CTM101 

agency

TEXT

address

TEXT

phone

TEXT REGEX

fax

TEXT REGEX

website

TEXT

ASR First Name

TEXT

phone

TEXT

email

TEXT

type

3517=Community

3518=Private Practice

3519=K-12 School

3520=Outpatient

3521=Inpatient

3522=Home-based

3523=Emergency/Crisis

3525=Church

5930=University / College

5931=Residential Treatment

5932=Addiction: Chemical Dependency: Behavioral or Process Addictions:

5933=Faith-Based

5934=Corrections/Jail/Prison

5935=Legal (i.e. pre-trial: post conviction: etc.)

5936=Intensive Outpatient Program (IOP)

5937=Hospital

5938=Partial Hospitalization Program (PHP)

5939=Psychiatric Hospital/Inpatient

population

3526=Adolescents

3527=Adults

3528=Children

3529=Couples

3530=Deaf and Hard of Hearing

3531=Persons with Disabilities

3532=Families

3533=Homeless

3534=Inpatients

3535=LGBTQ+

3536=Low Income

3537=Older Adults

3538=Rural

3540=Students

3541=Urban

5940=College/Young Adult

5941=Military

5942=Male Only

5943=Female Only

5944=Disabled or has disability status

5945=Severe: Persistent Mental Illness (SPMI)

5946=Addiction and/or Chemical Dependency

5947=Eating Disorders

5948=Domestic Violence

modalities

TEXT

supervisor

3542=Yes

3543=No

supervision_for

3544=LPCC

3545=LMFT

3546=MSW

3547=Certified Alcohol & Drug Counselor

3548=Clinical Psychologist

supervision_type

3549=Individual

3550=Group

languages

3552=English

3553=Spanish

3554=Arabic

3555=Cantonese

3556=Chinese

3557=German

3558=Greek

3559=Gujarati

3560=Hebrew

3561=Hindi

3562=Hmong

3563=Italian

3564=Japanese

3565=Korean

3566=Mandarin

3567=Navajo

3568=Persian

3569=Polish

3570=Portuguese

3571=Russian

3572=Tagalong

3573=Telugu

3574=Urdu

3575=Vietnamese

4427=ASL

5976=Kurdish

expectations

TEXT

hiring

3576=Yes

3577=No

start

Text? Date? Some experimentation might be in order

end

Text? date?

year_round

3578=Winter

3579=Spring

4428=Summer

4429=Fall

4430=Ongoing

extent

(Yes, it’s ‘extent’ not ‘extend’)

3580=Yes

3581=No

training

3582=Yes

3583=No

pay

3584=Yes

3585=No

amount

TEXT

deadline

DATE

requirements

TEXT

materials

3586=Application Form

3587=CV

3588=Cover Letter

3589=Recommendation Letter(s)

method

3590=US Mail

3591=E-Mail

days

3592=Monday

3593=Tuesday

3594=Wednesday

3595=Thursday

3596=Friday

3597=Saturday

3598=Sunday

comments

TEXT

accept

3599=Students

3600=Post-Graduate

experience

3601=Beginner

3602=Moderate

3603=Advanced

skills

TEXT

language

3604=Extremely Useful

3605=Moderately Useful

3606=Unnecessary

languages

3607=English

3608=Spanish

3609=Arabic

3610=Cantonese

3611=Chinese

3612=German

3613=Greek

3614=Gujarati

3615=Hebrew

3616=Hindi

3617=Hmong

3618=Italian

3619=Japanese

3620=Korean

3621=Mandarin

3622=Navajo

3623=Persian

3624=Polish

3625=Portuguese

3626=Russian

3627=Tagalong

3628=Telugu

3629=Urdu

3630=Vietnamese

4431=ASL

5977=Kurdish

asr

(probably shouldn’t be filled this way?)

approve

(Probably shouldn’t be filled this way)

3631=APPROVE

3632=APPROVE w/Contingencies

3790=DENY

pfma

(probably shouldn’t be filled this way?)

length

TEXT

number

3633=1-10

3634=10-20

3635=20-30

3636=30-50

3791=50+

city

TEXT

state

TEXT

zip

TEXT

monday

3722=Morning

3723=Afternoon

3724=Evening

tuesday

3725=Morning

3726=Afternoon

3727=Evening

wednesday

3728=Morning

3729=Afternoon

3730=Evening

thursday

3731=Morning

3732=Afternoon

3733=Evening

friday

3734=Morning

3735=Afternoon

3736=Evening

saturday

3737=Morning

3738=Afternoon

3739=Evening

sunday

3740=Morning

3741=Afternoon

3742=Evening

speciality

3757=Addiction

3758=Career

3759=Clinical Mental Health

3760=Clinical Rehabilitation

3761=College Counseling & Student Affairs

3762=Marriage/Couple/Family

3763=School

comments

TEXT

hours

TEXT

otherinfo

TEXT

contingent

TEXT

EHR

5928=Yes

5929=No

ehr name

TEXT

recording

5949=Video

5950=Audio

5951=None

month

5952=January

5953=February

5954=March

5955=April

5956=May

5957=June

5958=July

5959=August

5960=September

5961=October

5962=November

5963=December

time

5964=January

5965=February

5966=March

5967=April

5968=May

5969=June

5970=July

5971=August

5972=September

5973=October

5974=November

5975=December

ASR Last Name

TEXT