Confirmation Page

Thank you for all you do and the services you provide for our clients! We appreciate you!

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The following information is what was submitted on the Espyr Closed Case Form. We recommend that you save this page for your records.

Entry ID: {entry_id}
Provider Name: {Provider Name (First):114.3} {Provider Name (Last):114.6}

Authorization Number: {Authorizaton Number:113}

Client Name: {Client Name (First):118.3} {Client Name (Last):118.6}

Client DOB: {Client Date of Birth:71}

Attended EAP visit? {Attended EAP session?:36}



EAP VISIT DETAILS

Outcome: {Outcome:95}

Referral Recommendation: {Recommendation:96}

Did you conduct a client follow up concerning their satisfaction with the referral? {Did you make follow-up calls?:120}


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