New Jersey Department of Human Services

Division of Aging Services

Needs-Based Care Allocation Tool (NBCAT) (LTC-32)

QUARTERLY Data Report

A	B	C	D	E	F	G
No.	Participant Name	Medicaid Number	Care Manager Who Completed NBCAT	NBCAT Score	HBSC Hours Approved on the POC	Difference (Col. F

minus

Col. E)
Ex.:	Jane Doe	02100011109-01	Sue Smith	25	32	7

Total:	0
As the (check one) Care Coordinator Care Manager Supervisor,

I verify that the above information is true and accurate to the best of my abilities.

Name (Print)

Signature	Date

LTC-24

JUL 12	Page of Pages.

LTC-

FEB 10	-2-

LTC-24, Needs Based Care Allocation Tool (NBCAT) (LTC-32) Quarterly Data Report

LTC-24, NBCAT, Quarterly Data Report, LTC Options, LTC-32

2010-02-04

ewhite

human services