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