county_1_zip_codes (type: esriFieldTypeString, alias: County 1 ZIP Codes (Center 1), SQL Type: sqlTypeOther, length: 1000, nullable: true, editable: true)
is_this_a_new_or_existing_pace (type: esriFieldTypeString, alias: Is Center 1 a New or Existing PACE Center?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [New PACE Center: New PACE Center], [Existing PACE Center: Existing PACE Center])
is_the_pace_center_requesting_a (type: esriFieldTypeString, alias: Is Center 1 requesting a Service Area Expansion (SAE)?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [No: No], [Yes: Yes])
date_and_time_loi_application_s (type: esriFieldTypeDate, alias: Date and Time LOI Application submitted, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true)
pace_center_address (type: esriFieldTypeString, alias: PACE Center 1 Address, SQL Type: sqlTypeOther, length: 256, nullable: true, editable: true)
county_4_zip_codes (type: esriFieldTypeString, alias: County 4 ZIP Codes (Center 1), SQL Type: sqlTypeOther, length: 1000, nullable: true, editable: true)
estimated_date_center_will_be_o (type: esriFieldTypeDate, alias: Estimated Date Center 1 will be Operational, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true)
does_the_center_involve_any_cou (type: esriFieldTypeString, alias: Is Center 1 (or any other centers in this request) located in a County Organized Health System (COHS) County?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [No: No], [Yes: Yes])
pace_center_2_name (type: esriFieldTypeString, alias: PACE Center 2 Name, SQL Type: sqlTypeOther, length: 256, nullable: true, editable: true)
pace_planparent_organization_na (type: esriFieldTypeString, alias: PACE Plan/Parent Organization Name (if applicable), SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true)
pace_center_2_address (type: esriFieldTypeString, alias: PACE Center 2 Address, SQL Type: sqlTypeOther, length: 256, nullable: true, editable: true)
is_this_a_new_or_existing_pace_ (type: esriFieldTypeString, alias: Is Center 2 a New or Existing PACE Center?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [New PACE Center: New PACE Center], [Existing PACE Center: Existing PACE Center])
is_the_pace_center2_requesting (type: esriFieldTypeString, alias: Is Center 2 requesting a Service Area Expansion (SAE)?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [No: No], [Yes: Yes])
estimated_date_center2_will_be (type: esriFieldTypeDate, alias: Estimated Date Center 2 will be Operational, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true)
does_the_center2_involve_any_co (type: esriFieldTypeString, alias: Is Center 2 located in a County Organized Health System (COHS) County?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [No: No], [Yes: Yes])
county_5_zip_codes_copy (type: esriFieldTypeString, alias: County 5 ZIP Codes (Center 2), SQL Type: sqlTypeOther, length: 1000, nullable: true, editable: true)
pace_center_3_name (type: esriFieldTypeString, alias: PACE Center 3 Name, SQL Type: sqlTypeOther, length: 256, nullable: true, editable: true)
field_47 (type: esriFieldTypeString, alias: PACE Plan/Parent Organization Name (if applicable), SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true)
field_48 (type: esriFieldTypeString, alias: PACE Center 3 Address, SQL Type: sqlTypeOther, length: 256, nullable: true, editable: true)
field_49 (type: esriFieldTypeString, alias: Is Center 3 a New or Existing PACE Center?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [New PACE Center: New PACE Center], [Existing PACE Center: Existing PACE Center])
is_the_pace_center3_requesting (type: esriFieldTypeString, alias: Is the PACE Center 3 requesting a Service Area Expansion (SAE)?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [No: No], [Yes: Yes])
estimated_date_center3_will_be (type: esriFieldTypeDate, alias: Estimated Date Center 3 will be Operational, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true)
does_the_center3_involve_any_co (type: esriFieldTypeString, alias: Is Center 3 located in a County Organized Health System (COHS) County?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [No: No], [Yes: Yes])
field_64 (type: esriFieldTypeString, alias: PACE Plan/Parent Organization Name (if applicable), SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true)
pace_center_3_address_copy (type: esriFieldTypeString, alias: PACE Center 4 Address, SQL Type: sqlTypeOther, length: 256, nullable: true, editable: true)
is_center_3_a_new_or_existing_p (type: esriFieldTypeString, alias: Is Center 4 a New or Existing PACE Center?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [New PACE Center: New PACE Center], [Existing PACE Center: Existing PACE Center])
is_the_pace_center_3_requesting (type: esriFieldTypeString, alias: Is the PACE Center 4 requesting a Service Area Expansion (SAE)?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [No: No], [Yes: Yes])
estimated_date_center_3_will_be (type: esriFieldTypeDate, alias: Estimated Date Center 4 will be Operational, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true)
does_center_3_involve_any_count (type: esriFieldTypeString, alias: Is Center 4 located in a County Organized Health System (COHS) County?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [No: No], [Yes: Yes])
pace_center_5_address (type: esriFieldTypeString, alias: PACE Center 5 Address, SQL Type: sqlTypeOther, length: 256, nullable: true, editable: true)
is_center_5_a_new_or_existing_p (type: esriFieldTypeString, alias: Is Center 5 a New or Existing PACE Center?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [New PACE Center: New PACE Center], [Existing PACE Center: Existing PACE Center])
is_the_pace_center_5_requesting (type: esriFieldTypeString, alias: Is the PACE Center 5 requesting a Service Area Expansion (SAE)?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [No: No], [Yes: Yes])
estimated_date_center_5_will_be (type: esriFieldTypeDate, alias: Estimated Date Center 5 will be Operational, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true)
does_center_5_involve_any_count (type: esriFieldTypeString, alias: Is Center 5 located in a County Organized Health System (COHS) County?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [No: No], [Yes: Yes])
estimated_center_1_date_for_sta (type: esriFieldTypeDate, alias: Estimated Center 1 Date for State Readiness Review, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true)
will_center_1_be_serving_pace_p (type: esriFieldTypeString, alias: Will Center 1 be serving PACE participants only?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [No: No], [Yes: Yes])
field_105_0 (type: esriFieldTypeString, alias: Center 1 target quarterly submission deadline to CMS, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [End of First Quarter (Q1): End of First Quarter (Q1)], [End of Second Quarter (Q2): End of Second Quarter (Q2)], [End of Third Quarter (Q3): End of Third Quarter (Q3)], ... 1 more ...)
use_the_same_counties_and_zip_c (type: esriFieldTypeString, alias: Use the same Counties and ZIP Codes from another Center? (Center 2), SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [No. Enter Counties and ZIP Code: No. Enter Counties and ZIP Codes for Center], [Use Counties and ZIP Codes from: Use Counties and ZIP Codes from Center 1], [se Counties and ZIP Codes from: se Counties and ZIP Codes from Center 3], ... 2 more ...)
center_2_service_area_expansion (type: esriFieldTypeString, alias: Center 2 Service Area Expansion (SAE) Purpose, SQL Type: sqlTypeOther, length: 1000, nullable: true, editable: true)
center_3_service_area_expansion (type: esriFieldTypeString, alias: Center 3 Service Area Expansion (SAE) Purpose, SQL Type: sqlTypeOther, length: 1000, nullable: true, editable: true)
center_4_service_area_expansion (type: esriFieldTypeString, alias: Center 4 Service Area Expansion (SAE) Purpose, SQL Type: sqlTypeOther, length: 1000, nullable: true, editable: true)
center_5_service_area_expansion (type: esriFieldTypeString, alias: Center 5 Service Area Expansion (SAE) Purpose, SQL Type: sqlTypeOther, length: 1000, nullable: true, editable: true)
estimated_center_2_date_for_sta (type: esriFieldTypeDate, alias: Estimated Center 2 Date for State Readiness Review, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true)
estimated_center_3_date_for_sta (type: esriFieldTypeDate, alias: Estimated Center 3 Date for State Readiness Review, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true)
estimated_center_4_date_for_sta (type: esriFieldTypeDate, alias: Estimated Center 4 Date for State Readiness Review, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true)
estimated_center_5_date_for_sta (type: esriFieldTypeDate, alias: Estimated Center 5 Date for State Readiness Review, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true)
field_116_0 (type: esriFieldTypeString, alias: Center 2 Quarterly CMS Submission Deadline , SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [End of First Quarter (Q1): End of First Quarter (Q1)], [End of Second Quarter (Q2): End of Second Quarter (Q2)], [End of Third Quarter (Q3): End of Third Quarter (Q3)], ... 1 more ...)
will_center_2_be_serving_pace_p (type: esriFieldTypeString, alias: Will Center 2 be serving PACE participants only?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [No: No], [Yes: Yes])
field_117_0 (type: esriFieldTypeString, alias: Center 3 Quarterly CMS Submission Deadline , SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [End of First Quarter (Q1): End of First Quarter (Q1)], [End of Second Quarter (Q2): End of Second Quarter (Q2)], [End of Third Quarter (Q3): End of Third Quarter (Q3)], ... 1 more ...)
will_center_3_be_serving_pace_p (type: esriFieldTypeString, alias: Will Center 3 be serving PACE participants only?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [No: No], [Yes: Yes])
field_118_0 (type: esriFieldTypeString, alias: Center 4 Quarterly CMS Submission Deadline, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [End of First Quarter (Q1): End of First Quarter (Q1)], [End of Second Quarter (Q2): End of Second Quarter (Q2)], [End of Third Quarter (Q3): End of Third Quarter (Q3)], ... 1 more ...)
will_center_4_be_serving_pace_p (type: esriFieldTypeString, alias: Will Center 4 be serving PACE participants only? , SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [No: No], [Yes: Yes])
field_119_0 (type: esriFieldTypeString, alias: Center 5 Quarterly CMS Submission Deadline, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [End of First Quarter (Q1): End of First Quarter (Q1)], [End of Second Quarter (Q2): End of Second Quarter (Q2)], [End of Third Quarter (Q3): End of Third Quarter (Q3)], ... 1 more ...)
will_center_5_be_serving_pace_p (type: esriFieldTypeString, alias: Will Center 5 be serving PACE participants only?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [Choice 1: Choice 1], [Choice 2: Choice 2], [Choice 3: Choice 3], ... 2 more ...)
an_official_letter_of_intent_lo (type: esriFieldTypeString, alias: An Official Letter of Intent (LOI) must be attached before submitting through this portal. The LOI must be on the applicant's letterhead, must include all information required through the Application Process Policy Letter and must be signed. , SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [The Submitter has attached this: The Submitter has attached this letter])
Templates:
Name: New Feature
Description:
Drawing Tool: esriFeatureEditToolNone
Prototype: