Referral data Defendant Last name Defendant first name Defendant middle name Defendant suffix Street address Suite, apt no., etc. City State Zip code Phone no. in the format xxx-xxx-xxxx Gender Defendant's date of birth in the format YYYY-MM-DD Race State identification number Department of corrections identification number Employment status of defendant Relationship status of the defendant Highest Level of education completed by defendant Indicates if defendant has dependant children Number of dependant children. Enter 0 if no dependants Personal characteristics comments Date referral received. Format : YYYY-MM-DD Date the evaluation was completed. Format : YYYY-MM-DD Referral Source data Referral source Decision point of referral data Decision point of referral information Source of referral data Information source Referral sources comments Information sources comments Decision points comments Number of prior arrests Age at first arrest Number of prior adult convictions Number of prior adult misdemeanor convictions Number of prior adult felony convictions Number of prior incarceration episodes Number of prior jail incarceration episodes Number of prior prison incarceration episodes Criminal history comments Referral Case data Referral Case Number. example: 2004CF000010 or 2004CF000010AB or 2004CF000010A Case reference Case Referral county number Assessment data - should include risk and motivation data Assessment conducted on the defendant Assessor determined rating (if different then score) Numeric score from assessment Assessment comments Criminal behavior and recidivism factors Criminal behavior and recidivism factor Comments Need rating Positive attributes Comments Unique Characteristics (Responsivity) data Unique Characteristic Code Indicates if assessed Comments Intervention data Type of intervention service needed Name of service provider Service provider availability Intervention priority. Default is 1 Intervention plan comments Referral county number Referral number