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Check the participants you want to download.
Download IdFirst NameLast Name
29139ClevelandAmory
29257EleanorAnderson
29102PollyArmour
29258GanoushBobba
29193SteveCarlton
29204JoeConklin
29076AnnaDamman
29047DennisDannemora
29119HarleyDavidson
29115SophiaDavidson
29138JudyDeBoer
29084BambiDeere
29105DoloresDeerfield
29022MercyDemento
29028EdwardDeming
29005PaulDenver
29141VincentDePau
29243PollyDoodle
29171KathleenDuffy
29041TessDurber
29051DanielFelino
29227MariaGrace
29073ElaineGreen
29223FredGreen
29065LuluGreen
29162HarrietHanes
29066JohnHavearep
29224DavidHoran
29203LadyHoran
29123JamesIago
29100HarryJones
29192RobertJones
29110SulaimaJones
29099LouiseKennett
29168MarieLaFave
29079LewisMerriweather
29098ArthurMiller
29197SampleParticipant
29198SampleParticipant2
29255RoanRhonda
29196JamieRomano
29080FeliciaRose
29074ShirleyRoth
29152MichaelShortt
29169JoseSilva
29226FreddySmith
29180JosephSmith
29124LucySmith
29194RobertStephens
29195RobertStephenson
29140VioletSweeney
29101WheatonTerrier
29048MikeWaters
29063JuneWhite
The columns marked (r) are read only to you; changes to them will not be saved.
Address 1Address 2CityZip CodeTelephone NumberEmail AddressCountyEmergency Contact NameEmergency Contact NumberLocal Case Number (r)Medicaid Number (r)Date of Birth (r)Language Spoken Primary (r)Language Spoken SecondarySocial Security # (r)Last Assessment DateLocal Program (r)Date of EnrollmentDis-Enrollment DateSource of EnrollmentLast Phone MonitoringPrior Care AgencySupport BrokerFMSAGuardian First NameGuardian Last NameGuardian Address 1Guardian Address 2Guardian CityGuardian StateGuardian Zip CodeGuardian Telephone NumberGuardian Email AddressGuardian RelationshipRep First NameRep Last NameRep Address 1Rep Address 2Rep CityRep StateRep Zip CodeRep Telephone NumberRep Email AddressRep RelationshipLast InHome MonitoringGuardian Legal Guardian TypeGender (r)File StatusDate of Last Plan of CareRaceHair ColorService FieldsGuardian guardian of personGuardian guardian of fundsGuardian guardian of person and fundsLevel of Education CompletedPet typeLevel of Care ExpirationReferral methodBI Assessment UsedFavorite color
314 W. Clark St.Apt BPhiladelphia19104    (221) 233-23230443434333499906/10/1920  191-24-195602/01/2009DOH Region II08/28/2006 Aardvark Adult Day Care Center01/15/2009 Susan BeckACME Services LLC                    01/02/2009 MaleActive01/10/2009 AuburnAssociates DegreeBird10/31/2007Primary Freedom of ChoiceFalse
2132 Halliburton St. Philadelphia19123(215) 101-7321 DelawareHoward Kirby 02321138 English 101-32-4443  05/10/2008    Susan BeckACME Services LLC                      FemaleActive CaucasianAuburn-----6/1/2009Primary Freedom of ChoiceTrue
4 Tully St.Apt 315Philadelphia19113(215) 765-4321  Holly Armour(215) 765-43210123445506/03/1944SpanishEnglish345-67-123409/04/2006DOH Region II08/01/2006 Elverson Agency07/31/2006 Susan BeckACME Services LLCCherylArmour20 North Tandy St. PhiladelphiaPA19104  SisterBobbyBrookes1234 Main Street Enosburgh FallsVT05555  Rich Uncle09/04/2006Guardian of person and fundsFemaleRe-enrolled09/04/2006 AuburnFalseFalseFalseAssociates DegreeBirdPrimary Freedom of ChoiceFalse
  Beirut      0    232-78-7896  01/24/2009 Disability Waiver  Susan BeckGeorges Financial Services, Inc.                       New  Auburn-----Primary Freedom of ChoiceFalse
123 MyStreet Mytown33333 rjones@333.comMontgomery  044323412/25/1940  321-01-2312  08/12/2006 Elverson Agency07/09/2006 Susan Beck                        Inactive  Auburn-----Primary Freedom of ChoiceFalse
33 AmuseaPhila32322     055544234302/24/2007  324-23-2342    Section 5505  Susan BeckACME Services LLC                      MaleEnrolled  -----Primary Freedom of ChoiceFalse
445 Bread St.Apt. 6Philadelphia19104(215) 765-4321cleoxcat@yahoo.comMontgomeryFred Damman(215) 766-43215564312-3332801/01/1941SpanishEnglish191-33-543301/01/2006DOH Region II08/01/2006 Disabled & Elderly Waiver07/13/2006Fred Jones AgencySusan BeckACME Services LLCFredDamman567 Silver St.Suite 202PhiladelphiaPA19104(215) 765-4321cleoxcat@yahoo.comSon          03/15/2006Guardian of person and fundsFemaleActive01/01/2006 FalseFalseFalseElementary Education
40 Clover St.Apt. 1BFargo19103(215) 765-4321 DelawareMary Dannemora(215) 765-4321012345402/03/2003English 443-34-343408/10/2006DOH Region II03/19/2009 children with DD waiver  Susan BeckACME Services LLC                    08/10/2006 MaleActive08/10/2006 Auburn-----SnakePrimary Freedom of ChoiceFALSEGray
4 Hog Way York33421   Steve(232) 232-23231234563454241201/01/1961SpanishEnglish332-45-232305/01/2007DOH Region II06/28/200609/05/2006Disability Waiver02/27/2006 Susan BeckACME Services LLC                    05/01/2007 MaleActive05/01/2007African-AmericanAuburnAssociates DegreeBird9/30/2007Waiver change Form TransferFalse
2224 Sycamore Saraville33422(215) 444-3321 MontgomeryRobin Reiger(123) 123-123101232123101/01/1906English2324232-21-123101/07/2006DOH Region II08/06/2006 xx01/07/2006 Susan BeckACME Services LLCJohnHoran701 Lansdale LansdalePA12332(232) 232-2323 GrandfatherDennisAnthony406 Wall Ln JenkintownPa19036   08/06/2006Guardian of the personFemaleActive09/03/2005 AuburnFalseFalseFalseHigh School EducationPrimary Freedom of Choice
2121 W. Third St.Apt. EPhiladelphia19104(215) 523-2146cleoxcat@yahoo.comDelawareLouise DeBoer(215) 437-21023023119254305/27/1940English 410-20-909809/01/2006DOH Region II08/28/200609/03/2006Disabled & Elderly Waiver08/28/2006 Susan BeckACME Services LLC                    09/01/2006 FemaleActive09/01/2006 AuburnAssociates Degree
54 Fawn St. Philadelphia19103(215) 765-4321cleoxcat@yahoo.comDelawareFawn Deere(215) 765-4321234512-3332602/19/1970English 111-34-4566 DOH Region IV08/01/200608/10/2006NA08/07/2006 Susan BeckACME Services LLC                      FemaleClosed  Bluish GreenElementary Education
742 East Fenwick St.Apt. 10Philadelphia19104(215) 366-6373  Dennis Deerfield(215) 533-22111010319456305/10/1935English 140-44-789208/15/2006DOH Region II08/03/2006 Acquired Brain Injury Waiver08/03/2006 Susan BeckACME Services LLC                    08/15/2006 FemaleActive09/15/2006 AuburnAssociates Degree
14 Edgeworth Dr. Denver2919  BenningtonBrad Pitt 01818001808/04/1946SpanishEnglish1818001802/15/2006DOH Region II02/10/2006 Acquired Brain Injury Waiver09/08/2006 Susan BeckACME Services LLC                    07/09/2006 FemaleActive02/15/2006 BrownHigh School DiplomaElephantTRUEPutty
1485 Farewell St. Kansas City2863  Carbon  02424002402/03/1930EnglishNone2424002403/03/2006DOH Region II03/30/2006 Aardvark Adult Day Care Center  Susan Beck                     04/03/2006 MaleActive04/03/2006 AuburnMasters DegreeDogOrange
804 Glasgow Lane Chicago2889  BenningtonReston Closer(423) 773-47370101000101/10/1948SpanishEnglish901-34-565307/01/2006DOH Region II04/20/2006 Acquired Brain Injury Waiver  Susan BeckACME Services LLC                    08/01/2006 MaleActive08/01/2006 Red-----Golden Retriever12/31/2007Primary Freedom of ChoiceFALSERed
101 S. Vanover St. Philadelphia      0323112007/04/1936  121-20-2343 DOH Region II08/28/2006 Disabled & Elderly Waiver08/28/2006Lawson Senior Citizens AgencySusan Beck                       MaleInactive  AuburnAssociates DegreeBirdPrimary Freedom of ChoiceFalse
         07888504/04/1939  121-34-5678    Philadelphia Corporation on Ag  Susan Beck                       FemaleActive  Primary Freedom of Choice
38 W. Highland St.Apt. GPhiladelphia19103     012345703/18/1980  181-03-037506/25/2006 06/01/2006 Developmental Services Waiver09/07/2006 Susan BeckACME Services LLC                    06/25/2006 FemaleActive06/25/2006 AuburnPreschoolNonePrimary Freedom of ChoiceFalse
123 Blank St. St. Louis19103(215) 765-4321  Thelma Durber(215) 765-432105554442106/10/1915English 120-04-410703/04/2006DOH Region II07/03/2006 Aardvark Adult Day Care Center07/03/2006 Susan BeckACME Services LLC                    04/07/2006 FemaleActive  AuburnElementary EducationBirdFALSEYellow
217 Quartz Rd.Apt. 4Philadelphia19113(215) 765-4321 DelawareMary Felino(215) 765-432123477765401/26/1996EnglishPortuguese121-73-475606/01/2005DOH Region II07/01/2006 children with DD waiver07/01/2006Fred Jones AgencySusan BeckACME Services LLC                    06/01/2005 MaleActive06/01/2005 AuburnElementary EducationBirdBlack
1009 holly rd Espanola87532(505) 999-1212 ChittendenFrank Gallegos(505) 999-1555012312312305/08/1932SpanishEnglish231-22-325210/01/2007 07/01/2007 Disabled & Elderly Waiver  Susan BeckACME Services LLC                      FemaleActive10/01/2007Hispanic9/30/2008Primary Freedom of Choice
217 W. Ground St. Philadelphia19104(215) 765-4321 MontgomerySteve Green(215) 765-43211234213-453407/17/1933SpanishEnglish181-02-3098  08/01/200609/14/2006Aardvark Adult Day Care Center08/01/2006 Susan BeckACME Services LLC                      FemaleClosed  AuburnHigh School EducationBird
2000 W. Broad St. Philadelphia19103 cleoxcat@yahoo.comCarbonMary Green 012345601/01/1941English 121-23-4567    The Top Agency  Susan BeckACME Services LLC                      MaleActive African-American8th Grade10/10/2007Primary Freedom of Choice
1897 Main Street Old Town78964(215) 765-4321  Tina Smith(215) 765-43210111111111104/04/1912GermanFrench987-65-432109/15/2008DOH Region II07/08/2006 Disabled & Elderly Waiver11/08/2008 Susan BeckACME Services LLCTinaSmith  HopevilleAR72894(215) 765-4321tina.smith@comcast.netdaughter          09/15/2008Guardian of the personFemaleActive09/15/2008 AuburnTrueFalseFalseElementary Education1/1/2008Primary Freedom of ChoiceFalse
2120 Salina St. Philadelphia19104     0 08/10/1943  335-09-3030  09/01/200609/13/2006xx  Susan Beck                        Closed  Auburn-----Bird
111 MyStreet Jenkintown34343(215) 765-4321dennyandbeth@yahoo.com Steve(215) 765-432101234123403/02/2005English 443-34-353203/26/2006 06/09/2006 Acquired Brain Injury Waiver  Susan BeckACME Services LLC          BillImarep123 Mystreet     dennyandbeth@yahoo.com    Active  AuburnElementary Education
         01234112/25/1930  345-67-1235    The Top Agency  Susan Beck                        Active  High School Diploma5/28/2007Primary Freedom of Choice
55 Doghouse LaneApt bDeerville32322(222) 223-2322dennyandbeth@yahoo.com   0123323af12/25/1940  443-34-3232 DOH Region II  Section 5505  Susan Beck                        Active African-AmericanDoctoral Degree
221 N. Melrose PlaceApt 1Philadelphia19104(215) 332-2312 DelawareRasheed Iago(215) 334-22221235419234101/01/1940English 112-20-1918 DOH Region II08/01/2006 xx08/01/2006 Susan BeckACME Services LLC                      MaleActive  AuburnAssociates DegreePrimary Freedom of ChoiceFalse
218 Bones St. Philadelphia19113(215) 765-4321  Mary Bones(215) 765-432123238192225604/04/1939English 131-22-2345    NA  Susan BeckACME Services LLC                      MaleActive  AuburnAssociates Degree
123 MystreetaMyTown44244(222) 222-3333rjones@ama.ntMontgomerySophia Jones(222) 222-44560123-3308/07/1942English 223-23-123206/23/2006DOH Region IV05/10/2005 Disability Waiver05/23/2006The Friends GroupSusan Beck                       MaleActive06/15/2006 Doctoral Degree
533 Dance St.Apt. CPhiladelphia19104(215) 434-1206 MontgomeryTremont Jones(215) 433-70711234412356608/17/1920EnglishArabic414-20-7675 DOH Region II08/03/2006 Aardvark Adult Day Care Center  Susan BeckACME Services LLC                      FemaleActive  AuburnAssociates DegreeBird
56 W. Valley Dr.Apt. AKennett Square19233(215) 765-4321 DelawareSarah Jane Kennett(215) 765-432121376192225612/12/1940English 133-45-876305/09/2006 02/10/200609/05/2006NA02/20/2006 Susan BeckACME Services LLC          SarahKennett701 North Randolph St. PhiladelphiaPA19104  Mother05/09/2006 FemaleActive08/10/2005 AuburnBachelors Degree
2120 Salina St.Apt 2-CPhiladelphia19103(215) 331-1024cleoxcat@yahoo.comDelawarePaul LaFave(212) 031-9898012345208/05/1935English 912-34-565309/06/2006 09/01/2006 Aardvark Adult Day Care Center  Susan BeckACME Services LLC          Paul Lafave332 Salina St.Apt. 2-FPhiladelphiaPA19103(215) 334-6787cleoxcat@yahoo.comSon08/06/2006 FemaleActive09/06/2006 Brown High School EducationCat
45 W. St. Albans St. Philadelphia19103(215) 765-4321 DelawareSteve Green(215) 765-4321786523456701/06/1939English 151-62-262312/15/2008DOH Region II07/05/2006 Disabled & Elderly Waiver12/15/2008Fred Jones AgencySusan BeckACME Services LLC                    12/15/2008 MaleActive12/15/2008 AuburnSome CollegeBirdPrimary Freedom of ChoiceFalse
981 W. 11th St.Apt. CNorristown19113(215) 765-4321cleoxcat@yahoo.comMontgomeryRosie Faye Miller(215) 765-432123267819-22254801/08/1917English 181-23-980901/01/2005DOH Region II06/01/200609/06/2006Disabled & Elderly Waiver07/01/2005Fred Jones AgencySusan BeckACME Services LLCRosieMiller200 W. Broad St.Suite 204PhiladelphiaPA19104             01/01/2005Guardian of person and fundsMaleClosed01/01/2005 AuburnFalseFalseFalseHigh School Diploma
234234Anytown11121     0444412/25/1940  444-33-3223    Section 5505  Susan Beck                        Active  -----
12323       0434354201/01/2007 Secondary232-21-1232    Section 5505  Susan Beck                       MaleActive  -----
52 east st Barstow03333(541) 663-5555    054121322104/12/1955  541-21-322112/10/2008 07/06/2008 MD01/03/2009 Susan BeckACME Services LLC                    06/10/2009 MaleActive12/15/2008 Auburn-----Primary Freedom of ChoiceFalse
34 MyStreet Phoenixville23232     012332312/25/1940  443-29-2929    Section 5505  Susan BeckCenter City FMSA Agency                      MaleActive  -----
71 West Spinner Rd. Philadelphia19103(215) 765-4321cleoxcat@yahoo.comDelawareMaxine Rose(215) 765-4321123457333456912/28/1950English 111-53-454511/10/2008 05/01/2006 Disability Waiver01/10/2009Fred Jones AgencySusan BeckACME Services LLC                    11/20/2008 FemaleActive11/20/2008 RedSome CollegePrimary Freedom of ChoiceFalse
562 Holiday St. Philadelphia19103 cleoxcat@yahoo.com Susan Roth(215) 765-432112234512-3332103/06/1990English 444-42-1489    Children's Care Services LLC  Susan BeckACME Services LLC                      FemaleActive  Bluish GreenElementary Education
909 N. Sansome St. Philadelphia19104     012345678901/03/1940  121-33-434601/05/2007 09/01/200609/13/2007xx03/12/2007 Susan BeckACME Services LLC                    01/05/2007 MaleActive01/05/2007 AuburnAssociates DegreeBird1/1/2008Primary Freedom of ChoiceFalse
334 Cedar St. Philadelphia19104(215) 767-6868    0 08/17/1940Portuguese 912-24-5653  09/10/2006 xx  Susan BeckACME Services LLC                      MaleEnrolled  Auburn-----Bird
123 Blank St. Philadelphia19101     013245612/25/1930  123-66-1032  12/01/2007 The Top Agency  Susan BeckACME Services LLC                       Active  Primary Freedom of Choice
    (232) 232-1213dhoran@anexinet.com  (123) 123-123103231405/11/1962  123-12-1231    Elverson Agency  Susan BeckACME Services LLC                       Active  Associates Degree1/1/2008Primary Freedom of Choice
443 Danson St. Philadelphia19104(215) 332-4141  Randy Smith 02345902/21/1921English 124-44-500604/02/2007DOH Region II08/01/2006 NA08/01/2006 Susan BeckACME Services LLC                    09/02/2006  Special Case09/02/2006 Auburn-----BirdPrimary Freedom of ChoiceFalse
234 Lous Street Treasure Island12345 rls@eb1.com Jan Stephenson(222) 222-2222023-23-222212/25/1940  222-11-2364  07/04/2006 Disability Waiver04/23/2006The Jones GroupSusan Beck           PamelaJohnson332 Overlook HilltownNJ12345(222) 233-1233d@b.jSister07/26/2006  Active05/24/2006 -----
123 Mystreet Happytown12333   June Roberts(214) 215-2323023-23-222212/25/1940  123-93-5533    Elverson Agency  Susan BeckCenter City FMSA Agency                       Active  -----
40 W. Broad St.Apt. 2Philadelphia19104(215) 776-8090cleoxcat@yahoo.comMontgomery  0 03/06/1925  193-44-7370 DOH Region II08/28/2006 Acquired Brain Injury Waiver08/28/2006 Susan Beck                       FemaleActive  AuburnAssociates DegreeBird
220 Willow Lane Philadelphia19113(215) 765-4321  Sandy Terrier(215) 765-43210873329103/14/1989English 151-22-224303/20/2006DOH Region II03/01/200609/05/2006Developmental Services Waiver03/15/2006Johnson Care ServicesSusan BeckACME Services LLC                    03/20/2006 MaleClosed03/20/2006 AuburnAssociates Degree
905 W. Broad St.Apt. 6Philadelphia19104(215) 765-4321cleoxcat@yahoo.comMontgomeryGinny Waters(215) 765-432123487678908/10/1943SpanishEnglish177-44-5601 DOH Region II09/01/2006 Aardvark Adult Day Care Center  Susan BeckACME Services LLC          BillBlackman765 N. Sixth St. PhiladelphiaPA19104  Friend  MaleActive  AuburnSome CollegeNone
138 Markham St. Little Rock72209(215) 765-4321  Ed White(215) 765-4321059832700102/23/1922EnglishFrench547-09-806306/01/2005DOH Region II08/01/2006 Aardvark Adult Day Care Center07/07/2006 Susan BeckACME Services LLCEd White  Little RockAR72209(215) 765-4321ed.brown@sbcglobal.netSon          06/01/2005Guardian of the person Active  AuburnFalseFalseFalseElementary EducationBird
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