To Add a record:

• Select Add

• Select an address from the drop down

• • Prepopulated addresses were previously entered on the Address Information screen.

  • If changes to the addresses in the drop down are needed, they must be entered at the Address Information screen

  • Multiple Addresses and Counties may be entered into the grid

• Select a County Served from the drop down

• • Prepopulated counties were previously entered on the County Served screen

  • If changes to the counties in the drop down are needed, they must be entered at the County Served screen

• Select the appropriate Waiver Program from the drop down. If the applicant is Provider Type 34, all Waiver Program names and Services should be available

• Select the Service(s) provided for the specific waivers in each county by check marking the boxes that apply

• • Services are prepopulated according to the Waiver Program chosen

  • Select All is an option under Service

• Type in or select from the calendar the Effective Date. This is pre-filled from Requested Effective Date, but may be edited

• Type in or select from the calendar the End Date if applicable. End Date cannot be prior to the Effective Date

• Once complete, select Add To Grid to populate the grid with entered information, or Discard to clear the information and return to the grid

To View/Change a record:

• Under the Action column, select the Edit icon in the row or the record you wish to view/change

• Make desired changes to the fields

• Once complete, select Add To Grid to populate the grid with entered information, or Discard to clear the information and return to the grid

To Delete a record:

• Under the Action column, select the Delete icon in the row of the record you wish to delete

• A Confirm Delete pop up will ask, “Are you sure you want to delete the selected record?”

• • Select the No button to return to the screen without deleting

  • Select the Yes button to delete the entire record and return to the screen/grid

Required Fields:

• Please note that all fields marked with an asterisk (*) are required fields that must be populated in order to move forward. If they are left blank you will receive an error message

Special Characters:

• The following Special Characters cannot be used in the situations below. Field properties will not allow the following characters in the box:

 For First Name, Business Name, Other name (if any):    | + \ '

 For Last Name field:    | + \ ', and numbers are not allowed

 For Comment Boxes:     <  >  ^  ~ ` + | \ / ¬ £

 For Address fields:    | + ! @ # $ ^ * ( ) ? / \ " < > & : ; _

• If you copy and paste an excluded special character, an error message will display after clicking Save & Next

• Remove excluded characters from pasted information or uploaded text in the document

Save & Next:

• When finished, click Save & Next to save the information and proceed to the next page

• Click Back to go to the previous screen without saving

• Click Exit to return to the dashboard without saving

• Note that if the information is not saved, you will lose the data on the current page

Additional Notes:

• If an address is modified or deleted from the Address Information screen, the drop down in the Services Provided screen will update to reflect those changes

• If a county is modified or deleted from the County Served screen, the drop down in the Services Provided screen will update to reflect those change