<PreEncounterReport ReportType="Rules" SPA="DMH Use Only">
   <SenderData ProviderName="Pathways" ProviderETIN="43103283500" BatchNumber="20060907-1902" ElementID="1001" />
   <DocumentFunction DocumentNumber="yyyy0907-1902-001" DocumentFunction="2" ElementID="1002">
      <Error Type="ApplicationRules" Code="Application" Message="Element DocumentFunction, Attribute DMHID, This attribute is required for this function" />
      <ConsumerData>
         <Name LastName="xxxx" FirstName="xxxxx" MiddleName="x" Prefix="xx" Credential="PHD" ElementID="1003">
            <Error Type="ApplicationRules" Code="Application" Message="Element Name, This element is not allowed for this function" />
         </Name>
         <Demographics Gender="02" DateOfBirth="yyyy-mm-dd" SSN="###-##-####" HearingStatus="144" PreferredLanguage="164" MaritalStatus="2" EmploymentStatus="8" Occupation="01" ElementID="1004">
            <Error Type="ApplicationRules" Code="Application" Message="Element Demographics, This element is not allowed for this function" />
         </Demographics>
         <Address Street1="### xxxxxxx" Street2="Apt #xx" City="xxxxxxxx" State="xx" County="###" Zip="#####" Country="US" ElementID="1005">
            <Error Type="ApplicationRules" Code="Application" Message="Element Demographics, This element is not allowed for this function" />
         </Address>
         <Race White="1" Black_AfricanAmerican="0" Asian="0" NativeHawiian_PacificIslander="0" AmIndian_NativeAlaskan="0" OtherRace="0" NotOfHispanicOrigin="1" Hispanic_Mexican="0" Hispanic_Cuban="0" Hispanic_PuertoRican="0" OtherHispanic="0" ElementID="1006" />
         <StandardMeansTest FromDate="yyyy-01-01" MonthlyAbilityToPayAmt="750" PreparedBy="xxx xxx" ElementID="1007" />
      </ConsumerData>
      <EpisodeCare Division="ADA" EnrollingProviderSiteName="Columbia" EnrollingProviderSiteID="406" AdmissionDateTime="yyyy-05-12 12:00 PM" AdmissionReason="1" ReferralSource="19" LocalChartNumber="AX3456" FamilySize="2" NumberOfChildrenInCare="0" ElementID="1008">
         <Commitments CommitmentType="200" CommitmentFromDate="yyyy-05-12" CommitmentCounty="217" PrimaryIndicator="1" ElementID="1009" />
         <ProgramAssignment Program="ADACSTARGen " ProgramFromDate="yyyy-05-15" ProgramFromTime="12:00 PM" Status="1" LivingArrangement="20" ProgramLevel="1Basic" ElementID="1010">
            <ADAProgramAssignment DateInfoReceivedfromConsumer="yyyy-05-15" CodependentIndicator="0" PrimarySubstanceAbused="0201" PrimarySAFrequency="08" PrimarySARoute="1" PrimarySAAgeFirstUsed="16" SecondarySubstanceAbused="1605" SecondarySAFrequency="07" SecondarySARoute="1" SecondarySAAgeFirstUsed="35" ServiceCounty="217" PsychologicalProblemIndicator="0" DevelopmentProblemIndicator="0" TuberculosisTreatmentIndicator="0" CurrentPregnant="3" VeteranStatusIndicator="0" EnrolledInSchool="0" PriorDetox="0" PriorResidential="0" PriorOutpatient="0" NumberofArrests="1" NumberofDUIArrests="0" IncomeSource="2" PrimarySourcePayment="01" WeeklyIncomeCode="499" MonthlyIncomeAmt="1500" LegalStatus="3" LivingArrangement="20" Education="19" SpecialEducation="19" ElementID="1011" />
            <ADAProgAssignSocialSupportRecovery SocialSupportRecoveryActivities="RELIGIOUS" ElementID="1012" />
            <ADAProgAssignSocialSupportRecovery SocialSupportRecoveryActivities="SELFHELP" ElementID="1013" />
            <ADAProgAssignSocialSupportRecovery SocialSupportRecoveryActivities="INTERACTION" ElementID="1014" />
            <ADAProgAssignPubAsst PublicAssistance="1" ElementID="1015" />
            <ADAProgAssignMeds MedicationPrescribed="00" ElementID="1016" />
         </ProgramAssignment>
      </EpisodeCare>
   </DocumentFunction>
</PreEncounterReport>