个案管理员姓名：
个案管理员电子邮箱：
服务对象姓名：
服务对象姓名：
服务对象联系方式：
如未附上年度评估报告，请在此填写服务对象的联系方式
操作选项：
请从下列操作中选择一项，然后选择最符合 POS 文件状态及可用性的“POS 信息”选项。
新 POS
变更 POS
取消 POS
重新授权 POS
POS 信息（选择一项）：
POS
合同已生效
Please upload the POS information files
(We accept PDF or MS Word files)
POS #1 Document
Click the button to attach the file from your computer
Will Fax to 510-336-2903
POS #2 Document
Click the button to attach the file from your computer
Will Fax to 510-336-2903
POS #3 Document
Click the button to attach the file from your computer
Will Fax to 510-336-2903
POS
已口头获批
Please select/enter the POS information below
(Select / enter data only for the number of POS contracts you expect)
POS #1 Info
Type :
Repite Care
Adult Care
Child Care
period :
Weekly
Monthly
Quaterly
One Time
Dont Know
Hours :
POS #2 Info
Type :
Respite Care
Adult Care
Child Care
period :
Weekly
Monthly
Quaterly
One Time
Dont Know
Hours :
POS #3 Info
Type :
Respite Care
Adult Care
Child Care
period :
Weekly
Monthly
Quaterly
One Time
Dont Know
Hours :
POS
处理中
Please provide the information you have
更新文件：
若年度评估报告 (AR) 或个别化服务计划 (IPP) 发生变更，请勾选对应方框并提交更新后的文件。文件可随本表单
一同上传或通过传真发送
年度评估报告 (AR)
Click the button to attach the file from your computer
Will Fax to 510-336-2903
个别化服务计划 (IPP)
Click the button to attach the file from your computer
Will Fax to 510-336-2903
个人留言：
进事宜：
Your Auto-Reply Email Is Enough. Call Me When Case Is Assigned Or If A Problem Arises
Call Me To Confirm And Discuss
Sent Me A Personal Email To Confirm
收到自动回复电子邮件即可。个案分配后或出现问题，请致电与我联系