| Employee Name | Placed Date | Status | Start Date | End Date |
|---|---|---|---|---|
| [[item.employeeName]] | [[item.placedDate]] | [[formatStatus(item.status)]] | [[item.startDate]] | [[item.endDate]] |
| NPO | Start Date | End Date | Schedule | Placement Notes | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| [[item.npoName]] [[item.npoAddress1]] [[item.npoAddress2]] [[item.npoCity]], [[item.npoState]] [[item.npoZip]] | [[item.actualStartDate]] | [[item.actualEndDate]] |
| [[item.placementNotes]] |
| Start Time | End Time | Lunch | |
|---|---|---|---|
| Sun | {{_sunStartTime}} | {{_sunEndTime}} | {{_sunLunchType}} |
| Mon | {{_monStartTime}} | {{_monEndTime}} | {{_monLunchType}} |
| Tue | {{_tueStartTime}} | {{_tueEndTime}} | {{_tueLunchType}} |
| Wed | {{_wedStartTime}} | {{_wedEndTime}} | {{_wedLunchType}} |
| Thu | {{_thuStartTime}} | {{_thuEndTime}} | {{_thuLunchType}} |
| Fri | {{_friStartTime}} | {{_friEndTime}} | {{_friLunchType}} |
| Sat | {{_satStartTime}} | {{_satEndTime}} | {{_satLunchType}} |
| Start Time | End Time | Lunch |
|---|---|---|
| {{_startTime}} | {{_endTime}} | {{_lunchType}} |
| [[_formatPreferred(summary.nonProfit.preferred)]] | [[summary.nonProfit.name]] [[summary.nonProfit.address1]] [[summary.nonProfit.address2]] [[summary.nonProfit.city]], [[summary.nonProfit.state]] [[summary.nonProfit.zip]] Main Number: [[summary.nonProfit.mainNumber]] Contact: [[summary.nonProfit.contactName]] Email: [[summary.nonProfit.email]] DO NOT CALL |
|
| Status: | [[formatReferralStatus(referral,referral.status)]] |
|---|---|
| Local Time: | [[localTime]] |
| Client: | [[referral.employerName]] |
| Pre-Injury Job Site: | [[referral.jobSiteName]] |
| Electronic Time Sheet: | [[referral.electronicTimeSheet]] |
| DIP: | [[referral.dip]] |
| Claim #: | [[referral.insuranceClaimNumber]] |
| EMP Contact: | [[referral.jobSiteContact]] |
| EMP Email: | [[referral.jobSiteEmail]] |
| EMP Alt Contact: | [[referral.jobSiteAltContact]] |
| EMP Alt Email: | [[referral.jobSiteAltEmail]] |
| ADJ Name: | [[referral.claimsAdjusterName]] |
| ADJ Email: | [[referral.claimsAdjusterEmail]] |
| NCM Name: | [[referral.nurseCaseManager]] |
| NCM Phone: | [[referral.caseManagerPhone]] |
| NCM Email: | [[referral.caseManagerEmail]] |
| Notes: | [[referral.additionalNotes]] |
| Start Date Lead Time: | [[info.startDateLeadTime]] |
| Weekly Pay Period: | [[info.weeklyPayPeriod]] |
| Documents: | [[formatEnum(info.offerPackDelivery)]] |
| Days In Program: | [[formatDaysInProgram(info.daysInProgram)]] |
| Pay Rate: | [[formatEnum(info.payrollType)]] |
| Time Card Due: | [[info.timecardDueToEmployer]] |
| TC Hard Deadline: | [[info.employerPayrollHardDeadline]] |
| [[item]] | |