1. The Individual Information Section of the BASIS Form can be updated at anytime.

True
False

2. The social security number is a key field in BASIS and should be double checked, carefully keyed in, and rechecked to avoid transposed numbers, etc.

True
False

3. You may not have enough space to enter a person's entire name, but you should key in as much as is possible.

True
False

4. If you are collecting information on a person that lives in Concordia, KS, what county code would you use for County of Residence (field 11)?

026
062
MC
015
MT

5. In the Residential Status field (16), check as many categories as are applicable.

True
False

6. If a person is living alone, without a roommate, but has a paid staff that stay overnight, you would check the following in the Residential Status field (16)":

5 (Living with relatives).
1 (Living alone).
2 (Living with two or less persons with DD).
7 (Other).

7. If an individual works less than 20 hours per week in a setting in which at least 75% of the persons in the setting are not DD, you would check the following in the Day Programs field (17):

4 (Generic community activities less than 20 hours per week).
5 (Work environment designed for persons with DD less than 20 hours per week).
7 (Competitive employment less than 20 hours per week.)
9 (Agency-based non-work activities less than 20 hours per week).

8. The Primary Disability (19) must be one of the disabilities listed in Identified Disabilities (field 18).

True
False

9. If an individual was placed out of a private ICF/MR after October 1, 1994, as a result of bed or facility closure, you would check the following in the Special Population field (20):

1 (CIP).
7 (SMHH).
6 (ICF/MR Closure).
3 (Self-directed care).
5 (Special care rate).

10. An individual who had funding converted from an ICF/MR (not SMRH) to HCBS and a bed closed should also be marked as CIP in the Special Populations field (20).

True
False

11. Individuals who have special care rates approved for them, but who are not from a SMRH, should be marked as CIP.

True
False

12. You should update the Special Population field (20) as often as necessary.

True
False

13. If an individual does not have a psychiatric diagnosis, enter the DSM-IV diagnosis code for his/her Primary Disability (field 19) in the Psychiatric Diagnosis field (21).

True
False

14. If an individual is a child in custody, put the following in the Guardian's Last Name field (25):

Parent's last name.
SRS.
Guardian's last name.
Your last name, as you are his representative for care and services.