460 IAC 7-5-2 Personal and demographic information section

Sec. 2. The personal and demographic information section shall contain the following: (1) The individual's last name, first name, and middle initial. (2) The individual's address. (3) The individual's date of birth. (4) If applicable, the individual's Medicaid recipient number. (5) The individual's legal status. (6) The individual's current living arrangement. (7) The individual's Social Security number. (8) The individual's medical insurance information. (9) An indication of whether or not the individual is in school, is employed, or has another daily routine. If the individual has another daily routine, the daily routine shall be described.