,28,9],[28,10,28,13],[28,14,28,22],[30,0,30,22],[31,0,31,2],[31,4,31,6],[31,8,31,10],[31,12,31,14],[31,16,31,18],[31,20,31,22],[32,0,32,2],[32,4,32,6],[32,8,32,10],[32,12,32,14],[32,16,32,18],[7,12,7,13],[7,15,7,16],[2,0,2,10],[2,11,2,13],[2,14,2,16],[3,0,3,10],[3,11,3,13],[3,14,3,16],[6,12,6,13],[6,15,6,16],[6,18,6,19],[6,21,6,22],[1,0,1,22],[2,17,2,19],[2,20,2,22],[3,17,3,19],[3,20,3,22],[33,20,33,22],[22,1,22,11],[22,12,22,20],[4,12,4,20],[5,12,5,20],[7,18,7,19],[8,0,8,10],[8,12,8,13],[8,15,8,16],[8,18,8,19],[10,12,10,13],[10,15,10,16],[10,18,10,19],[16,1,16,22],[17,1,17,22],[7,21,7,22],[33,0,33,1],[33,2,33,4],[33,7,33,8],[33,13,33,15],[33,18,33,19]]}
["11) Laundry  (MFEI b*)"]
["Note: Reviews of time for laundry tasks above what is specified here can be requested on a case by case basis with thorough justification  under \"d.\" For example, if incontinence issues exist more time can be granted for washing of clothes and/or linens. WORK can only provide basic supports, which does not included ironing."]
["Time per Task Guide:",null,null,null,null,null,null,null,null,null,null,"(6)*",null,null,"(4-5)*",null,null,"(3)*",null,null,"(1-2)*"]
[null,null,null,null,null,null,null,null,null,null,null,"Total Assist",null,null,"Medium Assist",null,null,"Light Assist",null,null,"Cue/Prompt"]
["IN-RESIDENCE LAUNDRY (includes sort ,fold/put away, wash/dry)",null,null,null,null,null,null,null,null,null,null,null,"MAX OF 2 HOURS TOTAL PER WEEK"]
["OUTSIDE-RESIDENCE LAUNDRY (includes sort ,fold/put away, wash/dry)",null,null,null,null,null,null,null,null,null,null,null,"MAX OF 3 HOURS TOTAL PER WEEK"]
["Sorting",null,null,null,null,null,null,null,null,null,null,10,"minutes",null,8,"minutes",null,5,"minutes",null,5,"minutes"]
["Folding and putting away/hanging up ",null,null,null,null,null,null,null,null,null,null,15,"minutes",null,10,"minutes",null,5,"minutes",null,5,"minutes"]
["Washer/dryer in residence, per load ",null,null,null,null,null,null,null,null,null,null,15,"minutes",null,10,"minutes",null,5,"minutes",null,5,"minutes"]
[null,"(includes carrying laundry, any pretreatments, and operating machines)"]
["Washing/dryer outside of residence, per load ",null,null,null,null,null,null,null,null,null,null,30,"minutes",null,20,"minutes",null,10,"minutes",null,5,"minutes"]
[null,"(includes carrying laundry, any pretreatments, and operating machines)"]
["Time may vary depending on whether using a public laundromat or apartment complex laundry facility. If transportation is needed see the transportation section."]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Yes","No"]
["A.","Can you perform this task without any support?",null,null,null,null,null,null,null,null,null,null,"Please put an \"X\" in the appropriate box."]
[]
["B.","In the last 3 days, how did you get this done?"]
["  Performance  ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"B18","v":0}]
[]
["C.","How much or what aspects of these tasks are you able to do safely on your own?"]
["Capacity  ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"B21","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Yes","No"]
["D.","Are any hours of support needed for this task?",null,null,null,null,null,null,null,null,null,null,"Please put an \"X\" in the appropriate box.",null,null,null,null,null,null,null,null,null,null,{"$f":"IF(AND(X25=FALSE,X26=FALSE),TRUE)","v":true},"   Error. Go back to the Residency Information page and complete page."]
["If support is needed, list each task, describe the amount and frequency of support needed and include an estimate of the weekly hours of support needed. (Thorough justification of time greater than examples above is required.)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(AND(X25=TRUE,X26=TRUE),TRUE)","v":false},"   Error. Go back to the Residency Information page and fix page."]
[null,"Does Informal Supports policy apply to this member?",null,null,null,null,null,null,null,{"$f":"_xlfn.IFS(X23,Y23,X24,Y24,X25,\"No\",X26,\"Yes\")","v":"   Error. Go back to the Residency Information page and complete page."},null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"OR('Residency Information'!S3)","v":false}]
[null,"Is an exception to the Informal Supports policy being requested?",null,null,null,null,null,null,null,null,null,null,null,"Yes",null,"No","(Please put an x in the appropriate box)",null,null,null,null,null,null,{"$f":"OR('Residency Information'!S5,'Residency Information'!S24,'Residency Information'!S35)","v":false}]
["Time per task breakdown ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"B27","v":0}]
["Total Weekly hours needed for this activity",null,null,null,null,null,null,null,null,null,null,null,null,null,null,0,null,null,null,"hours"]
["Total Monthly hours",null,null,null,null,null,null,null,null,null,{"$f":"PRODUCT(P28,4.33)","v":0},null,null,null,"(Weekly hours X 4.33 = Monthly hrs.)"]
[]
["Time Conversion Chart and Calculation Tool"]
["5m = .08 h",null,null,null,"15m = .25h",null,null,null,"25m = .42h",null,null,null,"35m = .58h",null,null,null,"45m = .75h",null,null,null,"55m = .92h"]
["10m = .17h",null,null,null,"20m = .33h",null,null,null,"30m = .5h",null,null,null,"40m = .67h",null,null,null,"50m = .83h",null,null,null,"60m = 1.0h"]
["* No rounding ",null,"Number of Minutes",null,null,0,"=",{"$f":"ROUND(F34/60,2)","v":0},null,"Number of Hours",null,null,"or","Number of Hours",null,null,0,"=",{"$f":"ROUND(Q34*60,2)","v":0},null,"Number of Minutes"]

{"sheet":"Transportation","index":19,"n_rows":37,"n_cols":27,"rows_kept":37,"cut":false,"hidden":false,"merged":[[33,0,33,23],[34,0,34,2],[30,20,30,23],[27,13,27,23],[31,0,31,10],[31,11,31,14],[31,15,31,23],[34,4,34,6],[34,8,34,10],[34,13,34,15],[34,17,34,19],[34,21,34,23],[21,1,21,23],[24,0,24,23],[29,1,29,23],[12,0,12,11],[17,1,17,23],[25,10,25,23],[15,1,15,11],[15,12,15,21],[23,1,23,11],[23,12,23,21],[18,1,18,23],[26,15,26,23],[35,0,35,2],[1,0,1,23],[4,13,4,14],[4,16,4,17],[4,19,4,20],[4,22,4,23],[2,0,2,11],[2,12,2,14],[2,15,2,17],[2,18,2,20],[2,21,2,23],[3,0,3,11],[3,12,3,14],[30,0,30,15],[30,16,30,19],[20,1,20,23],[3,15,3,17],[3,18,3,20],[10,22,10,23],[3,21,3,23],[5,13,5,14],[5,16,5,17],[5,19,5,20],[5,22,5,23],[9,13,9,14],[9,16,9,17],[4,0,4,11],[5,0,5,11],[8,0,8,11],[13,1,13,23],[11,12,11,23],[12,12,12,23],[6,1,6,23],[7,1,7,23],[9,1,9,11],[10,1,10,11],[9,19,9,20],[9,22,9,23],[10,13,10,14],[10,16,10,17],[10,19,10,20],[11,0,11,11],[35,4,35,6],[35,8,35,10],[35,13,35,15],[35,17,35,19],[35,21,35,23],[36,21,36,23],[36,12,36,13],[36,0,36,1],[36,2,36,4],[36,7,36,8],[36,14,36,16],[36,19,36,20]]}
["12) Transportation (MFEI h*)"]
["NOTES: 1) Transportation support is allowed only for people who cannot drive due to their disability and includes both private and public transportation methods. 2) If a member has a driver’s license no transportation time will be approved because the member has demonstrated to the State of Kansas that he/she has the ability to drive. 3) If a WORK member drives for any reason the expectation is that the member provides their own transportation. 4) When transportation for medical appointments is needed, consumers must use NEMT (non-emergency medical transportation) services."]
["Time per Task Guide:",null,null,null,null,null,null,null,null,null,null,null,"(6)*",null,null,"(4-5)*",null,null,"(3)*",null,null,"(1-2)*"]
[null,null,null,null,null,null,null,null,null,null,null,null,"Total Assist",null,null,"Medium Assist",null,null,"Light Assist",null,null,"Cue/Prompt"]
["Scheduling transportation needs",null,null,null,null,null,null,null,null,null,null,null,20,"minutes",null,15,"minutes",null,10,"minutes",null,5,"minutes"]
["Locomotion to/from vehicle ",null,null,null,null,null,null,null,null,null,null,null,5,"minutes",null,5,"minutes",null,5,"minutes",null,"N/A","minutes"]
[null,"Note: For shopping, locomotion may be needed from the home to the vehicle, from the vehicle to the store, from the store to the vehicle, and back home. "]
[null,"This means for one trip to the store someone needing total assistance would need 5m x 4 for a total of 20m."]
["Transfer in/out of vehicle"]
[null,"Member needing assist in/out of vehicle no equipment",null,null,null,null,null,null,null,null,null,null,5,"minutes",null,5,"minutes",null,5,"minutes",null,"N/A","minutes"]
[null,"Member needing assist in/out of vehicle with additional equipment",null,null,null,null,null,null,null,null,null,null,15,"minutes",null,10,"minutes",null,5,"minutes",null,"N/A","minutes"]
["Transportation to/from store/bank/laundry mat",null,null,null,null,null,null,null,null,null,null,null,"Up to 1 hour per week based on distance/drive time"]
["Transportation to/from work",null,null,null,null,null,null,null,null,null,null,null,"Up to 1 hour per work day based on distance/drive time"]
[null,"(Must include work address and how many days per week member works)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Yes","No"]
["A.","Can you perform this task without any support?",null,null,null,null,null,null,null,null,null,null,"Please put an \"X\" in the appropriate box."]
[]
["B.","In the last 3 days, how did you get this done?"]
["  Performance   ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"B19","v":0}]
[]
["C.","How much or what aspects of these tasks are you able to do safely on your own?"]
["Capacity  ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"B22","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Yes","No"]
["D.","Are any hours of support needed for this task?",null,null,null,null,null,null,null,null,null,null,"Please put an \"X\" in the appropriate box.",null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(AND(Y26=FALSE,Y27=FALSE),TRUE)","v":true},"   Error. Go back to the Residency Information page and complete page."]
["If support is needed, list each task, describe the amount and frequency of support needed and include an estimate of the weekly hours of support needed. (Thorough justification of time greater than examples above is required.)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(AND(Y26=TRUE,Y27=TRUE),TRUE)","v":false},"   Error. Go back to the Residency Information page and fix page."]
[null,"Does Informal Supports policy apply to this member?",null,null,null,null,null,null,null,null,{"$f":"_xlfn.IFS(Y24,Z24,Y25,Z25,Y26,\"No\",Y27,\"Yes\")","v":"   Error. Go back to the Residency Information page and complete page."},null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"OR('Residency Information'!S3)","v":false}]
[null,"Is an exception to the Informal Supports policy being requested?",null,null,null,null,null,null,null,null,null,null,"Yes",null,"No","(Please put an x in the appropriate box if no check box option)",null,null,null,null,null,null,null,null,{"$f":"OR('Residency Information'!S5,'Residency Information'!S24,'Residency Information'!S35)","v":false}]
[null,"Does the member have a driver's license?",null,null,null,null,null,null,null,null,"Yes",null,"No",{"$f":"_xlfn.IFS(Z37,AA37,Y28,Z28,Y29,Z29,Y34,Z33)","v":"← Must answer question "},null,null,null,null,null,null,null,null,null,null,{"$f":"AA35","v":false},"STOP. Member is not eligible for transportation."]
[null,"Does the member drive for any reason?",null,null,null,null,null,null,null,"Yes",null,"No",null,"Does the member have a vehicle?",null,null,null,null,null,null,"Yes",null,"No",null,{"$f":"AA36","v":false},"CONTINUE. Member may be eligible for transportation."]
["Time per task breakdown   ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"B30","v":0}]
["Total Weekly hours needed for this activity",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,0,null,null,null,"hours",null,null,null,{"$f":"IF(Y29,1,0)","v":0}]
["Total Monthly hours",null,null,null,null,null,null,null,null,null,null,{"$f":"PRODUCT(Q31,4.33)","v":0},null,null,null,"(Weekly hours X 4.33 = Monthly hrs.)",null,null,null,null,null,null,null,null,{"$f":"SUM(Y31:Y31)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(Y28,1,0)","v":0},"← Must answer question "]
["Time Conversion Chart and Calculation Tool",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"NOT(Y32)","v":true}]
["5m = .08 h",null,null,null,"15m = .25h",null,null,null,"25m = .42h",null,null,null,null,"35m = .58h",null,null,null,"45m = .75h",null,null,null,"55m = .92h",null,null,null,{"$f":"COUNTIFS(J28,\"x\")","v":0},{"$f":"AND(Z35)","v":false}]
["10m = .17h",null,null,null,"20m = .33h",null,null,null,"30m = .5h",null,null,null,null,"40m = .67h",null,null,null,"50m = .83h",null,null,null,"60m = 1.0h",null,null,null,{"$f":"COUNTIFS(L28,\"x\")","v":0},{"$f":"AND(Z36)","v":false}]
["* No rounding ",null,"Number of Minutes",null,null,0,"=",{"$f":"ROUND(F37/60,2)","v":0},null,"Number of Hours",null,null,"or",null,"Number of Hours",null,null,0,"=",{"$f":"ROUND(R37*60,2)","v":0},null,"Number of Minutes",null,null,null,{"$f":"IF(AND(AA35=TRUE,AA36=TRUE),TRUE)","v":false},"   Error. Must check only one box."]

{"sheet":"Money Management","index":20,"n_rows":31,"n_cols":25,"rows_kept":31,"cut":false,"hidden":false,"merged":[[1,0,1,10],[1,11,1,13],[1,14,1,16],[1,17,1,19],[1,20,1,22],[2,20,2,22],[3,12,3,13],[3,15,3,16],[3,18,3,19],[3,21,3,22],[4,12,4,13],[2,0,2,10],[2,11,2,13],[2,14,2,16],[2,17,2,19],[5,12,5,13],[5,15,5,16],[5,18,5,19],[5,21,5,22],[6,12,6,13],[6,15,6,16],[6,18,6,19],[6,21,6,22],[26,12,26,14],[7,0,7,10],[7,12,7,13],[7,15,7,16],[7,18,7,19],[19,9,19,22],[9,1,9,11],[9,12,9,20],[17,1,17,11],[17,12,17,20],[12,1,12,22],[14,1,14,22],[15,1,15,22],[7,21,7,22],[30,12,30,22],[4,15,4,16],[4,18,4,19],[4,21,4,22],[29,12,29,22],[18,0,18,22],[21,1,21,22],[22,0,22,14],[22,15,22,18],[22,19,22,22],[11,1,11,22],[23,0,23,9],[23,10,23,13],[23,14,23,22],[26,0,26,2],[26,4,26,6],[28,18,28,19],[28,20,28,22],[25,0,25,22],[28,0,28,1],[28,2,28,4],[28,7,28,8],[28,13,28,15],[26,16,26,18],[26,20,26,22],[27,0,27,2],[27,4,27,6],[27,8,27,10],[27,12,27,14],[27,16,27,18],[27,20,27,22],[26,8,26,10]]}
["13) Money Management (MFEI c*)"]
["Time per Task Guide:",null,null,null,null,null,null,null,null,null,null,"(6)*",null,null,"(4-5)*",null,null,"(3)*",null,null,"(1-2)*"]
[null,null,null,null,null,null,null,null,null,null,null,"Total Assist",null,null,"Medium Assist",null,null,"Light Assist",null,null,"Cue/Prompt"]
["Retrieving mail from mail box (up to 6 days per week)",null,null,null,null,null,null,null,null,null,null,5,"minutes",null,5,"minutes",null,5,"minutes",null,5,"minutes"]
["Opening/sorting mail (up to 6 days per week)",null,null,null,null,null,null,null,null,null,null,5,"minutes",null,5,"minutes",null,5,"minutes",null,5,"minutes"]
["Developing, reviewing and maintaining a budget",null,null,null,null,null,null,null,null,null,null,30,"minutes",null,20,"minutes",null,10,"minutes",null,5,"minutes"]
["Assistance with bank accounts",null,null,null,null,null,null,null,null,null,null,30,"minutes",null,20,"minutes",null,10,"minutes",null,5,"minutes"]
["Paying bills",null,null,null,null,null,null,null,null,null,null,30,"minutes",null,20,"minutes",null,10,"minutes",null,5,"minutes"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Yes","No"]
["A.","Can you perform this task without any support?",null,null,null,null,null,null,null,null,null,null,"Please put an \"X\" in the appropriate box."]
[]
["B.","In the last 3 days, how did you get this done?"]
["  Performance   ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"B13","v":0}]
[]
["C.","How much or what aspects of these tasks are you able to do safely on your own?"]
["Capacity  ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"B16","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Yes","No"]
["D.","Are any hours of support needed for this task?",null,null,null,null,null,null,null,null,null,null,"Please put an \"X\" in the appropriate box.",null,null,null,null,null,null,null,null,null,null,{"$f":"IF(AND(X20=FALSE,X21=FALSE),TRUE)","v":true},"   Error. Go back to the Residency Information page and complete page."]
["If support is needed, list each task, describe the amount and frequency of support needed and include an estimate of the weekly hours of support needed. (Thorough justification of time greater than examples above is required.)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(AND(X20=TRUE,X21=TRUE),TRUE)","v":false},"   Error. Go back to the Residency Information page and fix page."]
[null,"Does Informal Supports policy apply to this member?",null,null,null,null,null,null,null,{"$f":"_xlfn.IFS(X18,Y18,X19,Y19,X20,\"No\",X21,\"Yes\")","v":"   Error. Go back to the Residency Information page and complete page."},null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"OR('Residency Information'!S3)","v":false}]
[null,"Is an exception to the Informal Supports policy being requested?",null,null,null,null,null,null,null,null,null,null,"Yes",null,"No","(Please put an x in the appropriate box)",null,null,null,null,null,null,null,{"$f":"OR('Residency Information'!S5,'Residency Information'!S24,'Residency Information'!S35)","v":false}]
["Time per task breakdown  ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"B22","v":0}]
["Total Weekly hours needed for this activity",null,null,null,null,null,null,null,null,null,null,null,null,null,null,0,null,null,null,"hours"]
["Total Monthly hours",null,null,null,null,null,null,null,null,null,{"$f":"PRODUCT(P23,4.33)","v":0},null,null,null,"(Weekly hours X 4.33 = Monthly hrs.)"]
[]
["Time Conversion Chart and Calculation Tool"]
["5m = .08 h",null,null,null,"15m = .25h",null,null,null,"25m = .42h",null,null,null,"35m = .58h",null,null,null,"45m = .75h",null,null,null,"55m = .92h"]
["10m = .17h",null,null,null,"20m = .33h",null,null,null,"30m = .5h",null,null,null,"40m = .67h",null,null,null,"50m = .83h",null,null,null,"60m = 1.0h"]
["* No rounding ",null,"Number of Minutes",null,null,0,"=",{"$f":"ROUND(F29/60,2)","v":0},null,"Number of Hours",null,null,"or","Number of Hours",null,null,0,"=",{"$f":"ROUND(Q29*60,2)","v":0},null,"Number of Minutes"]
["Does the member has a Representative Payee?",null,null,null,null,null,null,null,"Yes",null,"No"]
[null,null,null,null,null,null,"(Please put an x in the appropriate box)",null,null,null,null,null,"Name of Representative Payee"]

{"sheet":"Other IADLs","index":21,"n_rows":41,"n_cols":25,"rows_kept":41,"cut":false,"hidden":false,"merged":[[2,0,2,10],[2,11,2,13],[2,14,2,16],[2,17,2,19],[2,20,2,22],[1,0,1,10],[1,11,1,13],[1,14,1,16],[1,17,1,19],[1,20,1,22],[8,12,8,13],[8,15,8,16],[8,18,8,19],[8,21,8,22],[3,12,3,13],[3,15,3,16],[3,18,3,19],[3,21,3,22],[4,12,4,13],[4,15,4,16],[4,18,4,19],[4,21,4,22],[31,9,31,22],[30,0,30,22],[19,0,19,10],[19,12,19,13],[19,15,19,16],[19,18,19,19],[19,21,19,22],[23,1,23,22],[24,1,24,22],[26,1,26,22],[27,1,27,22],[21,1,21,11],[21,12,21,20],[29,1,29,11],[29,12,29,20],[39,0,39,2],[39,4,39,6],[39,8,39,10],[33,1,33,22],[34,0,34,14],[34,15,34,18],[34,19,34,22],[35,0,35,9],[35,10,35,13],[35,14,35,22],[37,0,37,22],[38,0,38,2],[38,4,38,6],[38,8,38,10],[38,12,38,14],[38,16,38,18],[12,12,12,13],[12,15,12,16],[12,18,12,19],[12,21,12,22],[11,12,11,13],[11,15,11,16],[11,18,11,19],[11,21,11,22],[18,12,18,13],[18,15,18,16],[18,18,18,19],[18,21,18,22],[14,12,14,13],[14,15,14,16],[14,18,14,19],[14,21,14,22],[17,12,17,13],[17,15,17,16],[17,18,17,19],[17,21,17,22],[15,12,15,13],[15,15,15,16],[15,18,15,19],[15,21,15,22],[38,20,38,22],[39,12,39,14],[39,16,39,18],[39,20,39,22],[40,20,40,22],[40,0,40,1],[40,2,40,4],[40,7,40,8],[40,13,40,15],[40,18,40,19]]}
["14) Other IADLs"]
["Time per Task Guide:",null,null,null,null,null,null,null,null,null,null,"(6)*",null,null,"(4-5)*",null,null,"(3)*",null,null,"(1-2)*"]
[null,null,null,null,null,null,null,null,null,null,null,"Total Assist",null,null,"Medium Assist",null,null,"Light Assist",null,null,"Cue/Prompt"]
["Scheduling and paperwork related to medical appointments",null,null,null,null,null,null,null,null,null,null,10,"minutes",null,8,"minutes",null,5,"minutes",null,"NA","minutes"]
["Accompaniment to Medical appointments (time per appointment)",null,null,null,null,null,null,null,null,null,null,"45 to 60","minutes",null,"20 to 44","minutes",null,"5 to 19","minutes",null,"NA","minutes"]
[null,"Remember you will need to take the time per appointment and divide it over the year."]
[null,"If a member needs this time for a monthly appointment that takes 60m use this calculation: 60m x 12 mnths = 720m ÷ 52 wks = 13.8m round to 14m per week)"]
[null,"If a member needs this time for an appointment 4 times per year that takes 60m use this calculation: 60m x 4 = 240m ÷ 52 wks = 4.6m round to 5m per week)"]
["Assistance with doctor ordered exercise, per day",null,null,null,null,null,null,null,null,null,null,30,"minutes",null,15,"minutes",null,10,"minutes",null,5,"minutes"]
[null,"(for in the home not outside of the home or at the gym)"]
["Life Line ",null,null,null,null,null,null,null,null,null,null,"1 hour/week maximum"]
["Certified Service Animal care (per day)",null,null,null,null,null,null,null,null,null,null,15,"minutes",null,10,"minutes",null,5,"minutes",null,5,"minutes"]
["Lawn mowing & snow removal",null,null,null,null,null,null,null,null,null,null,"30 to 60","minutes",null,"15 to 29","minutes",null,"5 to 14","minutes",null,5,"minutes"]
["Mowing only"]
[null,"9/12","(time is for 9 months out of the year 9/12, spread over the full year)",null,null,null,null,null,null,null,null,"30 to 45","minutes",null,"18 to 29","minutes",null,"5 to 17","minutes",null,5,"minutes"]
[null,"6/12","(time is for 6 months out of the year 6/12, spread over the full year)",null,null,null,null,null,null,null,null,"22 to 30","minutes",null,"14 to 21","minutes",null,"5 to 13","minutes",null,5,"minutes"]
["Snow removal only "]
[null,"4/12","(time is for 4 months out of the year 4/12, spread over the full year)",null,null,null,null,null,null,null,null,"12 to 15","minutes",null,"9 to 11","minutes",null,"5 to 8","minutes",null,5,"minutes"]
[null,"6/12","(time is for 6 months out of the year 6/12, spread over the full year)",null,null,null,null,null,null,null,null,"22 to 30","minutes",null,"14 to 21","minutes",null,"5 to 13","minutes",null,5,"minutes"]
["Safety in the community (for IDD/BI only) ",null,null,null,null,null,null,null,null,null,null,"30 to 60","minutes",null,"15 to 29","minutes",null,"5 to14","minutes",null,5,"minutes"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Yes","No"]
["A.","Can you perform this task without any support?",null,null,null,null,null,null,null,null,null,null,"Please put an \"X\" in the appropriate box."]
[]
["B.","In the last 3 days, how did you get this done?"]
["  Performance   ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"B25","v":0}]
[]
["C.","How much or what aspects of these tasks are you able to do safely on your own?"]
["Capacity  ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"B28","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Yes","No"]
["D.","Are any hours of support needed for this task?",null,null,null,null,null,null,null,null,null,null,"Please put an \"X\" in the appropriate box.",null,null,null,null,null,null,null,null,null,null,{"$f":"IF(AND(X32=FALSE,X33=FALSE),TRUE)","v":true},"   Error. Go back to the Residency Information page and complete page."]
["If support is needed, list each task, describe the amount and frequency of support needed and include an estimate of the weekly hours of support needed. (Thorough justification of time greater than examples above is required.)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(AND(X32=TRUE,X33=TRUE),TRUE)","v":false},"   Error. Go back to the Residency Information page and fix page."]
[null,"Does Informal Supports policy apply to this member?",null,null,null,null,null,null,null,{"$f":"_xlfn.IFS(X30,Y30,X31,Y31,X32,\"No\",X33,\"Yes\")","v":"   Error. Go back to the Residency Information page and complete page."},null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"OR('Residency Information'!S3)","v":false}]
[null,"Is an exception to the Informal Supports policy being requested?",null,null,null,null,null,null,null,null,null,null,"Yes",null,"No","(Please put an x in the appropriate box)",null,null,null,null,null,null,null,{"$f":"OR('Residency Information'!S5,'Residency Information'!S24,'Residency Information'!S35)","v":false}]
["Time per task breakdown  ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"B34","v":0}]
["Total Weekly hours needed for this activity",null,null,null,null,null,null,null,null,null,null,null,null,null,null,0,null,null,null,"hours"]
["Total Monthly hours",null,null,null,null,null,null,null,null,null,{"$f":"PRODUCT(P35,4.33)","v":0},null,null,null,"(Weekly hours X 4.33 = Monthly hrs.)"]
[]
["Time Conversion Chart and Calculation Tool"]
["5m = .08 h",null,null,null,"15m = .25h",null,null,null,"25m = .42h",null,null,null,"35m = .58h",null,null,null,"45m = .75h",null,null,null,"55m = .92h"]
["10m = .17h",null,null,null,"20m = .33h",null,null,null,"30m = .5h",null,null,null,"40m = .67h",null,null,null,"50m = .83h",null,null,null,"60m = 1.0h"]
["* No rounding ",null,"Number of Minutes",null,null,0,"=",{"$f":"ROUND(F41/60,2)","v":0},null,"Number of Hours",null,null,"or","Number of Hours",null,null,0,"=",{"$f":"ROUND(Q41*60,2)","v":0},null,"Number of Minutes"]

{"sheet":"Supported Employment","index":22,"n_rows":44,"n_cols":37,"rows_kept":44,"cut":false,"hidden":false,"merged":[[0,0,0,34],[1,0,3,34],[13,31,13,33],[5,31,5,33],[6,0,8,29],[9,0,9,29],[10,1,10,29],[11,1,11,29],[4,29,4,34],[13,0,13,29],[5,0,5,29],[12,1,12,29],[14,1,14,29],[15,1,15,29],[22,1,22,34],[23,1,23,34],[25,1,25,34],[16,1,16,29],[17,1,17,29],[18,1,18,29],[20,21,20,32],[20,1,20,20],[26,1,26,34],[36,1,36,34],[29,0,30,34],[35,1,35,34],[40,0,40,34],[31,0,38,0],[33,30,33,34],[37,30,37,34],[38,1,38,13],[38,14,38,21],[38,22,38,34],[31,1,31,34],[32,1,32,34],[33,1,33,21],[33,22,33,29],[37,1,37,21],[43,0,43,2],[43,3,43,7],[43,13,43,17],[43,19,43,23],[28,21,28,32],[28,1,28,20],[37,22,37,29],[34,1,34,13],[34,14,34,21],[34,22,34,34],[43,29,43,34],[43,8,43,9],[43,11,43,12],[43,24,43,25],[43,27,43,28]]}
["15) Supported Employment - Individual Employment Support Services"]
["Supported Employment includes consultation with and technical assistance for the employer by a certified job coach/specialist.  Individual Employment Support Services includes support to 1) learn new and evolving job responsibilities, 2) increase accuracy and/or speed, 3) exhibit appropriate work behavior, 4) interact appropriately with other employees and the general public, 5) practice safety measures at work.  Member must have a medical and functional need for this service. Individual Employment Support Services does not include assistance to operationalize or perform any aspect of the member’s job. Refer to the WORK Program Manual . This WORK Program Manual can be found on the WORK website https://www.kancare.ks.gov/consumers/working-healthy/working-healthy/work."]
[]
[]
["Time per Task Guide:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Max Allowable Time"]
["One-on-One Support: MAX allowed for 1-on-1 is equal to number of hours paid work per week = ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"'Member Information'!K33","v":0}]
["One-on-one support is permitted only with a detailed explanation of the member's need for that level of support, and justification of the need for a one-on-one support person. Hour-per-hour assistance must be decreased over time and will be reviewed every three months by the WORK Program Manager or MCO Care Coordinator. "]
[]
[]
["One-on-one support helps the individual while at work to:"]
["*","learn new job tasks, improve accuracy, and/or increase production"]
["*","remember how to behave correctly at work and interact with supervisor(s), coworkers or the public"]
["*","understand how to be safe at work"]
["Job Coaching: Max Allowed hours are 1/4 total hours per week divided by 4.33 =",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"('Member Information'!K33*0.25)/4.33","v":0}]
["*","assist individual in talking to supervisor about how best to deal with problems on the job"]
["*","help individual learn to and talk with employer about needed accommodations"]
["*","teaching individual how to behave correctly at work"]
["*","helping individual understand how to interact correctly with supervisor and coworkers"]
["*","assist individual in keeping his or her job if problems emerge"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Yes","No"]
["A.","Can you perform this task without any support?",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Please put an \"X\" in the appropriate box."]
[]
["B.","In the last 3 days, how did you get this done?"]
["  Performance  ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"B24","v":0}]
[]
["C.","How much or what aspects of these tasks are you able to do safely on your own?"]
["Capacity  ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"B27","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Yes","No"]
["D.","Are any hours of support needed for this task?",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Please put an \"X\" in the appropriate box."]
["If support is needed, list each task, describe the amount and frequency of support needed and include an estimate of the weekly and monthly hours of support needed. (Thorough justification of time greater than examples above is required.)"]
[]
["Time per task breakdown     ","******************************  1:1 SUPPORTED EMPLOYMENT  ********************************"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"B33","v":0}]
[null,"Total Weekly hours needed for this activity",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,0,null,null,null,null,null,null,null,"hours"]
[null,"Total Monthly hours",null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"PRODUCT(W34,4.33)","v":0},null,null,null,null,null,null,null,"(Weekly hours X 4.33 = Monthly hrs.)"]
[null,"************************  JOB COACH SUPPORTED EMPLOYMENT  ******************************"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"B37","v":0}]
[null,"Total Weekly hours needed for this activity",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,0,null,null,null,null,null,null,null,"hours"]
[null,"Total Monthly hours",null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"PRODUCT(W38,4.33)","v":0},null,null,null,null,null,null,null,"(Weekly hours X 4.33 = Monthly hrs.)"]
[]
["Time Conversion Chart"]
[null,"5m = .08 h",null,null,null,null,null,"15m = .25h",null,null,null,null,null,"25m = .42h",null,null,null,null,null,"35m = .58h",null,null,null,null,null,"45m = .75h",null,null,null,null,null,null,"55m = .92h"]
[null,"10m = .17h",null,null,null,null,null,"20m = .33h",null,null,null,null,null,"30m = .5h",null,null,null,null,null,"40m = .67h",null,null,null,null,null,"50m = .83h",null,null,null,null,null,null,"60m = 1.0h"]
["* No rounding ",null,null,"Number of Minutes",null,null,null,null,0,null,"=",{"$f":"ROUND(I44/60,2)","v":0},null,"Number of Hours",null,null,null,null,"or","Number of Hours",null,null,null,null,0,null,"=",{"$f":"ROUND(Y44*60,2)","v":0},null,"Number of Minutes"]

{"sheet":"Total Hrs Supprt & Alloc Req","index":23,"n_rows":41,"n_cols":56,"rows_kept":41,"cut":false,"hidden":false,"merged":[[40,0,40,27],[1,32,1,59],[2,32,2,54],[3,32,3,54],[4,32,4,54],[6,55,6,59],[2,55,2,59],[3,55,3,59],[4,55,4,59],[5,55,5,59],[5,32,5,54],[6,32,6,54],[26,15,26,16],[26,21,26,22],[26,17,26,20],[3,12,3,14],[37,11,37,13],[37,25,37,27],[39,0,39,27],[34,0,34,27],[35,0,35,13],[35,14,35,27],[36,9,36,13],[36,23,36,27],[36,4,36,8],[36,18,36,22],[32,0,32,5],[32,6,32,8],[32,12,32,16],[32,17,32,20],[32,23,33,27],[33,0,33,22],[29,0,29,5],[29,6,29,8],[29,9,29,10],[29,11,29,16],[29,17,29,20],[29,21,29,22],[29,23,29,27],[30,23,30,27],[31,0,31,5],[31,6,31,8],[31,9,31,10],[31,11,31,16],[31,17,31,20],[31,21,31,22],[31,23,31,27],[30,0,30,5],[30,6,30,8],[30,9,30,10],[30,11,30,16],[30,17,30,20],[30,21,30,22],[27,0,27,5],[27,6,27,7],[28,0,28,5],[28,6,28,8],[28,9,28,10],[28,11,28,16],[25,0,25,22],[25,23,25,27],[26,0,26,7],[26,8,26,9],[26,10,26,14],[28,17,28,20],[28,21,28,22],[28,23,28,27],[21,0,21,27],[22,15,22,22],[22,23,22,27],[23,15,23,22],[23,23,23,27],[24,0,24,16],[24,17,24,22],[24,23,24,27],[16,21,16,22],[17,15,17,20],[17,21,17,22],[12,15,12,20],[12,21,12,22],[13,15,13,20],[13,21,13,22],[14,15,14,20],[14,21,14,22],[0,0,0,27],[1,0,1,27],[2,15,2,20],[2,21,2,22],[2,23,8,27],[3,15,3,20],[3,21,3,22],[7,15,7,20],[7,21,7,22],[8,15,8,20],[8,21,8,22],[37,2,37,3],[37,16,37,17],[4,0,4,12],[4,15,4,20],[4,21,4,22],[5,15,5,20],[5,21,5,22],[6,15,6,20],[6,21,6,22],[18,0,18,27],[19,15,19,20],[19,21,19,22],[19,23,20,27],[20,15,20,20],[20,21,20,22],[9,0,9,27],[10,15,10,20],[10,21,10,22],[10,23,17,27],[11,15,11,20],[11,21,11,22],[15,15,15,20],[15,21,15,22],[16,15,16,20]]}
["Total hours of support and allocation requested:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"This should not print."]
["Total Number of ADL PAS hours PER WEEK Requested",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"This section will not print but is visible in the electronic excel format."]
["Does this member require two-person transfers?",null,null,null,null,null,null,null," ",null,"Yes",null,"No",null,null,"Bathing & Personal Hygiene",null,null,null,null,null,{"$f":"SUM('Bathing & Personal Hygiene'!P30:S30)","v":0},null,{"$f":"SUM(AC3,AC9)","v":0},null,null,null,null,{"$f":"SUM(V3:W8)","v":0},null,null,null,"Maximum hours per month are calculated as follows: 24hrs x 365days / 12mnths = 730hrs per mnth",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"SUM(I27)","v":730}]
["How many hours per month are required for two-person transfers?",null,null,null,null,null,null,null,null,null,null,null,0,null,null,"Dressing",null,null,null,null,null,{"$f":"SUM(Dressing!P24:S24)","v":0},null,null,null,null,null,null,null,null,null,null,"Subtract time the member is at their job: working hours per month.",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"SUM(P27)","v":0}]
["Only provide time for 1 extra person when 2 person transfer is needed.",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Prosthetic and Orthotic Device",null,null,null,null,null,{"$f":"SUM('Prosthetic, Orthotic, Other Dev'!P34:S34)","v":0},null,null,null,null,null,null,null,null,null,null,"Add time for any Supported Employment per month.",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"SUM(V27)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Toileting",null,null,null,null,null,{"$f":"SUM(Toileting!P40)","v":0},null,null,null,null,null,null,null,null,null,null,"If 2 person transfers are needed add how much time per month for 1 extra person.",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"SUM(G28)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Eating",null,null,null,null,null,{"$f":"SUM(Eating!P25)","v":0},null,null,null,null,null,null,null,null,null,null,"This member can be assessed for up to this many hours per month",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"SUM(X25)","v":730}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Other ADL's",null,null,null,null,null,{"$f":"SUM('Other ADLs'!P23:S23)","v":0},null,null,null,null,null,null,null,null,null,null,"The above number will auto populate and take care of rounding when info is added to the assessment. "]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Other ADL's - Night Suppport",null,null,null,null,null,{"$f":"SUM('Other ADLs'!P29:S29)","v":0},null,null,null,null,null,null,{"$f":"SUM(V9)","v":0}]
["Total Number of IADL PAS hours PER WEEK Requested "]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Medication Management",null,null,null,null,null,{"$f":"SUM('Medication Management'!P29:S29)","v":0},null,{"$f":"SUM(V11:W18)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Meal Planning/Preparation/Clean Up",null,null,null,null,null,{"$f":"SUM('Meal Support'!Q33:T33)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Shopping",null,null,null,null,null,{"$f":"SUM(Shopping!Q36)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Housekeeping",null,null,null,null,null,{"$f":"SUM(Housekeeping!P23)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Laundry",null,null,null,null,null,{"$f":"SUM(Laundry!P28)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Transportation",null,null,null,null,null,{"$f":"SUM(Transportation!Q31)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Money Management",null,null,null,null,null,{"$f":"SUM('Money Management'!P23:S23)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Other IADL's",null,null,null,null,null,{"$f":"SUM('Other IADLs'!P35:S35)","v":0}]
["Total Number of Supported Employment Hours PER WEEK Requested "]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"1:1 Supported Employment",null,null,null,null,null,{"$f":"SUM('Supported Employment'!W34:AD34)","v":0},null,{"$f":"SUM(AC20:AC21)","v":0},null,null,null,null,{"$f":"SUM(V20)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Job Coach Supported Employment",null,null,null,null,null,{"$f":"SUM('Supported Employment'!W38:AD38)","v":0},null,null,null,null,null,null,{"$f":"SUM(V21)","v":0}]
["Total Assessed Hours and Monthly Allocation Amount"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Total hours per week requested",null,null,null,null,null,null,null,{"$f":"SUM(X3,X11,X20)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Total hours per month requested",null,null,null,null,null,null,null,{"$f":"PRODUCT(X23,4.33)","v":0}]
["Maximum hours per month are 730 - time employed + supported employment + 2 person transfer",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"This member can't have more than",null,null,null,null,null,{"$f":"I27-P27+V27+G28","v":730}]
["Stop = Hrs over allowed # per month, needs reviewed.   Continue = Hrs within  allowed range. ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(X25>X24,\"Continue\",\"STOP\")","v":"Continue"}]
["24hrs x 365days / 12mnths = 730hrs per mnth",null,null,null,null,null,null,null,730,null,"Employed time per mnth",null,null,null,null,{"$f":"SUM('Member Information'!K33:M33)*4.33","v":0},null,"Support Employ per mnth",null,null,null,{"$f":"SUM('Supported Employment'!O35:V35,'Supported Employment'!O39:V39)","v":0}]
["Two-person transfer hours",null,null,null,null,null,{"$f":"SUM(M4)","v":0}]
["Total Wkly Night Support hrs  ",null,null,null,null,null,{"$f":"SUM(AC9)","v":0},null,null,"X 4.33",null,"Total Monthly hours  ",null,null,null,null,null,{"$f":"PRODUCT(G29,4.33)","v":0},null,null,null,"X $10.62",null,{"$f":"PRODUCT(R29,10.62)","v":0}]
["Total Wkly Personal Care hrs  ",null,null,null,null,null,{"$f":"SUM(X11,AC3)","v":0},null,null,"X 4.33",null,"Total Monthly hours  ",null,null,null,null,null,{"$f":"PRODUCT(G30,4.33)","v":0},null,null,null,"X $16.50",null,{"$f":"PRODUCT(R30,16.5)","v":0}]
["Total Wkly 1:1 Emp Sup hrs  ",null,null,null,null,null,{"$f":"SUM(AC20)","v":0},null,null,"X 4.33",null,"Total Monthly hours  ",null,null,null,null,null,{"$f":"PRODUCT(G31,4.33)","v":0},null,null,null,"X $16.50",null,{"$f":"PRODUCT(R31,16.5)","v":0}]
["Total Wkly Job Coach hrs  ",null,null,null,null,null,{"$f":"SUM(AC21)","v":0},null,null,"X 4.33",null,"Total Monthly hours  ",null,null,null,null,null,{"$f":"PRODUCT(G32,4.33)","v":0},null,null,null,"X $16.50",null,{"$f":"PRODUCT(R32,16.5)","v":0},null,null,null,null,{"$f":"SUM(X29:AB32)","v":0}]
["Total hours per week",null,null,null,null,null,{"$f":"SUM(G29:I32)","v":0},null,null,null,null,null,"Total hours per month",null,null,null,null,{"$f":"SUM(R29:U32)","v":0},null,null,null,null,null,{"$f":"IF(X26=\"STOP\",0,AC32)","v":0}]
["Total Monthly Allocation"]
["Administrative Fee discount allocation "]
["Discounted for agency direction",null,null,null,null,null,null,null,null,null,null,null,null,null,"Discounted for self direction & combination"]
[null,null,0.03,null,"Total Allocation",null,null,null,null,{"$f":"IF(C38=TRUE, ROUND(PRODUCT(AC32,0.97),0),\"$0.00\")","v":"$0.00"},null,null,null,null,null,null,0.1,null,"Total Allocation",null,null,null,null,{"$f":"IF(Q38=TRUE, ROUND(PRODUCT(X33,0.9),0),\"$0.00\")","v":"$0.00"}]
[null,{"$f":"COUNTIFS(B37,\"x\")","v":0},{"$f":"AND(B38)","v":false},null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"COUNTIFS(P37,\"x\")","v":0},{"$f":"AND(P38)","v":false}]
[]
["Summary of significant assessment needs and/or changes"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"A41","v":0}]

{"sheet":"Additional WORK Services","index":24,"n_rows":22,"n_cols":30,"rows_kept":22,"cut":false,"hidden":false,"merged":[[1,1,2,25],[9,1,10,11],[11,1,12,11],[13,1,14,11],[9,12,10,25],[11,12,12,25],[13,12,14,25],[20,1,20,25],[21,1,21,25],[7,1,8,11],[3,1,4,11],[5,1,6,11],[3,12,4,25],[5,12,6,25],[7,12,8,25],[17,1,18,11],[15,1,16,11],[15,12,16,25],[17,12,18,25],[19,1,19,25]]}
[null,"Additional WORK Services:"]
[null,"Independent Living Counseling Service                                                                                                                             (Note: This is an optional service and is paid directly to the provider not through the WORK allocation)"]
[]
[null,"IL Counseling Agency Name:"]
[]
[null,"IL Counselor Name:"]
[]
[null,"Address:"]
[]
[null,"City:"]
[]
[null,"State:"]
[]
[null,"Zip:"]
[]
[null,"Phone:"]
[]
[null,"Email Address:"]
[]
[null,"Assistive Services                                                                                                                                                     (Note: This is an optional service and is paid directly to the provider not through the WORK allocation)"]
[null,"What types of Assistive Technology and services do you currently use to support your independence? "]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"B22","v":0}]

{"sheet":"Signature Page","index":25,"n_rows":35,"n_cols":9,"rows_kept":35,"cut":false,"hidden":false,"merged":[[7,0,10,10],[23,8,23,10],[33,8,33,10],[17,0,19,10],[0,0,0,10],[2,4,2,5],[12,0,16,10],[4,0,5,10],[34,8,34,10],[23,0,23,7],[24,0,24,7],[29,0,29,7],[28,0,28,7],[34,0,34,7],[33,0,33,7],[24,8,24,10],[28,8,28,10],[29,8,29,10]]}
["WORK Assessment Signature Page"]
[]
["Date of WORK Assessment:"]
[]
["I participated in the development of this WORK Assessment and agree that it reasonably reflects my need for support."]
[]
[]
["I am responsible for complying with WORK program policies and procedures as laid out in the WORK Program Manual, including those that apply to the WORK Assessment.  Note: Members unwilling to follow these program policies and procedures will not be able to remain in the program.   "]
[]
[]
[]
[]
["I understand that I am responsible for accurately reporting my need for assistance during the WORK assessment.  NOTE: Falsifying the need for services will result in removal from the program, and may be reported to the Office of the Attorney General Medicaid Fraud Control Unit (MFCU). "]
[]
[]
[]
[]
["I understand that the time currently reflected in my WORK assessment is subject to review by the State and my Managed Care Organization (MCO), and that this review may result in a change.  "]
[]
[]
[]
[]
[]
[]
["Member Signature",null,null,null,null,null,null,null,"Date"]
[]
[]
[]
[]
["Guardian or WORK Representative Signature (if applicable)",null,null,null,null,null,null,null,"Date"]
[]
[]
[]
[]
["MCO Signature",null,null,null,null,null,null,null,"Date"]