Add a New PCAP Individual to Penelope
Use this form to add a new PCAP individual to the Penelope Outcomes Tracking Application. The Penelope Administrator will use the information you have provided to create the individual's profile, case, and service files. If you require multiple individuals to be added, use the following spreadsheet and submit it to qa@alberta-pcap.ca: https://alberta-pcap.ca/wp-content/uploads/2019/06/Add-an-individual-multiples.xlsx
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Your Name *
E-mail address *
Work phone number
Site Number (3 digits) *
As assigned by AB PCAP Council Quality Analyst. Ex. Site 123
When do you need this entered?
If this form is completed by Wednesday, the individual will be added by Friday of the same week. Enter a date if required sooner.
Is this a transfer client from another PCAP program? *
If yes, you will be contacted by Penelope support to provide additional information.
If answered yes to the question above, does this transfer follow the PCAP transfer guidelines?
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PCAP Individual's Information
PCAP ID (6 digits) *
6 digits: site # (3 digits, ex.Site 123) + client # (3 digits, ex. Client 456) = PCAP ID: 123456
Date of Birth *
MM
/
DD
/
YYYY
Date PCAP Consent signed *
MM
/
DD
/
YYYY
Assigned PCAP Mentor *
Acting PCAP Supervisor *
Penelope Consent signed? *
PCAP individuals may only be entered if they have signed a Penelope Consent form.
Referral Source
Referral Date
MM
/
DD
/
YYYY
Area
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Other comments
Submit
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