SAMPLE FILE COVER SHEET
CASE FOLDER COVER SHEET
| County: | Caseworker: |
| Client Name: | |
| Old System ID: | New SACWIS ID: |
| DATA WHICH MUST BE CLARIFIED FURTHER: (The current system and SACWIS/AFCARS do not have a one to one match ratio) | |
| Race: Old System Race=Other | |
| New SACWIS Values are: | ________ American Indian/Alaskan Native |
| ________ Asian/Pacific Islander | |
| ________ Unable to Determine | |
| Current Placement Setting: Old System=Group Home/Child Caring Institution | |
| NEW SACWIS Values are: | _________ Group Home |
| _________ Institution | |
| NEW DATA ELEMENTS | |
| Has disability been clinically diagnosed’ | _____ Yes |
| _____ No | |
| _____ Not Yet Determined | |
| Has client ever been adopted’ | _____ Yes |
| _____ No | |
| _____ Not Yet Determined | |
| Hispanic Origin’ | _____ Not Applicable |
| _____ Yes | |
| _____ No | |
