Manual of policies, revised April 1952

:f!P
GEORGIA STATE DEPARTMENT OF EDUCATION DIVISION OF VOCATIONAL REHABILITATION
MANUAL OF POLICIES REVISED APRIL 1952
M. D. Collins Executive Officer State Board for Vocat ional Education
P. S. Barrett Director Vocational Rehabilitation

FOREi:YORD
To the personnel of the Division of Vocational Rehabilitation:
This manual is written for the purpose of your using it as a guide in carrying out ;your duties as a staff member. Every effort has been made to cover all phases of the program as thoroughly as possible and to present it in such a manner that i.t will be of the greatest assistance to you.
To conform to our State and Federal Plan, you are obligated to follow the contents of this manual. I urge that each member of the personnel read and reread the manual until all of its contents are thoroughly understood.
There are certain points of interest which I wish to call to your special attention and these are as follows:
1. To accomplish our aims in rehabilitating the handicapped, there must be a most agreeable working relationship between all personnel. Yie have one common goal, which is rehabilitating the physically and mentally impaired, and to accomplish this we must have the united effort on the part of all of the personnel.
2. There are many related or cooperative agencies whose help we must have in carrying out the provisions of this Manual of Policies and the State ~lan, and it is most urgent that all personnel conform promptly to the vrorking agreements. Referrals are secured from many so1rrces and no colmselor can have too many individuals and agencies who are interested in referring clients for services, and for that reason I request that you strive to build up and maintain the very best relationship between all referral agencies and your office. To maintain this relationship we must provide written reports to re;;orting agencies advising them of the action taken on the case. These written reports, of course, may be supplemented by personal contact when visiting referral agencies.
3. A large portion of our proGram is devoted to physical restoration
vrhich includes servicing all types of clients needing all kinds of rehabilitation services. To do an adequate job, counselors must put forth every effort to see that clients receiving any phase of pqysical restoration are given necessary supervision and follow-up from time case is accepted until closed satisfactorily rehabilitated.
I wish to call your attention especially to clients who are classified as severely disabled. These individuals require much study and considerable time in order to become familiar with the many problems confronting the individual. In vrorking >vi th this type, a counselor must collect neces::;ary information and make sufficient interviews to the point that he is reasonably sure that he knows what services will be necessary for the division to provide in rehabilitating the client, and that he can anticipate the whole-hearted cooperation on the part of the disabled person in the planned rehabilitation program. After the requ:ired physical restoration services have been completed, the counselor must not delay the client but immediately follow through vdth the remaining services required to place the person in employment.

4. A counselor must visit the home of each client before accepting
a case for rehJ.''ilitation services. This is absolutely necessary in order to knor.r all the facts about the client and to determine economic need. Counselor should contact client as often as possible after rel~bilitation services are provided and certainly at least once prior to the case being closed.
5. Diagnosis, counseling and guidance, placement, and training do not
require the establishing of economic need. All other services require the establishing of economic need which necessitates the counselor making a thorough investigation of the financial ability of the client's parents or guardian, as the case may be, before furnishing the services other than those available to all physically handicapped individuals. To do othernise is a violation of the policies and the state plan and cannot be condoned.
6. Counselors have access to the services of the district supervisor,
district medical consultant and the central office personnel, and should take full advantage of this consultative service. In offices where there are more than one counselor, it is very convenient for one counselor to discuss problems that he is having on a case with another counselor and both arrive at a better solution of the case than handled alone. On those cases that you desire consultative services, you will refer them to the district supervisor for his opinion who, v;hen necessary, in turn may refer them to the central office. The central office personnel will visit your offices from time to time for the purpose of assisting the professional personnel in imrjrovin;:; the nrocram in their area, and giving consultative service on matters relating to their field of responsibility. A local office ~~na~er has been designated for each office and the personnel in those offices are expected to give the office manager their best cooperation.
7. Adequate supervision of clients after they have been placed on a
job is very necessary No client should be closed as employed if he is residing within the territory, until the counselor has seen him and is convinced that the job is reasonably permanent and is in keeping vrith the client's disability. If the client is employed outside the co1mselorts territory, the counselor serving that area should be asked to contact the client on the job to determine its suitability and permanency.
8. The division has purchased a considerable amount of equipment to be
used by rehabilitation clients This equipment should be left with the client so long as he is making use of same; hO"wever, if he ceases to use th8 equipment it should be repossessed in order that it nay be used by another client. Notice of the repossession should be given to the Supervisor of Services for the Blind, who is acting as a "clearing house11 for such equipment. Every counselor should certainly avail himself of this service.
9. The work with the mental cases at the State Hospital in :Milledgeville is a relatively neYr phase of the program and vdll require the cooperation and help of all to make it a complete success. You should thoroughly acquaint yourself with provisions set forth in the manual relative to this phase of the work and lend your usual cooperation.

J.G. !tr;ccnsly the State l3oard oi' Ednc.'ltion, u~:on rccr-nrr~enclation of the 3te:.te Supe!'intendent of Schools, tr1"msferred the Georc;ia Sc '1ool for th:~ Jeaf, Cave Spr:i.r.e;, anci. the Georgia i~cademy for the Blind, I:;a_con, to the Division of Vocational Hch::.bilit:.tion. Henceforth, cmmsclors will be expected to coorerate closely vrith th~srs tv;o schools. Couns:::lors and all other professional l'Crsormel ,qre expectc;d to refer sd.thcr deaf or blind children nho need trainin:; in -:::;ither of tbf:se inc:;titutions to their :::u-:Jerintendents. It is not expected th3.t the counsc;lor vrill refer a child vrho he docs not think has the intelligence to bo.nei'it :'rcn c.raining in these institutions. Under no circurns~c:;nccs should the counselor make any commitment for accepting ap ;licc.'ntc~, but he should '.rrite the superintendents and t;ive t:1el-n a::J co:n~)lcte inforr.:ation as possible. Acceptance vrill be left u.:_J to th::: of:f.'icials of the t'rro schools.
Agc:d.n let ne emphasize the importance of ;."our obtaininc; a thorou;o;h knrmled:~n of tl:e ccmt<'ni::,s of ::,his manual. ':lith this i:1fornation, Yi8 m.ve every rr;ason to bc;li(nr-.:: tlr t JOU cc:m do a better job in rcnderin:.: the services that we have available for voc.~.t:Lono.lly h::mcJ.icap ..ed fJoople.
Your closest coo'!)cr~tion vril_l be 3nprecie.ted.

GEORGIA STATE Hb.NUAL OF POLICIES GENERAL OUTLINE
SECTIONS 1.0 Tir.c"; PHILOSOPHY FOR REHl\.BILITATION IN GEORGIA 2.0 ORGANIZATION
3.0 CASE FHIDING
L.O CASE LOAD EANLGE:iENT
S.o ELIGIEILITY
6.0 CASE DH.GlJOSIS
7.o GUIDANC~~ AlJD COillJSELING
8.0 Th'E PROVISION OF SER.VICE3 9.0 REPORTS AN:J RECORDS 10.0 FISCAL PRCCEDURES 11.0 INSTRUCTIONS FOR USE OF REPORT AND CAS1.'JORK FOfll.IS 12.0 CASE SUPERVISION

2.0
2.1
2.2
2.3 2.4 2.5 2,6
3.0 3.1 3.2 3.21 3.211 3.212 3.213 3.214 3,.215 3.216 3.217 3.218 3.219 3.220 3.221 3.222 3.223
3.224
3.225 3.226 3.227
4.0
4.1
).j.,2
4.3
4.31 . 4.32 4.33 4.34
4.35
. )~.36 ~. 37 h.38
4.39 4. 4
1+.41 h.42
4.43
L~.44
4.45 4.46
).j.,5
4.51

TABLEJ OF CONTENTS
THE PHILOSOPHY.rQfl REHABILITATION SERVICBS IN GEORGIA The Philosophy ' Scope and Results
ORGANIZATION State \"fide Personnel District Personnel Local Office Personnel Yrorking Relationships With Other Personnel Counselor Serving the Blind and Placement Agents Local Office Manager
CASE FINDING Rosponaibility for Finding Sources of Referrals Agreements and Working Relationships With Referral Agencies GeorGia State Employment Service State Industrial Board Department of Public Health, Crippled Children's Service Georgia Tuberculosis Association Deparunent of Public Health Farm Home Administration Federal Prison Atlanta Metropolitan Association For the Colored Blind Veterans Administration Georgia Academy for the Blind School for the Deaf Battey State Hospital l1iilledgeville State Hospital Public and Private High Schools "Key" People in Each Ccrnmunity Inter-Agency Comnunity Committee Local Selective Service Officers
CASE LOAD HANAGEMENT General Statement Registration of Cases c:ase Status Classifications Referred - Status 0 Accepted - Status 1 Plan Completed - Status 2 Physical Restoration and Training - Status 3
Physical Restoration - St.:ttus 4 Training - Status 5
Ready for Employment - Status 6 Employment - Status 7 Service Interrupted - Status 8
CLOSUR~ STATUSES Gneral Statement Closed Referred
Closed Employed - Status 12 Closed Unemployed - Status 13
Closed Transferred Out - Status 14
Closed Other Reasons - Status 15
CASE ACCOUNTING General Statement
-1-

- 2-

4.52 4.53 4.54 4.55

:laster List of Cases Flow Sheet Renort Transfer of Cases Vfithin the State Transfer of Cases From Another State Into Georgia

5.0 5.1 5.2 5.21 5.22 5.23 5.24
5.25 5.26 5.27 5.271 5.272 5.273
5.3
5.301 5.302 .5.303 5.304 5.305 5.306 5.307 5.308 5.309 5.3091 5.3092 5.310 5.311 5.312 5.313 5.314

ELIGIBILITY
Responsibility for Determination Factors Considered in Determining Eligibility Age Residence Presence of a Physical or l.Iental Disability The Physical or Mental Condition Constitutes a Handicap to Employment iiore Shitably Employed Eligibility for Service a Second or Third Time Eligibility From the Economic Circumstance of the Individual Federal and State Standards of Economic Eligibility I.Iethod of Obtaining Data on Ylhich to Establish Need Amount of Supplementation by the Division GUIDES WHICH HAY BE USED IN DET:t:::R.MINING ELIGIBILITY OF CERTAIN TYPE CASES Visual Disabilities Hearing Disabilities Asthma Disabilities Ulcers of the Stomach or Intestinal Tract Cardiac Disabilities Tuberculosis Disabilities Orthopedic Disabilities Size and 1;reight Uental Disabilities Snotional Disturbances Hental Deficiency Hernia Disabilities Facial Deformities Urological Disorders Female Disorders Arthritic Disorders

6.0

CASE DIAGNOSIS

6.1

Responsibility for Diagnosis

6.2

The Use of Specialized Services

6.3

l!iedical Diagnosis

6.4

Vocational Diagnosis

GUIDANCE AND COtn~SELING
General Statement The Selection of an Objective Techniques or Methods of Guidance Results of Counseling and Guidance

8.0

THE PROVISION OF SERVICES

8.1

Services Provided by the Agency

8.11 Investigation

8.12 Vocational Diagnosis

8.13 Counseling and Guidance

8.14 Authorized Services

- 3-

Bol5 8,151
8"152 8,.16 8.,17 8e2
8~21
~~ 0 22
Go221
::;.222
8.223 8.224 3.225
8.226 8.23 8.231 8.232 8.233 8.234 8.235 8.236 8.. 237 S.2h G.2hCl G.2402 S~ 2l.t.03 8.2h04 B.2Lo5
B. 21.~-06
8.21-tO?
8 .2L~o8
8.2409 8.2hl0 8.2411 8.2hl2 8.2413 8.25 8.2501 8.2502 8.2503 8.2504
8.2505 8.2506 8.2507 8.2508 8.2509 8.2510 8.2511 8.2512 8.2513
8~2514
8.2515 8.2516 8.2517 8c2517a 8.2518

Supervision Supervi.sio:1 Provided by the Counselor Jupejvisio;:" b;>' the District Supervisor Placement Follovr-Up Service Fi.:F:c;;t.SED ~'ERVICES f;e-c:-j_c~i.l Ex<~raination
Psychological Examinations Kuder Preference Record Hechanical Comprehension Form AA, George K. Bennett Hinnesota Mechanical Assembly, Box A General Clerical Test by the Psychological Corporation Psychological Test for College Freshmen - American Council on
Education
Weschler-Bellview Intelligence Optional Tests Which Hay be Used Otis Intelligence Test, Form A or Form B tlinnesota Vocational Test for Clerical Workers Perdue Pegboard Test Johnson O'Connor Finger Dexterity Test Johnson O'Connor Tweezer Dexterity Test Revised Beta Examination The Adjustment Inventory, Adult Form, by Hugh M. Bell TRAINIHG Standards for Training Facilities Preference Given to Public Institutions Private and Denominational Schools Out of State Schools Business College Training Colleges or Universities State Trade Schools Employment Training Correspondence Training Tutorial Training Training For Vending Stand Operators
I.~aintenance
Transportation PHYSICAL RESTORATION SERVICE 1.iedical Treatment Dental Treatment and Dentures Surgery Hospitalization Allergies (Astruna, etc.) Arthritis Cardiac Involvement Circulatory Impairments Diabetes Endocrine Epilepsy Eye, Ear, Nose, and Throat Gynecological Disorders Hernia Eental Orthopedic Plastic Surgery
Burns Ulcer - Peptic (duodenal or gastric)

8.2519 8.2520 8.2521 8.2522 8.2523 8.2524 8.2525 8.2526 8.2527 8,2528 8.2529 8.26
9.0 9.1 9.101 9102 9.l.J3 9.184 9.105 9.106 9.107 9.108 9.109 9.110 9.111
9.ll2
9.ll3 9.114 9.115 9.116 9.117
9.2
9.21
922
9.23 9.24 9.3 9.301 9.302 9.303 9.304 9.30) 9.306 9.307 9.3CS I 9.309 9.310
9311 9.312 9.313 9.314 9.315 9.316 9.317 9.318 9.319 9.320

- 4-
Urological Disorders Drugs Clinics Convalescent Care Appliances Intercurrent Illness Trar.sportation and l,laintenance for Physical Restoration Service-s Rehabilitation Centers Thoracic Surgery Neurosurgical Insurance TOOLS AND EQUIPI lENT
REPORTS Al'ill RSOOP.D3 Local Office Records Closed Case Card File Active Case Card File Closed Case Folder File Active Case Folder File Haster List File Report of Authorization File Inventory File iIemoranda from District and Central Office Training Institutions and Rates Hospital Rates, Schedule of Fees, and Panel of Specialists Itinerary Reports l:ionthly Expense Reports Occupational Information File Federal and State L'lanual of Policies Federal Office Releases Correspondence File Other Files DISTRICT OFFICE RECOB.DS Studies of Work in District Closed Case Report File Correspondence File List of Cases Closed by Counselors CENTRAL OFFICE FILr~S Cloeied CJ.se Gard File Active Ga~;e Card File Closed Caf:>e Files Activo Go.~o ~;ile Enc"Wnlra!J.0e Record File Rei_,ort of Authorizations Easter list File Flm Sheet File Itinerary Reports Eileage Reports Lonthly Expense File Personnel Rating File - Report of Performance Hailing List for Hehabilitation Nevrs Training Information File Schedule of Fees, Eospital Rates, and Panel of Specialists Federal and Regional Releases Inventory File Correspo~dence with Other State Agencies Ger.eral Co~respondence File Gene t!H l:emoranda File

9.321 9.322 9.323 9.324 9.4
10.0 10.1 10.2 10.3 10.4 10 .5 10.6 10.7 10.8 10.9 10.10
11.0 11.01 11.011 11.012 11.013 11.014 11.02 11.03 11.04 11.0.5 11.06 11.07 11.08 11.09 11.10 11.11 11.12 11.13 11.14 11.1.5 11.16 11.17 11.18 11.19 11.20 11-21 11-22 11.23 lh24 11.2.5 11.26 11.27
11.28 11.29
12.0 12.1 12.2 12.3

- .5 -
Attendance, Sick Leave, and Annual Leave File Invoices Submitted for Payment Requisitions for Purchases Occupational Information File Discarding Records
FI~OAL PROCEDURES Authorization for Payment of Salaries Authorization for Travel of Personnel Authorization for Expenditures for Diagnostic Purposes Authorization for Case Services Authorization for Expenditures for Supplies, Equipment and Rent Authorization for Other Costs Responsibility for the Accuracy of Accounting Responsibility for the Approval of Bills for Payment Responsibility of Coding Bills Preparation of Budget Request and Financial Reports
INSTRUCTIONS FO::t USE OF REPORT Al\TD CASEWORK FORlViS Fonn R-4, Survey, Economic Need, Plan and Encumbrance Personal Data Section Economic Need Form Initial Plan Section Encumbrance Record Section Form M.E.A. (Medical Examination Authorization) Form R-3, General Hedical Report Form R-3a, Pulmonary Tuberculosis Report Form R-3b, Cardiac Disability Form R-3c, Visual Medical Report Form R-3d, Hearing Medical Report Form R-3e, Orthopedic Disability Fonn VR: PR:3f, Psychiatric Disability Form R-3g, Dental Report ChrorJlogical History Couns.1lor's Report of Authorizations and Encumbrance Records Contr.;..ct for Rehabilitation Course Letter of Authorization Forms ~',oom and Board Bill Form Trcdning Progress Report Physician's Report of Treatment Clo<>ure Heport 0-13-14-1.5 Closure Report, Form R-9, Employed Haster List of Cases Referral Caseload Report t,;Iileage Report Honthly Report of Expenses Itinerary Report File Card Form VR-6, Referral to Employment Service Form G3ES 1021, Referral to Georgia Division of Vocational Rehabilitation Form EQ - Employment QuestioP~aire Form FS - Financial Statement
CASE SUPEEVISION Training Supervision Physical Restoration Supervision Placement Supervision

1.n
N..ANUAL OF POLICIES GEORGIA DIVISION OF VOCATIONAL REHABILITATION
1.0 THE PHILOSOPHY FOR REHABILITATION SERVICES IN GEORGIA
1.1 The Philosophy
It is the purpose of the Georgia Division of Vocational Rehabilitation to give, or make available by purchase, such services for which provisions are made under Public Law 113 to individuals who are physically or mentally disabled to such an extent that the disablement constitutes a substantial employment handicap, and yet who are not so severely handicapped that the service will result in at least a partial rehabilitation of the individual. It is the agency's desire to make producers of the disabled individuals who, without this service, will not be able to compete with non-disabled individuals.
Rehabilitation is the restoration of the handicapped individual to his fullest physical, mental, social, and vocational usefulness so that he may become a contributing member of society.
The agency believes that those individuals with very minor disabilities who will fare about as well without the service should not be accepted as the responsibility of the agency. The agency does not assume responsibility for those cases on which medical and vocational diagnosis indicates that the individual probably cannot be restored to useful employment, at least on a part-time or sheltered basis. It is believed that individuals who are severely disabled but on whom the diagnosis is reasonably favorable for restoration should be accepted for service even though complete success cannot always be expected.
The Division of Vocational Rehabilitation believes it is the responsibility of the counselor to allow the individual as much latitude in the selection of a suitable vocational objective as possible provided he tactfully counsels the client so that the client recognizes his abilities and limitations and evaluates them in terms of the desired result.
1.2 Scope and Results
The agency's experience indicates there are large numbers of the population in need of its service and a greater effort should be made to secure adequate financial support, in order that a real job of rehabilitation can be accomplished. The agency has rehabilitated an average of over 2400 cases per year for the past seven years. The concern of the agency is in making the greatest use of the available funds in serving the disabled and in guarding against waste at all times.

2.0
2.0 ORGANIZATION
The staff is organized for three purposes and on three levels. The purposes are administration, supervision, and provision of services to disabled individuals. The three levels are state, district, and local.
2.1 State-wide Personnel
The state-wide personnel has responsibility for developing overall policies and methods of administration as well as the provision of consultation to staff members. It also exercises overall supervision through the district offices to assure conformity to establis~1ed policies. It does not provide services to individual clients, but through proper request may advise staff members who have responsibility for working with clients in order that they may take such action as needed for the solution of the problems involved. The accounting section on the state level has responsibility, with the advice of the director, for developing budget estimates, making state and federal reports, accounting for all expenditures, and for keeping within regulations regarding amounts and purposes for which expenditures are made. The accounting section depends on the counselor who authorizes the services to see that the services for which he submits bills are received by the clientft
2.2 District Personnel
The district supervisor and his staff have responsibility for carrying out the administrative policies and procedures within the district, and for supervising the work of counseling personnel in the district. He has the authority to correct deviations from established policies and procedures. The position of district supervisor is principally a supervisory one in which he not only secures conformity to policy but also gives assistance to counselors in the solution of problems. He is the laison between the counselor and the consultative and administrative staff on the state-wide levelo He may request assistance of the state-wide personnel in instructing district and local personnel in procedures and/or technical problems, if necessary. He does not provide services direct tc clients, but will advise with counselors in the solution of their problems in an effort to assist them.
2.3 Local Office Personnel
The counselor is responsible for rendering services to clients. He is the only staff member who works directly with individual clients except as he may call on supervisory or consultative staff members for help in the solution of the problems involved. He should be given the assistance of the district and state-wide persor~el, but the final rehabilitation of his clients depends largely upon his efforts and the enthusiasm he exhibits toward his work. The counselor is responsible for the work of th8 agency in his assigned territory; for the adequacy of supervision provided his clients; for determining eligibility and for rejecting non-feasible cases; for authorizing expenditures and for seeing that the client receives the authorized services; for developing and keeping proper relationships with other agencies in his territo~ so that referrals, exchange of information, and securing available services for his clients may be effective. Vfhen the counselor needs assistance from a member of the state-wide supervisory or consultative staff, he will request the aid through his district supervisor.

2.4 Harking Relationships with Other Personnel
Infromation is not contained in this manual of the various positions in the agency. They are outlined in the state plan, a copy of which has been supplied each staff member. For good working relationships, lines of responsibility should be adhered to rather carefully. The initiative of a staff member may be retarded if he feels that he does not have authority to act within his field of responsibility so long as he stays within established policy. Caution should be taken against usurping the duties of other staff members, but help should be readily given when it is requested. 7he assistance of supervisory or consultative staff members should be sought when it will be helpful. Care should be eYercised in seeking aid too readily, however, for decisions should be made without help, when possible. The best results are obtained when all staff members maintain a satisfactory working relationship.
2.5 Counselors Serving the Blind and Placement Agents
Their work is that of providing service directly to blind clients. The rehabilitation of the blind is more difficult than the rehabilitation of many other clients, and there are usually more problems involved. For this reason, there is a special supervisor for the blind on the state level who is available to the staff members working with blind clients. His help is frequently solicited in working with blind clients. Counselors serving the blind and placement agents have the srune responsibility to the district supervisor as other counselors, but they have the added source of assistance from the Supervisor of Services for the Blind.
2.6 Local Office Manager
The State Director shall designate the Office Hanager whose responsibilities are as follows: (1) to requisition all supplies and e~~i?ment needed to carry on the work of the office; (2) mainter.ance and up-keep of tho office and any necessary contacts with thE: rer..tc..~- :::.gent to see that these are carried out; (3) physical arrangem<:::nts of the office such as assigning space, including
telephones, desks, etc.; (4) arrange ~aves to clerical personnel
so as to least interfere vrith the work schedule and make whatever arrangements are necessary to keep the office open on work
days during all hours; (5) establish good public relations;
(6) see that reception room is kept in order for visitors; (7) see that telephones are answered promptly; and (8) send in inventory to the State Office in July of each year.

3.0
3.0 CASE FINDING
3.1 Responsibility for Finding
The state has been divided into local service areas, each of which has been assigned to a counselor for rendering services to disabled persons within the area. The counselor serving the blind has responsibility for services to blind clients, and his area overlaps that of other counselors rendering services to disabled other than the blind. Each of the four districts of thco st.:tte is divj.ded into two parts, each of such parts is supervised by a counselor serving the blind. They are under the immediate supervision of the district supervisor just as other counselors in the district, but they also have additional supervision from the supervisor of services for the blind.
It is the responsibility of the counselor (both the counselor serving the blind and tho counselor for the sighted) to find the disabled persons within his area and render such services as are necessary to rehabilitate those individuals wllo are eligible and feasible. He builds and maintains a reporting system within his area which will assure a sufficient referral of cases for services without his spending too much time locating cases. On regular visits to various sections of his territory he will visit personnel of all private and public agencies in position to know and report cases in need of rehabilitation services. He will instruct the personnel of these agencies as to the type cases which should be referred, the financial limitations of our program, and our general policy of not accepting cases on which examining physician cannot give a reasonably favorable prognosis. o.f the individual's return to employment. He will report in writing to these agencies the action taken on all cases referred to him for service. It is the policy of the Division for the counselor to maintain a wellbalanced relationship in each county and canmunity rather than deal principally with one person or agency in that county.
The counselor will give such publicity to the progra"ll in his territory as will inform the public generally of the availability of rehabilitation services. This may be done by newspaper articles, radio addresses, and proerams at civic clubs in the area. The counselor may add to the mailing list for the Reha1)ili tation News such persons in his territory as may be in position to refer cases for service so they may be better informed of the nature of the program.
3,2 Sources of R~C~ferrals
3.21 Agreemontc, and rorl-:::Lng R(}lationships with Referral Agencies
The Division of Vocational Rehabilitation at the state-wide level has worked out with a number of other agencies coo?erative relationships providing for inte.rchango of referrals for such services as are available under the provisions of the particular agency. The agreements are not given here, as copies have already been supplied personnel of each agency. A brief statement about plans of cooperation with each agency follows. The written agreement, as well as the following material, will assist in developing 011 the local level a mutually beneficial worki!lg relatimlship with local personnel of the other agencies.

3.211

3.211

Georgia State Employrnent Service
The State )~rnployment SGrvice in cooperation with the U.S. Employment Service and the Department of Labor, develops and keeps in their offices the information about employment trends, job opportunities and job descriptions for various jobs within the area, This service can be utilized to a great advantage in the final stage of the individual's rehabilitation process when job placement is to be madeo The rehabilitation counselor will avail himself of this opportunity by enlisting the aid of the State Employment Service in finding employment for his client when :1e is readyo

The rehabilitation counselor will visit the employment service offices within his 2rea frequently to discuss placement of individuals on his caseload who are ready for employment and to receive referral of cases applying at the Employment Service Office who are i~ need. of rel.u11ilitn~ion services. The success in carrying out the .:<>,lpt->t'atlve ag:reAmon~ made at the state level depen,w lJ1t t/1~ :._.~.,......,..:ti uiJLt business reJ ~,tionship which the cou11u,: ..,. ,'ln~ ~o-l.., .tr..._,,g_l personnel of the Employlltei:t Service Office
rlc vt~l p
Lhe rehabilitation counselor can provide the placement personnel of the EmployMent Service such personal data, physical capacity, aptitudes and interests of the client as he has collected in his diasnosis and preparation of the client for employment. He can provide such follow-up service on the job after placement as needed to see that the client makes proper adjustment to his work situation&

3,212 State Industrial Board

The Rehabilitation Division has a rritten agreement with the State Industrial Board for referral of cases reported to them after injury in employment covered by the laws relatinG to injury while employed. Personnel of the Rehabilitation Agency visit the office of the Industrial Board weekly to receive "uch referrals as the data would indicate might be eligible for service under the rehabilitation program. These referrals are sent to the counselor responsible for investigation and for service to the client, if needed. The counselor is responsible for making reports on these cases to the Industrial Board after services are rendered or when it is determined that the clier.t does not need rehabilitation serviceso

.3 .. 21.3 Department of Public Health, Crippled CD.ildren rs Service

There is a written agreement between the Division of Vocational R;ehabilitation and the Department of Public Health, Crippled Children's Service, which provides for reciprocal referral of clients between the tr.vo a3encies to take advantage of the services available under the provisions of each a gcncy, The rchabilitati on agency does not accept elien ts for reha'oilitation aic1. Hho can receive the service under the cripy;led children's program, unless officially released, but will accept them for tra.ining and other services which nre not r:rovided by that agency.

Orthopedic and plastic surgery cnses under 21 may receive service under the crippled children's program, bu.t other types of disabilities are not generally served. Some plastic cases are not accepted by this program, and after it is determined they cannot be served, they may be accepted by the Rehabilitation Agency, provided they are of such age they are ready for preparation for employment. Cases ma~r be referred directly to the counselor serving the area lvhere the client lives or tc the central office.

3,214 Georgia Tuberculosis Association
There is a written agreement between the Geo1gia Tuberculo::ois As so ciation and the Division of Vocational Rebabi_lit_.at,ion providing for reciprocal referral of cases and provision of services, available under each, to clients so referred.
The Tuberculosis Association in some instances aids the family of a tuberculous client while he is receiving rehabilitation services. The association has assisted in a fine way in the beginning of the iu-crtui.-t-o.dmn program at Battey Hospital by making a loan for equipment for some of the classes.
The counselor contacts frequently the personnel in the local units of the Tuberculosis Association for assistance with cases needing service and for receiving referral of cases in the area.
3.215 Department of Public Health
There is a written agreement between the Division of Vocational Rehabilitation and the Department of Public Health for reciprocal referral of cases between the agencies. Many counties have a county health department with a physician or nurse in charge who is in position to make referral of cases in need of rehabilitation serviceso The rehabilitation counselor uses such public health services as are available in diagnosing and rendering services to his clients. Securing sputum examinations and X-rays from the local rEaltq department is a frequent method of helping to diagnose the case, as well as having the Kahn and urinalysis tests made, should the examining physician not have this in his medical diagnosis of the client. The public health nurse often does follow-up on cases returned to their homes for con~oence.
3.216 Farm Home Administration
There is a written agreement between the Farm Home Administration and the Division of Vocational Rehabilitation for the reciprocal referral of clients for service under each agencyo The rehabilitation counselor may provide some physical restoration for the individual who is being assisted in his program under the Farm Home Administration. The counselor often secures assistance of personnel working with Farm Home Administration in developing "on-the-farm" projects (such as poultry raising) for rehabilitation clients.
The counselor has a close working relationship with the Farm Home Administration on the local level.
3.217 Federal Prison
There is a written agreement between the officials of the Federal Prison and the Division of Vocational Rehabilitation for referral of prisoners who are physically or mentally disabled for guidance service and for physical restoration services in preparation for employment upon dismissal from the prison.
A rc;habilitation counselor makes frequent scheduled visits to the prison to work with prison officials and the individual concerned for the selection or a suitable objective and plan for the preparation of this objective while the individual is still in prison. There are available at the prison many opportunities for vocational training. The counselor participates in the

3.217
vocational diagnosis and selection of a suitable objective. The prison provides the training and the counselor may assist in the placement of the client on leaving the prison.
3.218 Atlanta l:Ietropolitan Association for the Colored Blind
There is a written agreement between the Atlanta Metropolitan Association for Colored Blind and the Division of Vocational Rehabilitation for the referral of cases in need of rehabilitation services. The association provides limited facilities for training blind clients and the rchabilita~n division accepts for service such referrals made by the association as are eligible and feasible for rehabilitation services.
3.219 Veterans Administration
Vfuile there is no written agreement between the two agencies, the Division of Vocational Rehabilitation works in close cooperation with the Veterans Administration for reciprocal referral of individuals eligible for services under each of the agencies. Personnel of one agency attend conferences held by the other to prevent duplication of effort and to develop full understanding of the services available to disabled persons and plan for full utilization of these services. vVhen a ve~eran applies to the rehabilitation division and it is found that the only service, other than guidance and placement, that he needs is available under the Veterans Administration, the case will not be placed on the case load of the division. VVhen a supplementary service is needed by a veteran who is being served or has been served by the Veterans Administration, the case may be accepted as a client of the division for those services which he cannot secure under the Veterans Administration.
3.220 Georgia Academy for the Blind
There is no written agreement between the two agencies, but there is a close working relationship between the Academy for the Blind and the Division of Vocational Rehabilitation. Personnel of the rehabilitation agency visit the school frequently to administer aptitude tests and help plan for the blind individual who is nearing completion of the work offered at the school. Vfuen the client leaves the school, the rehabilitation counselor is provided with such personal information as the school has which will assist in determining the objective and in preparing the client for employment in line with his abilities and aptitudes. The rehabilitation counselor reports to the school the result of the rehabilitation program for each individual referred for service by the schoolo
3.221 School for the Deaf
There is a close working relationship between the School for the Deaf and the Rehabilitation Division for reciprocal referral of cases in need of the services of either agencyo The rohabilitation counselor visits the school freqnently. He contacts E.:ach graduate and starts working with him in the selection of a suitable vocational objective. He makes full use of tho infonnation the teachcrrs and school have collected that will be of assistanc, in serving the individt;.al. Eost of the graduates accept rehabilitation service on loaving tho school, and many of them are vocationaLy trained with aid from the Rehabilitation Division.

3o222
3.222 B~ttcy State Hospital
The Division of Vocational Hehabilitation and the officials of the Battey State Hospital worked out jointly an in-sarlitorium program for serv:ing clients. \vhile the client is still in the hospital and as soon as the physician in charge of the case recommends sufficient exercise, the client and the counselor will start planning and preparing for a suitable vocational objectiveo
The Georgia Tuberculosis Associ~tion and the Rome vocational School assisted dth the program at the be~innin~. in providing teaching service and equipment for classes to be established at the sanitorium~ The teachers are still furnished by the vocational school, and the Rehc:tbilitation Division pays n tuition fee >vhich provides some equipmEmt and supplies needed in the classes.
vJ'hen the client can complete his vocational preparation and be placed on the job iwnediately upon leaving the hospital, the case will be closed by the counselor at the hospital. \Jhen the preparatory services cannot be completed by the time the client le~ves the hospital, the counselor at the hospital will transfer the case to the counselor serving the area of the client's legal residence. The counselor accepting the transferred case will be responsible for immediately checking with the client and making plans to carry out the planned program; as well as helping the client make such adjustments as are necessary due to his change in residence.
3~223 Hilledgeville State Hospital
The Rehabilitation Division has established an office in the sanitorium. The counselor who is located in the hospital spends his full time vlorking with the in-sanitorium cases who appear to be fensible for rehabilitation services. The counselor located at the hospital is responsible for making complete diagnosis, screening after they are in referred status, accepting for service and initiating service ns needed to clients while in the hospital. As soon as the resident counselor knows that the client is to be dismissed, he will notify the counselor serving the territory of the client's legal residence and keep the local counselor informed of developments until the dismissal takes effect, at which point the case shall be transferred from the resident counselor to the local counselor. The client's residence will be considered the sar.,e as ~he client's parent or guardian, unless there is justification otherwiss. ,jhen the resident counselor feels that it is advisable for the client to go from the hospital direct to some place other than tho client's residence for rehabilitation services, the resident and the local counselor will ~gree on the services to be rendered before the client is dismissed, if at all possible. The resident counselor may establish a tentative objective for use by the local counselor, for the local counselor's benefit. It is the responsibility of the local counselor to establish the economic need and obtain permission for rehabilitation services from the parent or gu~dian of the client just prior to authorizing rehabilitati0n services. The economic need will be established on the resources of the client, unless the client be a minor, whose guardian is a pnrent, in which case the econcmic need will be based on the parent-guardian, as in all cases of rehabilitation cliontso When the client can complete his vocational preparation anc'. "Je placed on the job immediately upon leaving the hospital, the case ~ov-ill be ~losod by the resident counselor in the hospital.

3.223
The resident cotmselor may serve cases going directly to North and South Georgia'Trade Schools. If these clients go back to the home for a period of time before going to trade school, they will be transferred to the counselor serving the territory in the client's place of legal residence.
There are approxj~ately 200 or more patients furloughed each month from the iiilledgeville State Hospital. The manner in which most of these furloughs are granted at this time prevents the resident counselor from contacting the patient. The guardian, in many instances, arrives at the hospital unannounced and desires to take his ward home. The physician calls in the patient and if, in his opinion, the patient is not too sick the furlough is granted. The procedure requires only twenty to thirty minutes, and the patient is on his way home. i:.ihile efforts will continue to be made by the resident counselor to contact all feasible cases before they are furloughed, a plan has been developed whereby those persons considered feasible will be contacted after leaving the hospital. A daily report, listing the names of patients furloughed the previous day, is sent to the resident counselor by the head of each department (white males, white females, colored males, colored females). The resident counselor then contacts each ward physician vrho has furloughed a patient and discusses the feasibility of referring the patient to the counselor serving the county to which he returns. In this manner, it is felt that most of those who would prove unfeasible rill be eliminated, while an inunediate referral can be made by the resident counselor on those who may benefit from services.
A form has been made up for referral of potential clients from the hospital. Whe;.i a counselor receives such a referral from the resident counselor at the State Hospital, he is to make an investigation, complete the lower section of the referral fonn, and return it to the resident counselor. This is necessary in that each doctor at the hospital desires to know the outcome of cases he refers. If the case is rejected, the reason must be stated; if accepted, or disposition is deferred for further investigation, all infonnation available at the hospital vrill be transmitted to the counselor upon return of the lower section of the referral form to the resident counselor.
All professional personnel are required to comply with this policy and to make their investigations as soon as possible after referral as mG.ny cases may prove unfeasible if not contacted before or shortly after leaving the hospital. On the other hand, they have a much greater chance at readjustment in community life if they recaive services vQthout delay. The psychological effects of failure to get employment, inactivity, etc., are much greater on the psychiatric client than any other type of disabled person. Delay in contacting them may result in their having to return to the State Hospital when, in many instances, such can be avoided.
3.224 Public and Private High Schools
The counselor serving a local territory is responsible for visiting each high school in the territory prior to graduation of each class. He will taLl< vrith the faculty and members of the graduating class for the purpose of locating those illdividuals who have a physical or mental disability which m<:.kes them eligible for rehabilitation service. Clients who have attended public school vrithin the past twelve months but who have not graduated from high school, will not be accepted for rehabilitation service until they have been cleared with the school officials in order to determine the advisability of pursuing a vocational objective before completion of high school. The counselor obtains the high school transcript, as well

as aptitude test results when possible, and. uses them in helpin~ to make his vocational diagnosis of the individuale
3.225 "Key" People in ~<:.ch Community
l'Iost of the counselors have established working relationships 1iith "key" people in each community who are in position to know and refer cases in need of service and who can assist in making investigation of the individual as to his possible financial status, as 1.-J"ell as his relic;.bility.. The names of these people are added to the mailing list of the Rehabilitation News in order that they may more fully understand the nature and scope of the service available.
3.226 Inter-Agency Comli1uni ty Commi ttec
A number of the counselors have vrorked with representatives of local agencies in establishing an inter-agency committeeo The committee has officers and it functions somewhat like a civic cluba At the meetings discussions of all services available through the various agencies arc hclda Through the combined efforts of the several groups represented, a better understanding of the community services and activities is gained and more adequate services are planned~ This is c;. very good means by which the counselor can know of and utilize community services in the solution of problems pre;sentcd by some of his difficult cases. It ~-Jill also stimulate the development of additional facilities and result in more employment opportunities for the disabled because of a bettor understanding.
It shall be tho policy of tho Division of Vocational Rehabilitation to actively support the formation of inter-agency committees, designee', to coordinate the work of tho various public agencies, and utilize all available communi~ resources.
3~227 Local Selective Service Officers
Effective as of February 26, 1952, counselors will call on Draft Board
Officers to secure names of registrants rejected from milita~/ service because of some mental or physical disability. The counselor shall screen these referrals very carefully, offering service only to those Hhich evidence indicates needs some service available through the Division.

4oO CASE LOAD !"IANt~GEIIENT
For the purpose of reporting .:md m.:1naging the case load, the various stages in the reha.cilita.tion process are cl<J.ssi:':'ied into nine active and four closed sto.tuses. At the end of each quarter the counselor ntakes stock11 of his case load to determine ho;,r m:ony ol his cases a:-:e in each status, and to evaluate the floH of his cas2s. The tr~.bulated information is the basis of the flow she:-;t report ~'hi<e is made to the district and cent:-al offices and from which the report L tabulated for the Feder2l Office.
4.2 Registration of Cases
VJithout rc;c;ard to how the; information is secured, tte mlnlr.tur!1 information to justify plncing a case in referred status is: (a) date of referral, (b) source of referr<'-1, (c) name and address of the client, (d) disability, and (e) ageo Every one with minimum information should be placed in referred status so that the records will show all investigations made by the counselor and give the counselor a record of action t:<.ken in the caseo
':Jhen registering a case in referred status, the counselor will check the name against his closed and active case files to learn if the case has been knm.vn to the division or if it has been previously served. If he finds that it has been served, he will study the previous record to learn what was done before he reGisters the case a second time.
The counselor "lvill m<'-ke two file c:J.rds on each case he places in referred status o One of these Hill be sent to ~he district oflice and then to the central officeo The other will be placed in the active file by statuses. In the larger offices a third file of all cases served by counselors Horkine; out of the o~fice may be maintJ.ineo., but thi3 is not necessary in offices hc:vin::, only one or tHo counselors, If the case is one that is beine; reopened, the ncm card will be stapled to the co.rd previously used and the tHo filed together in the active filee This will remind the counselor each time he deals 1.1i th the cnrd that i t is a second or third time the case has been served; and '.;hem he closes the case, he should
place on the H-9 the required information on such cases.
If the c<'..sc is one which is beinG reopened, the counselor will note on the back of the new card that he knmv-s the case has been served before or has been knmm, and give his reason for reopening ito This will let both the district and central offices know that it is a reopened case, and will obviate the necessity of advising the counselor that it is a reopened case.
The Supervisor, Services for the Blind, keeps a separate file of all blind cases referred throughout the State of Georgia.
The counselor will, at the time he registers the case, begin the chronological history and complete the sections of the survey form for which he has information; such as, name, address, date referred, disability, and source of referral. This chronolosical history must be kept current as the case develops.

4.3 Case Status Classifications
The counselor will refer to the Federal 1\.fanual of Policies, Chapter 13,
Section 2, pages 20-25 for tho definition of each status, and will keep his cases moving from one status to another as they progress. The counselor must check frequently the curr8nt status of his cases and not allow them to accumulate and remain in a particular status if they are not actually in that stage of their progressu The states of progress represented by each status are as follows.
4~31 Referred - Status 0
Referred status covers that period of time from registration of the case until the survey form, followed by the general medical report, is secured and it is determined that the client has a disability which probably makes him eligible, that services are needed, and that the service will probably be accepted. >~hen these factors prevail, the case leaves referred status and is placed in the accepted status. It is then placed on a tally line and the master list. The period a case is in this status is from the initial investigation to the time the counselor decides to accept the case.
4.32 Accepted - Status l
Status l covers the period of time from which the case is thought to be eligible and feasible for rehabilitation services, until the time the authorization for the first case service is written. This may include obtaining of family, school, work and social histories, appropriate psychological tests and additional medical data. (THE Ej\.SIS ON dHICH ELIGIBILITY HLS BEEN :LST~.BLISHED, FROH THE STL.NDPOIHT OF THE PHYSICJ,L IMPAIBJ11ENT 1\.ND THE EHPLOYNENT HANDIC;~.p, MUST BE STHTED IN THE CASE RECORD BEFORE 1\UTtiORIZATION FOR C;~.SE SERVICE IS wRITTEN.) Refer to Item 17 of R-9 for vocational handicap~
4.33 Plan Completed - Status 2
The plan completed status covers the period from the date of au+-horization of the first service, other than diagnosis, to the time the client begins to receive the service authorized.
4.34 Physical Restoration and Training - Status 3
Physical restoration and training status covers the period the client is receiving training and at the same time is receiving one or more of the physical restoration services. This status appliea more to the 11insanitorium program" or "rehabilitation centers 11 , but may also include cases which are at the same time being trained and treated as part of the counselor's plan of preparation. (The physical restoration services may be paid for by other agencies or secured without cost to the Division, but if the counselor's plan for the client includes these services, the case may be placed in Status 3 if the client is receiving training and physical restoration.)
4.35 Physical Restoration - Status 4
The physical restoration status covers the period of time from the date the client begins receiving the services until the convalescent period has bE'en

4.35
completed and the client is ready for training, employment, or another phase of his program. Uhen a prosthetic appliance is provided a client,
the case will enter Status 4 ~oJhen it is fitted or Hhen physical therapy
is begun.
4.36 Training - Status 5
The training status represents the time from the beginr,ing of training until the course apnroved has been completed and the individual is ready for employment or for another stage of his plan of preparation. College students out of school for summer vacation may be allowed to remain in
Status 5 if they intend to reenter school in the fall term, but when they
discontinue training, the status should be changed at once to reflect their true status. If they accept temporary employment they may be changed to Status 7, pending their return to another stage in the progress.
4.37 Ready for Em~loyment - Status 6
This status represents the time from the date the cl:ie nt has completed all his preparation services and is ready for employment until the date he begins work.
4.38 Employment - Status 7
This status reDresents the time from the date the client starts IJOrk until the ~roper adjustment oeriod has oassed and the counselor is ready to close the case.
4.39 Service Interrupted - Status 8
This re;Jresents tl-Je time from the date the client for some reason stops receiving the services as ::Jlanned until the counselor has worked out and authorized another service an1 the client has started to receive th~ new service. Cases in this status are the ones on which the counselor should be working to return them to service or make his case records clear that for some reason the nroblems involved are beyond his control at the time.
4.4 Closure Statuses
4.41 General Statement
There are four categories into which closed cases may be grouped. The counselor should study the Federal ~':::Jnual of folicies, Chapter lJ, Section
2, pages 23-25 for discussion of these statuses.
The closure must be justified in each case history, and the closure report form must be com::>leted fully to shm-J clearly what happened to the case. The material in the Fd.eral l1anual of Policies is being briefly su,)"lemented so that the on,mselor cJill understanrl fn1l y who. t is expcc r.-ed of him in closing cases by each rneLhori. The R-9 is used only on closed employed
cases. The state closure forr.,, C-0-13-14-15, is used on other type closures.
1t.!,'? Closed Referred (See Federal ~ 2nual Chapter 13, Section 2, page 21)
Every case placed in referred stotus rr,ust be investigated. ~.~ben the investigation discloses that the client is not eligible, does not need the service, trill not acce1)t the service, or he is in such serious

4.43

condition that it is needless to attempt rehabilitation, the case will be closed as referred. The closure form should be completed indicating the action taken and under "remarkst1 the counselor should justify his action in closing the case, indicating the extent of the investigation and his findings in the case.
Closed Employed - Status 12

In order for a case to be closed in this status the counselor must have set up a plan of rehabilitation for the client who must have received rehabilitation services. After a case goes beyond Status 2, it will be closed either as Status 12 or 13, un~ it is transferred out of the state.

If the counselor cannot show that the service provided or purchased for the client resulted in substantial benefit, he should not take credit for the case and should close as Status 13.

VVhen the client interrupts the services planned and returns to the same job he had before or at the time of survey, and the service rendered has been of no substantial value on that job, the counselor should not close the case as employed.

Tho case history must justify the closure in each case. (See Federal
Hanual of Policies, Chapter 24, Section 2, pages 4-5). When the R-9 is
completed and there may be some question as to whether it indicates a real service to the individual, the counselor should use the space under 11remarks 11 for an explanation. Explanations are to be made when the vocational
objective and rehabilitation job are different, and when a case is closed as not consistent vrith training. (See Section 12.0 of this Hanual)

4.44

In cases of eye restoration services the visual acuity reading or visual field restriction after services are to be shown in the justification for closure of the case.
Closed Unemployed - Status 13 (See Federal Nanual, Chapter 24, Section 2,
pages 6, 7)
After a case passes Status 2 and has entered one of the statuses from 3 to
8 inclusive, if the client fails to achieve the end result of employment as planned by the counselor, and the counselor determines that the client cannot be rehabilitated, he raay close the case as unemployed, Status 13. The counselor may reevalaute the case and try a second or a third time, if necessary, in an effort to select a new objective which will result in rehabilitation, but if he is unsuccessful, the case will be closed as Status 13. Cases closed in this status should be studied carefully to prevent more of the same type. Cases closed as Status 13 may not always be the fault of the counselor, but they should be evaluated to see if improvement can be made in necessary tecrilliques and a recognition of unfavorable situations which must be avoided in the future.

In closing cases in this status, the counselor must give full information to justify his action in closing the case. Copies of the chronological history are submitted with the closure form whon a case is closed in this status.
4.45 Closed Transferred Out - Status 14

Vihen a client of the rehabilitation agency who was accepted and placed in Status 1 and has not been closed and moves to another state, the counselor

4.45
will transfer the case to the rehabilitation agency in that state and close
tho case Status 14.

The counselor will nake the transfer directly to the agency serving the area in which thG client has moved. If he does not know what counselor serves the area, he will transfer it to the state director of the state for assignment to the counselor. The counselor should first write the out-ofstate counselor giving him a brief resume of the situation and the stage of progress the client has achieved and ask if he will accept the transfer. Upon receipt of a favorable reply, the counselor will make four copies of his transmittal memorandum listing the matE::rial in the case file which is being transnitted and send all case data collected on the case with the original of the memorandum to the receiving counselor. One copy of the transmittal memorandum will be filed by the counselor, one will be sent to his district supervisor, and one to the central office so that records in these offices may be adjusted to show the disposition of the case.

In tho event tho co~~selor in the other state does not wish to accept the
case, tho counselor may close the case as Status 15 if in Status 1 or 2,
or as a Status 13, if it has gone beyond Status 2.

4.46

If a case in reforrod status ;,1oves to another state, the counselor will send the case data -,,-hich ho has collected on the client to the counselor in tho othor state vrith a transmittal memorandum. The counselor will complete the closur0 report form for referred cases and submit it to his district supervisor vrho will send it on to the central office.
Closed Other Reasons - Status 15

4.5 4.51

This status covers thoso cases who have progressed to Status 1 and 2, and are closed vd_thout further servico. There must be evidence to substantiate the reason for closure in the casn folder.
Case Accounting
General Statement

With the use of the most r0cently revised survey form there is no place to show the tally line and status changes on the form. The counselor should keep this record on tho front of his case folder. There will be an entry on the case history justifying each change. At the end of each quarter, the counselor vrill review his cases and tabulate from the record on this form the inforn1ation for making tho quarterly report on his caseload. In making this report, two fornts will be used as described below.

This is a fo~n on which the counselor lists by tally lines all his cases except thoso in referred status. On July 1 of each year, he will classify
cases as "Q" or "R". The tally line "Q" cases are those which are in
Statuses 1 throuGh 8 which have been on tho casoload more than one year. The tally lino "R" cases are those cases which have 'been on the master list less than one yoar. Tho new cases that are added to the caseload during
the yuar arc classified as "S", "T", "Vf", or "X", depending on the quarter
in which they are added; as first, second, third, or fourth quarter respectiYely.

Tho tally line lists are compiled by grouping in alphabetical order all cases vrith tho same tally line. The master list form provides a space for the status of each case at the end of each report period. After each case has been reviewed by the counselor and the status inserted, he is then ready to tabulate the number of cases on each tally line by status and record them on the report form.
4.53 Flow Sheet Report
The flow sheet is a means of showing a summary of cases in referred status and by tally lines on the case load at the end of each quarter. These reports are made in triplicate. The counselor keeps one copy and sends two with master list of cases to his district supervisor, vrho consolidates the reports of all counselors in the district and fonrards the consolidated report, with the master list of each cotmse lor and one copy of the counselor's flow sheet, to the central office. The central office consolidates the four district reports and makes the report to the regional representative for the Federal Office. The counselor's copy of the master list of cases is rettrrned to the cotmselor for use with his next report.
The counselor should study carefully the instructions for completing this report and for checking his figur8S to see that his report is in balance before mailing it to his district office.
4.54 Transfer of Cases Yfithin the State
Ylhen it becomes necessary to transfer a referred case from one counselor to another, the counselor making the transfer will prepare five copies of a me!norand~:1 to the counselor to whom the case is being transferred. In t11is memorandum he will explain the reason for transferring the case and list the material which he is sending the counselor. He will file one copy of this memorandum in his file; send one to his District Supervisor; send one to the counselor receiving the case with the material; one to the Distfict Supervisor in whose territory the counselor receiving the case is located; and one to the Central Office, in order that all offices concerned may make a record of the transfer. The counselor receiving the referred case which is being transferred will not count it as a new referral coming to him dtrring the quarter, since the original counselor had already counted it as a new case.
'Hhen it is fmmd necessary to transfer a case that is already on the master list, the co1.mselor will prepare five copies of the memorandum to be distributed as above explained for referred cases. The co1mselor transferring the case will mark through the name on his master list and thereafter will not count it as a case when making up his flow sheet. The counselor receiving the case which is being transferred will list the case as a "transferred in" case on the same tally line on which the original counselor had placed it.
4.. 55 Transfer of Cases From Another State Into Georgia
Any cases transferred to Georgia from any other state, regardless of tally line and status used in the other state, will be received as a new referral in Georgia and treated as any other new referral in processing the case.

50 5.1 5.2 5. 21
5.22

5.0
ELIGIBILITY
Responsibility for Determination
The counselor has the responsibility for determining eligibility and feasibility within established policy of the agency. Eli~ibility and feasibility will be determined only after all factors hava been considered on tnc basis of adequate, valid diagnostic data collectud from reliable sources.
Factors Considered in Determining Eligibility
There are a number of factors to be considered in determining eligibility. Some of the i.1ost important are tho following:
Age
Vocational Rehabilitation has as its goal suitable employment for the individual. Age must, therefore, be a factor since the individual must be ready for employment when the preparatory services are completed. Sixteen is usually the min~num age at which a person can be regularly employed in industry. Hany employers refuse to employ persons under eighteen or twenty years of age. There may be a few instances where a person under sixteen completed his high school education and his vocational objective requires four years' training before he vdll be ready for employment. In these cases a counselor might conceivably accept for service a person slightly under sixteen, but in most cases the minimum age will be sixteen.
A definite maximum age limit beyond which the agency will not accept cases for service is not established. Since employment is the objective, the individual ~.mst be young enough and his general physical condition such that ho can become employed as a result of the service and expect to remain in omployment a sufficient length of time to justify the expenditure for his rehabilitation. This often depends on the condition as shown in the medical diagnosis of the case and the prognosis which the physician gives relative to his general physical condition. Caution must bo taken against accepting old people who are the responsibility of tho ;rolfar0 dorartmont and VIho cannot be rehabilitated.
Residence
A person must be a citizon of the Unit0d States (displaced persons are consider0d citizens) and a r0sident of tho State of Georgia. Residence is defined as tho place an individual resides voluntarily and for other than temporary purposes. A transient is not eligible, but if a person moves into the state with a firm intention of making it his home, the case may be accepted for service, all other factors being satisfied. The counselor will use care in determining rosidence of the individual in case he recently came into th~ state; has he moved his family, has he established a home?, etc.
County residence must be determined on an individual basis. If client is married his residence would bo determined as to where his family resides. If single, it will be determined on the basis of statement fran the client as to his residence.

5 . 23 5 . 24
5.25
)

5.23
Presence of a Physical or Mental Disabi lity
The presence of a physical or mental defect must be established by medi cal diagnosis as one of tha ,aajor factors of eligibility . This physical or mental condition must be r easonably static and not of a temporary or acute na ture . Distinguishing botween conditions which are acute or stati c and thos e which ar e r easonably permanent or tem~orary, is often diff icult. The couns e lor must guar d against being too liberal in his de cis ions . Certainly he must r efrain from s e: rving those cases villose probl ems belong in the fi eld of general medical practice . Section 5.3 of tl:is Manual contains guides that will help the counselor de cide the el igib ility of ca se s with certain types of disabilities . In other types for which guides are not given, the counselor will be expected to exercis e good judgment and his history of the case must show what basis he uses for deciding eligibility in the individual case. The counselor should r evie w fr e quen tly Chapte r 16, Section l, Part lll, ~ages 3-4 of t he Fe de rc.l Manual of Policies to comply with the Federal regulations in establishing th<3 pr e s ence of tho phys ical or mental condition on whi ch eligibility is based .
The Physical or Mental Conditi ~,:: Cons titutes a Handicap to Employme nt
The counse lor must show tha t the impuirment constitute s a substantial handic ap to employment . Chapter 16, Se cti on l , Part 111 B, of the Feder al Manual gives the nine con ditions which may be state d by the couns elor as indication that tho impairm~nt is a vocational handicap. Those conditions should be studie d carefully, and when the couns elor vuites in his case history his statement of eli gibility, he should indicate Vlhich of the conditions fits the individual case. Thes e conditions
ar e also us e d on the n- 9, clos e d cas e r e port, and whe n the ca se is
closed , the couns elor will che ck the one i t ern he cons ider s the basis of eli gi bility f r om the ~mp loyment basis . If the couns elor establishes this Ylhen he determines eli gibility, in compl e ting the R-9, he will simpl y r Jcord the same it em he us e d in his statement of eligibility.
The couns elor must not be too liberal i n his interpr e tati on of ~~ether a condit ion is an employment handicap . If the condition do es uot r eally constitu t e a handicap to emp l oyment, the cas e should be r e jected as ineligibl e . I f t ho client has alr ~ ady secured Gmploymont vhich is r easonably s atisfactor y oven though his physical or me ntal condition might other wis e n~c k0 him cligibl a , the case should not be served .
Chapte r 16 , Se ction l , Par t lll D, of the Federal Manual, should be studi ed carefully befor e a decision is made to se rve a client who is on the job , or vmo is ~ r epar cd f or job ~~hich is reasonably cons ist ent with h is aptitudes , ab ility, and phys ical condition, which is avail able for the client . This s e cti on of the Federal Manual de scribes the conditions unde r which the clie nt may b o given tr a ining for a skill in keeping vrith his ability at a hi gher level . It eliminates thos e cli ents who have reasonabl y suitable employment, but VJho want service in orde r to be more r emune rative ly cmploy ' d. I n most instances a couns elor will r e ject cases that are alr ea dy employed unless it is evident (and the couns elor has such evidence in the case history) that the client cannot continua on the job without a ssist ance from the r ehabilitati on division ,

5.25
or unless tho elicnt is employed on a job which will aggravate his imp9.irment c.'.ld a cll:.cnge in voc:;,t:ional objective will lik!Clly become necessary. The couns~lor c>roulcl exercise caution in accepting cases that are making a :~ood salary.
5.25
Vfn:;n a cl :i(cmt v1ho has been served previously m&kes application a second or third t:Lue, the case may be considered on the same basis as a new case. n'r;ibility 1:ill be established on his concition at the time of the second cr t:tird request vvithout prejudice because of his previous service. The conns .l~r must recognize, however, tlL.t if his cases come back too fregu,:ntly, he nrobably did not do a r;ood job the first time. His rercentage of reocenod cases should bo kept relatively small, or it will reflect on th~ quality of his rehabilit~t:ion service.
ktturally some cases vrill return 1J<;ce.uso of the loss of e;aployment or because the client 1 s ph;ysical condi Lion beca;ae 1i1ore severe and he could not continue on the job. B,3fore clos:~ng a case, th8 counselor should be rt.c.son!.'.lbly cert~i11 tho.t th3 job is satifJf.:.ctory and the client will remain un it.
1.~<:m u. cli:mt loses hj s iob soon aft :r closure and returns to the counselor
for a ;.. inor s,Jrvice (not' exceeding '~50 .oo), the counselor should provide
this service vdthout reopsning th::; case, esnecially if the case has been clos :d less th:~n >:Jlla ye .r. If th.) cl iont returns for a major service such as ~n opGratia~ r~quiri~g hospitalization, or for a justifiable change in objocti v~ vhich roc;uirc)3 :"' Dorio.i of tndning, the c&se should be reopened bei'oco nrovi(hng the so !ti,.,j or services. No large expenditure should be made on a cli<mt r.ft"'r th0 case is closed. A minor service such as guidance, and nLac,: ,..mt, :~1ay 'oo provided without reopening tho case and considering it as bt-ins; r,:hc.:."8ilitcttJd :.:c S(3Cond time.
5.27 Eligibil ~, ty From the Economic Circumstt:;nces of the Individual
Tho Divi~'ion may provid..:; counselling ann ;:::uid:.nc3, diaE:;nos:i.s &nd tuition v:ithout est[.;.bl ishing economic need of the individual. Th,; ocon:)i:iiC need s!10uld bo cousid.:Tod before S'')Jnding money for diagnosis if the only s:oJrvice likely to bu necdod by th0 clLnt vmuld require establishing the economic no.~d. For ull otlhlr servi.c,)~- the; counselor must estcblish economic ne0d. Th<J counselor :.n~;t r,;-.Jst~.>,lish the economic need of e&ch ca.se requJ r1ng sorvic.:os 0Jxt:.m~ling mor; than ~. p3riod of one ye&r prior to v.Titing su?JleJnEmt<c:.ry LJtt,~r of :..<nthorization and mora often if it is found that financi::..l condition of th.: cl iant or client 1 s family ho.s changed.
5.271 F0derd C'.. nd Str.te Stc,ndards of .~::-onn.:ic Eligib~lity
The Federal Agancy has givJn to tho states, (see Chap. 21, Section 1, of l<'.:;d.~ru.l l<c.nual of Policies), the basj s on vhich r;uch stato is to establish a sh:.ndard for c1et::"rmination of 3Conomic eligibiUty. Considerable latitude is t.;iv,;n the stu.te in cst;,.,bl :i.shing its mm pol icy &s to the amount
of c~.p:ito.l t:.nd liquid ar.sat:.; v1hich may oe exe;npt 1~nd also c.s to the amount
uf th.) cl i0nt 1 s r.::sourc;;s r;hich m~Ly be used in suoport of the client 1 s f::.unily v:hilc h2 is r0c,:iving rehabilitution services. The counselor should study Chap. 21, Section 1, c<.:.refully to hav0 as a background the fc3.i3rt,l vi::.'Doint of ,:cono.nic oligLJility, but ho must conform to the more strict intcrDrJt~tion of tho Georgia agency.

The follo111ing st~ndards and instrut::tions for establishing economic need are given as a guide for the use of the counselors in establishing need. The stand'lrds a~e very liberal and in no cas~-< should the counselor exceed them. In rr.any cases the counselor will get the client to p.::ty for part of the service uhen it co.n b8 done 'Hii:.hout the client borrmdng money or ask::.ng otjer people to pa7 it for him;.
1. When a client is found to possess real estate, or considerable p.;rsonal property, the cc'lnselor r.hould have same apprais8d by bJ:ee f~1eehold.ers who possess knowledge of values in tho community, o:1 in l:i.eu t;h:>:reof~ a representative of F.E.A. (I".ILA. cl:i..ents o":-:y), o:c a pcr~o~ -w~:.o has defin-i.te l\:n'J1deci.g-s of f'a:e p:d.:::e of p:r;:;pe::-~y so:.d 1Iii:.h:Ln th:~ p::tst thr8e ye.'lrs, In de:.c:cmin::'.r:g t1w
V;01..:.:'..1e oi: real c:.nd p;rsoi181 property, the cou:1selor vTill take ?5%
of the market value of th-3 prope:::-ty, as deterr.ined by the inv e s t i g a t i o n ..
2. The counselor may exempt $3,000.00 of capital assets when evaluated on the c..tove basis~
3. The following amo':nts m.~y be ex3!i1pt f~om the liquid assets in
determining econ01~i~ eh.:::.'.bility of a client: If a client has no dependents - ClSO~OO If a client has one or more d.ependeuts - $300.00
4. The counselor Htay allow from the client 1s resources the amount. of $20.00 per vreek for the first dependent; $1So00 per W8ek, each, for the second and third dependent; ~.10. 00 per rTeek, each, for the fourth and fifth dependent; and t5~00 per week, each, for the sixth and seventh dependent, for the:i_:r :;_iving expe~1ses while the client is receiving rehabilitation serv~ceso Additional dependents may not be counted when figuring exemptions, (R-4a - IV-25).
S. The client wi:.l be considered as cne of the dependent m.ember3 of t:1e fa:nily onJ..y if tr.e Di.rision is not providing maintenance for him during the rehabilitation period.
6. The counselor must make sufficient investigation to be certain
a:!..l resources of the client are listEd. when determining need~
7. Re11abil3. tation funds will not be available to provide living
expenses of the f<-.rnily dependents whil8 the cJ..ient is ree;eiving servic3S 1 but such :rE:sources as the c~ient may have on hand or may acc:tue d'lring the period may be Pscd fer this purpose on the basis of the weekly allowance for depe:adents.
8. Certain fixed obligations which, if not paid during the rehabili-
tation period, would constitute a :::u1:;~:t.o"ntial obstacle to the achievement of the objective ma.y t~ in~luded in the exemptionso The counselor r.r..1st tj.:.ard against i::1c~:.1:ling as fixed obligations items which the clir:::.:..t vlill not actually pay during the rehabilitation period or any which may be postponed until a later date without being a hazard to the achievement of the objectiveo
9. Government bonds or other bonds llhich may be cashed are to be con-
sidered as liquid assets of the client..

10. !~vc.ilable resources from family members (although not legally liable for assistance) uhich can be depended upon for use during the rehabilitation process, must be counted as resources.
lle To prevent criticism of providing services to a client '"ho has been, or at the time of survey is making a large weekly WD.ge ( (~So.oo or more per week), the counselor should avoid serving the case unless he can establish clearly that the client is unable to make the necessary arr~ngements himselfe
5.272 Nethod of Obtaining Data On Which To Establish Need
The agency has adopted a form on which to list resources and exemptions for the client and his dependents durinG the reho.bilitation :::>eriod. The counselor is responsible for the collection of sufficient data to use in determining economic need. He must realize that it is often difficult to obtain the exact finnncial status of an individual, especially when the client is asking for financial aid. It will take tact and persevero.nce to get all the facts in most cases and the counselor must continue to question the individual until he is reasono.bly sur2 that he has a true picture of the financial situation. In cases of doub~, 1 even though the client does not mm real estate, the counselor should inquire runong neighbors, o.t the loco.l rrrocery store, the local vleli'n.re department, the county agent, the bank, and of other key people in the community to verify the information given by the client.
The counselor must be as conserv~tive as possible in providing those services for wl1ich economic need must. 1)e established. He should alvmys get the client to lX'-Y for o..:w part of tl1e service which he is finnncially o..ble to pay, but should refro..in from asking the client to do more than he co.n be reasonably expected to do.;>
In every instance, a counselor must visit the home of the client at the time of or before filling out the form to establish economic need. This visit will often, but not o..hr2ys, give the couCJ..selor some idea of the financial circrui:3tances of the individuaL
\fuen investigation shows that a considerable amount is required to pay outstanding obligations of the client during the rehabilitation period, the counselor should check these items with the individual to whom the payments are to be made to verify t:1e information as to fixed obligations.
5.273 Amount of Supplementation by the_D::.:,rision
After determining the resources of the client and the amount which uill be needed to rehabilitate the client, the counselor will make his plan to provide the necessary services, within the policies of the agency, which the client cannot provide or vlh:!_ch the counselor cannot secure from other sources.
So3 Guides Which l':G.y Be Used in Determining Eligibility of Certain 'JYpe Cases
The counselor will use Chapter 16, Section 1, of the Federal Iinnual as the sto.ndard for determining eligibility. All co.ses must conform to the rezulations outlined in this chapter. ,Since it is not very specific in indicating how severe a disability should be before considering it nn employment handicap, the follovTinr; o.re brief discussions of a fe~o:r disabilities to be used as standards.

5.301
5.301 Visual Disabilities
Ono of tho followins conditions must provail before a client is eligible on the basis of a visual disability:
(a) Th~ visual ~culty in tho better eye, aft~r best correction by glasses, h~ 20/60 or L.:ss ( 25y; loss or more).
(b) The visual field is restricted by 25% or more. (c) Th~ client does not hnvo binocular vision by reason of the following
condi t:ions: 1. hore thJ visual acuity, r.fter correction by glasses is 20/200
or loRs :in the worso eye. 2. ThosJ requiring four or more diopters of correction. 3. Thos.:: vd.th di vc;rr;,;nt or convGrg..mt strabismus. (d) Prosonc,; of a ntaryc,:ium, tho grovrth of wr.ich has begun to restrict vision.
ln cases 1;her..; thJ loss of vision is less than 80% but is rapidly approachinc 80)~ loss, in the bett.:::r eye, tho cr,so mf,y be served by tho counselor serving tho blind, upon u.t;r0-.;m.:;nt with the counselor sarving sighted cases. In cases of question, tho District Supervisor will holp decide vmo will serve the cuso. In cases whcro visual r~cuity is greater than 20/200, but with c. limitation in tho field of vis ion such th:::..t tho vridest diameter of the visual fidld subtonds an anglo no groat0r than 20 degrees, the couns0lor serving the blind may likevriso sGrv:; this client.
5.302 He~ring Disabilities
The degree of loss of hearing is the most important, though not the only criterion for det,Jrmining eligibility of cases with hearing disabilities. G0nerally a client ~ith a loss of 30 decibels in both ears, 25% or more, will be considered eligiblo. If th3 condition is rapidly progressive, th) clLmt m~y be eligible with slightly less than 25% loss in both ears. If one ear is normal there must b0 a total speech range loss in thJ othsr ear boforo a client may be considered eligible on th0 bas is of hearing acuity. Otitis media is not usually considor..;d us making a client :;ligiblc unloss thGre is considerable loss of hoLring associated with it.
5.303 Asthma Disc":1jlity
Asthma cases ~r-. Utf!.cult to diagnose and oftGn difficult to control. S omo iLdi vi ,;;_oc.l s ;.; _: th .'m occ8.e. Lnal a tt:-1ck of hay fever think they have asthma. H~.y fov-.;r c:;sus vlill not be consid0red eligible for service. Tho only asthma cuses ~.rhich shoulcl be ccc..;ptcd 'ls eligible are those with a long history, t::0lvo months or more, and those which are sev0ro enough that the counselor cc.n prus .mt evidence in his case history that the client has bjJn missing considerable tDne from school or work bocuuse of the asthma.
UnL;ss the examining physicis.n has boon tr,n:.ting th:J cliEmt for asthma or is a specialist in thCi.t field, tho cl j ent must be s.:;nt to c. specialist for adequate dic.gnosis bcforo declaring tho client eligible. The diarnosis of cases VJith asthma is often oxpensivo since allergy tests ur.:; often run on the cl iont. Tho co1mselor should not start diagnosis of an [:~sthma casa unless he f0.;ls reasonably certr,in the client is eligible and will cooperate in tho program of rehabilitation.

5.304 Ulcers of the Stomach or Intestinal Tract

5.304

People with nervous disorders or in poor general health often think they have ulcers. Early treatment for stomach or intestinal tract ulcers should be considered general medical treatment. People with this disability are not the responsibility of the reh::tbilit:::~.+,ion division. Diagnosis is difficult and is often expensive, The l')ouu~lor should not, have a client diagnosed for suspected ulcers unless he is reasonably certain the client is eligible and will cooperate in a program of rehabilitation.

Generally speaking, the counselor should not accept a case suspected of having ulcers unless the condition has existed for six months or more, indicating that it is not an acute condition and is reasonably pel'lnaucHt.

The counselor will not declare a client eligible on the basis of stomach or intestinal tract ulcers until the physician has established the presence of an ulcer. If the presence of an ulcer has been established by a medical diagnosis, the client may be declared eligible for service.

It may be hard to draw the line between people in poor general health and those who have ulcers. Those in poor general health are in the field of general medical care and are not for the rehabilitation divisiono Those with established ulcers may be eligible for service. The counselor must be as discriminating as possible in selecting cases with ulcer disabilities.
5,305 Cardiac Disabilities

There are four major types of heart diseases: (l) rheumatic, (2) hyper-
tensive, (3) syphilitic, and (4) coronary. Only two of these classes
are considered good risks for rehabilitation; namely, rheumatic and hypertensive.

The main basis for determining eligibility of cases with heart disease is by the classification used by the physician on his report. Numbers are used for the functional capacity and letters for the therapeutic classification. Those classified as I and A are not considered eligible for service, Those classified as I and B, or as II and A may be eligible, but in most cases are not eligible, If any in these classifications are served, the counselor must be careful to show just how the minor heart condition would constitute a real employment handicap.

Cases in Classes II and B, and in III and B or any combination of t,:ae se numbers and letters are considered eligible for service, other con:litions being met.

Cases classified as IV and D are usually so severely disabled that they are not gocd risks for rehabilitation. If any in this class are accEp-':.ed for service" the counselor must shC' ., -r.hat he hac' conferred with tJc cardiologi:: t, about the condition of ;te cJ :.c>nt c.:v:l the natur8 c:f -,, objective, and that he -:,hinks it saL: to :;:.~:::..ace tae client in +-'.ict+, objective.
The counselor should avoid accepting for service those individuals with heart conditions such that they can~ot be expected to be good risks for rehabilitation.

5.306
Car e must be exorcis ed in working with persons with this disability to pr event r ocurrvn ce of the dis ease . The health of the client should be t h3 first consideration and the vocational objective should be second. In de t en1ining eligibility there are two situations which r equir e different skndards: (l) in-sanitorium cases , (2) those case s outside the sanitorium.
(l ) Cns cs under tr eatment in the s ani torium may start their vocational r u habilit~tion earli er than those outside because they are unde r the daily c nr of nurses and physicians. The cas es may be ~ccepted for counselling and guidance as soon as the physician gives his permission, which is usually after the diseas8 r oaches the quiescent stage . Thu ind ividual may at this time become an ac cep t e d cas e . The client may begin tr a ining when he has sufficient exercis e to have time to attond class for one hour or mor e per day . In many cases in actual practice, it has beon two hours pe r day .
(2) Cas os with old healed primary scars, and ~e rsons who have had childhood tuberculosis are not considered el i gible for service under the pr ogr am , unl e ss ther~ is a r e sidual impa i r ment which causes a vocational handicap . Any cli ent 'lho has had moderately advanced tub8r culosis and has r ea ched the arr e sted stage is considered eligibl e for service , provided the physician in charge of the cas e gives his approval for the vocational r ehabil itation program to begin . Usually the physician will not gi ve this permission until the case has been arrested long enough to b e r easonably certain that exercise will not cause a r e curr nce of the disease. In most cases , the counselor would not start the actual training or ''JOrk progr am (other than cor r es pondence) b efor e the client has at least four hours 1 work tolerance per day ,
Cli0nts vnth tuberculo sis of the bone are elig ibl e when the disease has subsid0d sufficiently for the client to st art his r ohabili tation pr ot r am or ovi ded there is sufficient r e sidual disability to be an omploymont hrmdicap . Cases with T. B. of the bone whe r e the dis ease is still c ctive , .110.y b0 eligibl e for s ervice if the prognosis is good for r ocovury .
5 , 307 Orthopa dic Dis abiliti 0 ~
Any orthope dic 'mputr. tion , cong:mital abs ence , or defo rmity which limits the functi on suffici ently t o constitute a substant i al handicap to employment , is sufficient to rr~tke u p0rson 0ligibl e . The r e a r e many minor disabilities tha t do n ot constitut~ sufficient employment handic aps to be consider ed as making a person eligibl e fo r s ervice . Some of these are :
(a ) Absence or amputation of on~ or two fing ers when the r ema inder of the fingers and hand are not damaged.
(b) Absence or amputation of one , two , or thre e to e s when the f unct ion of the foot is not damage d.
(c) Slight hunch back when the st r ength is unimpair e d and flexion is r easonably good .
(d ) Slightly stiff arm when th3 str ~ ngth is normal and the flexion is not too r estricted.

5 . 307
( e) Ab sence of tha first jo int of three or four fingers when the r emainder of the finge rs e r e normal in function .
(f) A slightly crooked leg from fractur e but vmcr e str ~ngth is normal and fl exion is normal .
( g) A l eg ~ inch short .
The r e ar c many other examples , but the s e should give some ide a of the t ype conditi on which does not constitute eligibility .
Minor conditions which might make a client el igibl e ar e :
( a ) Abs en ce or amputation of threa or more fing ers. ( b ) Absence or amputation of four or mor e toes . (c) Abs ence or o.mput~, tion of the whol e thumb , or the giant toe
f ar enough back to limit function of hand or foot . (d) Parti al amput ation of the hand or foot t o such ext ent that normal
funct ion is conside r ably limite d . (e) lfe~kon ing of muscular tissue in arms or legs that restricts
functi on of normal movement.
The couns elor mus t avoid inte r preting a mino r impairment as constituting an employmvnt handicap unl e s s i t is a r eal impair ment of function .
5.308 Siz e and Wei ght
The r e ar c t wo conditions of siz e on which e ligibility mi ght be e stablished: i. e ., (1) midget and (2) ob ~ sity .
(1) Midget . In det er mining eligibility on siz a , a gr oat daal wil l de pend on the pe r s onality of the individual . As a general rul e , the counsel or should not consider shortness of statue an employment handicap if the person is at l east 52 inches t all; he should not conside r a pers on eligibl e for smallne ss of si ze if he weighs more than 70 pounds .
(2) Obe sity . Many pe opl e ar e ove rwe ight b e cause of ove reating , and tho we ight could be controll e d if they would di et . Su ch cas e s should not be c onsider e d e ligibl e for r ehabilitati on s e rvic e c::ven tho ugh the ir excessive weight is a vocati onal handicap . Some peopl e with glandula r trouble become so exce ssively ovon\'o i ght that they ar e considerably handicap ue d for employment and dj ot i ng alon0 ~ill not corr e ct the condition. Some of the s e cas e s may b e COl~ s i:lor ..: d dl ig ibl e for s ervice. It is difficult to fix a weight and siz e li:nit that will do justice to all cas e s . As a gene ral rul e , a person who woi ghs 100 pounds or mo r e abov~ normal vreight for his age an d height a ccordi ng t o t ho U. S . Dopartmunt of Health chart, may be considere d eligibl e on the ba sis of obe sity, other f a ctors be ing s atis factory . Tho couns elor should be cons ervative in accepting p~ opl e as eli gi bl e on the basis of statue and we ight . Y:hen they ar e acce pted there should be r eal 0vidence that statue or weight has been the cause of their failur e to s e cur e employmant .
5 . 309 Mental Dis abilitie s
The r e a r e t wo type s of mental def e cts that may make a pe rson eligibl e for r ehabil it a tion s ervice : (1) emotional disturbance s of various kinds , and (2) mental de fici ency . Most of the clients ac cepte d for r ehabilit~tion s e rvic e s will b e in the first group .

5 . 3091
5,3091 Emoti onal Disturb an ce s
In ca s >J s whe r e tho psychiatrist shows in his r e port that the individual ha s some t ;y-pe of mental disorder, the couns elor will study all factors to de t e r mine if the condition constitute s a substanti al handicap. (S ee Suct i on 8 . 251 5 of this Manual) .
5 . 3092 Mentel De fici en cy
Cl i ent s vr ith ment al de fici ency a r c eligibl e unde r the law and may be serve d . !hen on " is a cce pte d, he should be t e sted by a psychologist and e li gibility shoul d b0 ba s ed on his r eport. A pe rson with an I . Q. of l ess than 40 sho uld usua l ly be consider e d non- f aasibl e for training . A cl it:mt with an I . Q. of bet wean 40 and 70 may be eli gibl e for s e rvice and mi ght be t r a i ned for s ome r outine j ob .
5 . 310 He rnia Disabiliti e s
The couns elor should b e cons e rvative in accepting a cas e with he rnia for r e hab ilitation s er vice . If tho herni a has not r eache d the stage wher e a ct i vity is limited s eve r e ly, i t ~~ll not be conside r e d an employment handicap . A person \tith a hernia ~Qll not be consider e d eligibl e unl e ss it can be shom that he ha s been r e fus e d employme nt or is unabl e to cont i nue employment on the ba sis of his he rnia and that if the condition is corre cte d ho can r smain or be plac ed in employment .
5 . 311 Fa ci al De formiti e s
~l i g ibility on t he ba sis of f a cial deformiti e s will be dete rmine d by the extent to which the c L~ un t is handicap'Jed in s e curing suitabl e employment . I f such f a ci al de formiti e s can b e shown as the caus e for the client not s e cur ing cmployr.10nt, the cli ent may b e consider ed eligibl e . Usually a ca se ;ri ll not b0 accept J d for s e rvic e for cosmetic purp oses only . The condit ion must be t he ba si s of an employment handic a p or for an emotional conditi on whi ch may r e sult in mal a djustment of the individual. Facial de formi t i e s which caus e s pe e ch def e cts se ve r e enough to bo an employment handic ap may constitute eligibility .
5 . 312 ~lo gi c al Di s orde rs
Kidney and bl a dde r di s orde r s ar '"' of t en t he caus e of an employment handicap , e spe cially in older peopl e . I n t he se ca se s it is difficult to di stinguish bet ween t hos e which a r c t ho r e sponsibil i ty of gen er al medi cal pructice and thos .:J wh ich shoul d b "' a c cepte d for r ehabilitation s e rvic e . The couns elor must be con s e rvc.tive i n a cce pting these ca s e s. The couns elor coul d spend a largo part of h is monvy in di a gnosing ca s e s of this ty pe which do not come unde r the provisi ons of t ho l aw, and he should be cons ervative in autho ri zing di ugnostic examinations un t il he consults th ~ f amily physician to get his opinion of tho disorder . Many of thes e ca s ; s can be r e j e cte d by the couns elor without diagnosis unl e s s he i s c onvinc~ d t hat the disability is r easonably permanent and of such nature t hat the cl ient is eligibl e f or service by our agency .
'i~ho r e the r e a r e many exc options which th e couns el or can just i fy, usually he should not a ccept ca s e s with urological prob lems which a r e of l e ss duration th an s ix months. He can simply t ell the client that we do not pr ovide gene r al mGdic al car e , but t hat when his family physician t e lls him nothing short of surg3ry or major tr eatment can relieve his condition, DVR vtill then consider det ermining his eligibility.

5.313
5 . 313 Famal e Disorde rs
The couns e l or could s pend his e nti r e a l lotm ~t of f unds on cas e s with f emc.le disorde rs i f the physici ans in his ar - e. we r 0 to s end him all C2.scs in nee d of this type of s e rvic e . Th e co uns e lor mus t , in or da r to hn v e a b al c.nc o d ca s e lond , l earn to s e lect these ca s e s c are fully and cons ervatively.
One crit e rion he mi ght use to r educe the percentage of gyne colo gica l case s is n ot t o con 3ider for ucc0ptnnco a cas e unl e ss th a disabi l ity has been pre s ent ic six months or longer. Another crit or ion might b-J not to di ar;-.c.s.; client suspected of hav ing a female disoY cJ~, ~
unt"i.l t :-. f<',,1.:.ly phy ic ian hils told her the nly solution f or h'-'r
di sc.b il ::.-~y is ~ lrge-1-y .
F 1r.o.l di.s orders sho 1ld not b u ruled out us the r espon si bili ty of our a e;ency , but solr.t3 limitat i on must be us od t o hold do wn tho per cent a ge of thu so v:-.~o~ d ; cl".r ad eligible t o not mor e tho.n 20% of the ph:v-d c e. l r 0 st o! .:.,:~o-~ t:.as~.:s . 'JhJ c ouns lor shoul d devt3lop such r ele.tions;tLp s
with hi;:; L. ~)-~ .me thnt thoy will und0 rst c.nd that ,.ro c annot a cc J pt
a ll f om:,.l .; -~Lscr do rs t hat n ov d me dic c.l car or s ur ge ry .
5.314 Arthr itic Di~G r do r s
An i n cli v-i (~ ual v;ho is di sabl e d by a rth ritis is el i gibl e for r ehabil i t ati on servicv ~he n his phy s ica l condition i s r e as onably static. The agency do \; s not a ss umo r e s p onsibi l ity fo r the gen e r a l me dica l care of tho a rthritic pati ent .
The cli ent wit h a rt hritis that ma y have s ome activity but which the sp e ci a li s ts f e d may b e gr oatly i mp r ov J d by me di cati on V'r.i. t l.-.in a r e asonabl e l ength of time , may b <J de cl a r e d .;:ligiblc . Cas e s wh e r e the physi cian me r e ly state s that the cliont ha s a r t hr itis , wh i ch i s usua lly of a dogen orat c natur o P s hould not b e c ons i de r ed el i g~bJ.e frr r e hab i litation s orvic e . In cas e s of doubt , th e me dic a l con st;l tant s ho uld be a skod to r e view the r .;port and a dvis e c.s to t h e pr ogn osis.

6.0
6,0 CASE DIAGNOSIS
6.1 Responsibility for Diagnosis
The counselor is responsible for making a diagnosis of each case within established policies, before authorizing any service for the individual. The diagnosis vrill be based on all factors which might help or hinder the progress of the rehabilitation program, and will include such items as: physical, vocational, economic, social, personality, aptitudes, interests, family situation, and available resources. Part of this data will be collected by the counselor and part will be purchased from other sources.
Before the counselor authorizes any purchased service he must see the client hiE1self or, if this is impractical, the client must be seen by another counselor designated by the counselor who is to serve the case. In any event, the client must be seen by the counselor and the responsibility for authorizing purchased services is not to be delegated to the secretary.
6.2 The Use of 3pocialized Services
Often valuable info!'lilation can be secured from other agencies with which the client has rod previous contact. If the client has been served by another abency, it will be well for the counselor to contact the agency and learn what had been done for the client and how he cooperated in receiving the service. If a written report cannot be secured, the counselor can talk "With personnel of the other agency and learn their success in working vdth the client. The Social Service Exchange, in cities where it exists, should be used in investigating a client who may have been seen by another agency.
If a client has been previously treated for his disability by a private physician or a clinic, the report should be secured, if possible, and the information used in the evaluation of his present circumstances.
The counselor may purchase psychological testing service from a private or a public facility if he thinks more testing is needed than battery of tests provided by the agency.
As a counselor collects his data, he should write it in the case history so that it may be reviewed at the time he makes his diagnosis of the case; thus bringing tog~.;ther all data collected.
6.3 Eedical :!Jiagnosis
The presence of a physical or mental impairment will be established on the basis of medical reports purchased or secured from competent physicians. Theso reports vdll indicate the presence of the disability, the extent of involvement, the physical lir:litations it imposes on the individual, the pro~nosis for future development or limitations, and whether correction or substantial improvement is possible, and he will prescribe the services needed.
The counselor will be responsible for explaining to the examJ.m.ng physicians the purpose of the examination and the need for a full report, giving all the information the counselor will need in determining eligibility and in planning a program to meet the needs of the client.

6.3
In no case will an authorization for nedical examination be given until after the counselor has had at least one personal visit with the client and under no circumstances will the client be given ru1 authorization for medical examination unless the counselor is reasonably certain that the client will be served in the near future, (thirty to sixty days).
fhere there is any doubt as to whether cli3nt would meet economic need, and when the services apparently needed by client would require that economic need be met, no medical examination will be authorized for paJ~ent by the Division until economic need has been established,
A general medical examination will be secured in each case, and t-Jhere reasonably necessary to a decision in doubtful cases, a c'io.gnosis, if at all practical, will be secured fron1 a specialist in the specific field indicated by the general medical report. Prior to securing any mec'ic~l examinations to be paid for ty the Division, cour;selor should secure all medical information on client uhere he has been under treatment previousl;r b;)r a physician as well as any medical data from hospital, clinic, etc.
In all cases, the general meclical examination should include a urinalysis report, and in cases where physical restoration service is likely to be needed, a serologic test i'or syphilis must be included, If there is any reason to suspect that there might be a chest disability, the counselor will secure an ;;:-ray of the chest.
The counselor is responsible for determi11in~; the extent of diagnosis by specialists within established policies, based upon the recomnendations of the physician makins the general examination, \lhile there must be adequate medical diagnosis, the counselor should avoid authorizing needless examinations. As an example: a blind client with no vision in either eye and who has had previous examinations deten;d.nine; that no improvement can be e;::pectec.l, in the vision, eligibility may be determj_ned for service on the 'Qasis oi' the general medical report, provided it shOi-Is that the client is blind, Those examinations which are authorized should be done near enov.gh the tine the cli,~nt e:>-.'..])ects to enter service that they will not be out of date and need to be securec1 acain when the client starts to receive the service,
In the past vle have held to the provlSlOn oi' physical restoration service on the basis of a medical report not over three months old. In some instances, new medicals have been secured to conply vJith the 90 day limit, le are leaving it to the c:iscretion of the counselor nou to determine when new medicals are needed. ',Jhen the medical is more than three months old, he will either get a nevl medical or statement from the physician who is to do the surgery, stating that a new medical is not necessary. In lJost cases this will not be necessary since the first nedical should not be authorized that long before the service is to be initiated, Clients suffering with tuberculosis or cardiac involvement tvill be examined if the specialist's report is more than three months old before starting service, Clients "~<Tho apply ..:or their cases to be reopened a second or third time who are totally blind or c.'.e2.f and OJ' which there is a visual or hearing report secured at the time of previous services, maJr be served again after securing
only the general medical report. The old ncdical report will be placed in the
current file.
The various types of medical reports lrill be discussed unc~er the instructions for the use of forms,

6.4
6 .4 Vocational Diagnosis
In making the vocational di a gnosis , the counselor ~~11 use all data coll e cte d or purcha sed . This vvill include personal histo ry, f amily situation, social status , economic condition, personality t r aits, int :: r ~ sts , aptitude s, gene r nl level _ of inte lligence , wor k h i story and av:;.ilo.ble r es ources , as well a s tho physical 8-nd mental limito.tions .
The counselor will make a care ful investigation of the r eliability of tha client and should have in his case history, a statement giving tho r e sults of two investigations. The tests which the counselor may actn1inister as a part of his voc Gtional diagnosis are discussed in s e ct ions 8 . 22 and 8 . 23 . Ho may purcho.se other tests in c c.s e s who re he f oJls that additional tests are requir e d or where speci['..liz e d tests are no ode d t o ad,~ quc.tely diagnos e the client ' s situation .
The client will b e ass iste d in e valuating his own situation on tho b as is of fa ct o -wh ich havo bee n collected. The choice of a suitable ot.';jcctive may b :1!' 1 ' -~v od at join t ly by the client and counselo r on the bas is of thes e ft'c+:s, 'l'~..:: R'.ll' voy fo rm, the medic a l r e ports , and the case history, as W<:ll c.::: t~--- inf or m~tion the counselor has gathered f rom others, is the b e sis of: 1.r1king the diagnosis .

7.:
'!ov GUIDANCE AliD COUNSELING
7.1 General Statement
The success of the individual client in achieving his vocational objective depends to a large extent on the guidance and counseling he receives during his vocational diagnosis and during the preparation for the job. Guidance and counseling are among the major services which the agency provides. The counselor is responsible for providing this service to his clients.
It is during the period of guidance that the counselor assists the client in the evaluation of his abilities, aptitudes and opportunities. If this is done adequately the client will not try to prepare for a vocational objective which is beyond his reach. He is led to the type work in which he may hope for success and for which there will be a demand. It is during this period that the counselor and client analyze the requirements of various jobs and select one which best suits the assets of the client. It is during this period that the client is brought to realize that he has a great responsibility in making his program a success.
The counseling process will continue as needed until the case is closed as employed. There will be times during the preparatory period that problems must be solved and adjustments made to achieve best results, and these are the functions of the counselor when the client needs assistance.
7.2 The Selection of an Objective
Before the counselor provides any service other than diagnosis, he and the client should jointly select same suitable vocational objective consistent with the client's physical and mental condition and within the range of his abilities. The guidance process leads naturally into the selection of a suitable vocational objectiveo The client should be given as much freedom in discussing his interests and abilities as possible in making the choice, but he must be guided to an objective which he can expect to attain and in which he can hope to become an efficient worker.
Among the many factors that may influence the selection of a suitable vocational objective are the follmving most important ones:
1. The grades made by the client in high school, college or trades courses. 2. The work experience through which he may have developed skills.
3. Hobbies or avocational activities which indicate interest and ability.
4. Aptitudes as shown by appropriate intelligence or aptitude tests. 5. Availability of work in the vocational objective being considered.
6. Family or community situations that may affect achieving the objective.
In same cases where extensive physical restoration services are to be provided as part of the preparation, it may be difficult to select the specific objective before the physical restoration services are begun. Even in these cases, the counselor must have diagnosed the case sufficiently to at least select some type of work in which he thinks the client may be rehabilitated. There must be a job objective written on every plan. If the amount of recovery is not sufficient to reach one type work in the broad field first selected, then he may be able to enter another in the same field.

7.2
The counselor must constantly keep in mind that the objective of the rehabilitation agency is to return the individual to employment. The counselor should not refuse to serve the severely disabled people who can be made employable, but even with the severely disabled he must be able to believe that at the end of his services the client will be able to enter some vocation.
7.3 Techniques or Methods of Guidance
The approach the counselor uses in working with the handicapped individual often determines the amount of cooperation he will receive from the client. He cannot drive the client into a vocational objective and expect much cooperation. The approach should be made on the level with the client. Confidence of the client in the counselor must be established. Often the first interview means more to the success of the program than any other interview. The approach must be that of a friend offering assistance. The interviews should not be hurried, and the client must be given time to discuss fully what he thinks his problems are. There are too many methods and techniques of guidance for discussion here. Most counselors have had instructions about interviewingo It is wise for the counselor to have available several books on guidance, counseling, and interviewing and review them frequently in an effort to improve on his technique in working with his clients. The counselor cannot establish a pattern that he can use on all clients. One approach Will work better on one client than another. The counselor must know human nature. He must be tactful, have a sense of humor, and a great deal of patience. He deals with all kinds of people and with a wide variety of problems.
7.4 Results of Counseling and Guidance
The end result of good guidance and counseling should be a well adjusted suitably employed, happy individual. If the counselor has succeeded in getting the client to properly evaluate his own situation, including his aptitudes, abilities, and opportunities; if he has succeeded in getting full cooperation of the client; if he has given careful supervision of the preparatory services assisting the client at every point where problems arise that might interrupt service; and if the proper preparatory facility has been selected, the program in most cases will be a success.

v.)u
8.0 THE PROVISION OF SERVICE3
It is the responsibility of the counselor to see that such services as are needed to prepare the client for his vocat.i.onal ohje'.:t.ive, consi ~..13.nt with provisions of the law, are provided the client. Some of these are provided by the agency but many of them must be purchased from approved facilities.
8.1 Services Provided by the Agency
8.11 Investigation
The counselor is responsible for investigating every case which is referred to the agency that appears may be eligible or need service. The investigation snuuld be mad9 as soon after referral as possible.
8.12 Vocational Diagnosis
The counselor is responsible for making a vocational diagnosis of every case accepted for service. This is discussed in Section 6.0.
8.13 Counseling and Guidance
The counselor is responsible for providing counseling and guidance, This is discussed in Section ?.O.
8.14 Authorized Services
The counselor is responsible for making necessary arrangements for all services and will authorize those which are to be purchased,
8.15 Supervision
There are two types of supervlslon that need some discussion in the manual: 1. Supervision of the client provided by the counselor. 2. Supervision of the counselor provided by the district supervisor. The first of these is the one that belongs in this section 11 The Provision of Services". The other will be discussed only briefly.
8.151 Supervision Provided ?Y the Counselor
The quality of the work done by a counselor can be judged to a great extent by his record of supervision. If he does not provide adequate supervision he will not have much record of his work with the client. If he has a good record it will show what he did for the client in the way of helping him to achieve his vocational objective. The case history is the place to record all his supervision of the case, as well as his study and diagnosis of the case, to arrive at the proper objective. The case history should begin the day the client is referred and be added to every time something is done for the client or in his behalf.
Problems often arise in the process of recelVlng physical restoration service, during t.::aining periods, in securing emp:.')jiDent, or even after the client is placed, that call for assistance from the counselor to keep the program from failing or to make it more effective. It is the counselor's responsibility to either provide the necessary service or to see that it is provided by some other capable peroon The problems are so num.berous :'1
that

8.151
they will not be discussed here, but a few are mentioned to give a brief idea of some of the things which may be involved or accomplished by the proper supervision.
(a) The hospital appointment may be changed at the last minute and new arrangements must be made.
(b) The client finds that his arrangement for going to the facility does not materialize.
(c) The physician may find that the client is not ready for surgery after he enters the hospital and there will be some treatment and a waiting period necessaryD
(d) The client's boarding arrangement may collapse and new arrangements must be made.
(e) The client's disability may become worse and attention needed to prevent collapse of the program.
(f) The arrangements with the service facility may need some adjustment. (g) The client may have some social problem that if not solved may result
in failure of the program. (h) There may be some family problem that will upset the plans of the
client and some adjustment must be found necessary. (i) The client may be found to be eccentric or non-cooperative with the
sorvico facility and need some good counseling to help him adjust to his situatione (j) The client may become discouraged and need some good guidance to restore his confidence in hlinself and his service facility. (k) The employment training facility may be found to be exploiting tho client and not carrying out the program designed. (l) The client may fail to make satisfactory grades and a chango in the program become necessary. (m) The appliance purchased may need some adjustment and the counselor may need to see that the company is notified and proper adjustment made. (n) Tho client may accept part time employment and neglect his training, and tho counselor may neod to step in and get the client back into full time training.
All the above ar.d many other probloms show the need for frequent contact with the client during the process of his rehabilitation program.
VJhon the counselor sonds a client outside his immediate ar0a for a service of any kind, he should first communicate with the counselor serving the area vrhere the service is to be received and make necessary arrangements for supervision of the cast.:~ vrhile out of his area. In doing this, he must give the counselor, vrho is to supervise tho client, sufficient information about the case to enable hlin to intelligently provide supervision.
8.152 Supervision by the District Supervisor
The District Supervisor is responsible for the operation of the program in his district and has full authority to ask tho counselor to make such adjustments in his work that he can get better results. He is responsible for seeing that the couns8lor conforms to regulations and to policies adopted by the state agency for the oparation of the program. To do this he will make such studies as are necessary to evaluate the counselor's work .. When he finds that tho counselor is not conforming to policy and is authorizing services not permitted under policy, it is his responsibility to ask that the authorization be revoked.

8 .16 8.17

8 . 152
The district supervisor also has the responsibility for advising the counse lor in his work with s evar ely disabled or probl em case s and a ssisting him i n finding suitabl e vocational obje ctive s and s e curing pr ope r se rvic es . He will make fi el d trips with the couns elor to help ~~th i ndi vi dual ca ses , as nee de d by the counse lor.
Pl acement
Cl ients , who upon be ing i nte r vie;ved, ar e found to b e in ne e d of services othor than di rect placement . should be accepted by counselor, if evidence ind~ cdo s th;~t it wili take counselling to sati sfactorily fl cljust this i nd:;.vidual on a job .
Foll o~... ~~ , Survi. ce
Th3 co'J.."l.selo is r ~ sponsibla for providing fol low- up service to ass ist tho c1 jctt with probl ems of ~-djustment and assure satisfactory job pl ac.; ,;.r --:J t; ,

Many of t:1 s ~c- !' V.!.0C'S a r e pu rcha sed from appr ove d facilities . The counselor makes all arrangements t:.nd autho riz es the purchased services. The fol lowing arG the principal s ervices which a r e purchas e d :
8 . 21 Medical Exami nations:
l.ledical examinations to deter mine eli gibility, feasibility, and what corr octi ve procedures may b e us e d to corre ct or r emove the disability are purcha s ed . The f amily physician, or any r eputable licens e d M. D. may be u sed for this examination . vihen it ap oears likely that medical treatment or surgery may b e done by a general surgeon, the counselor should have him make the genor al medical diagnosis to avoid the exp ense of two examinations. The coun selor is expe cte d to have the client examin e d by the physician who is to do the surgery be for e authorizing it . The counse lor vnll authorize surgery only by physicians who a r e on the appr oved list .
Vfuen the physician mak i ng the general medical examination r e commends that thv client be examined by a spe cialist, the counselor will follow the advic e or giv;:J in his case his t ory a good r ea son for not doing so . In ca s s whe r e ..; lig;5~-: ' lity is to be det er mine d on a spe cific disability such as : visunl , he . ring , et c., the c ouns elor will s e cur e the s pe cialists exami nation in 2dJ.ition to the gener al medical report.
The couns 3lor will b e expecte d to s e cur e all the examinations necessary for adequat e diagnosi s of his client but must r e fr ain from authorizing ne edless examinations . '\h.fhe r e r ecent examinations have b een made by compet ent physicians , the counselor may se cur e r eports from these examinati ons . Wnen r e cent treatment has bedn provided, the counselor may obtain good i nformation by t alking to the phys ician who pr ovided the treatment, and thus l earn that a dditional specialist examinations ar e not necessary.

8.22 Psychological Examinations

8.22

The couns.:lor hc.s bGon pr'Ovided with several tests which he will uso vrith his cl L:nts ~ especially on tro.ining, cases. There will bo some difficult cases when, he may foel that he needs mort:J coJ.~prchonsive testing service than he is prvpared to c.drr.inister to his client. In these cases ths coun;,olor will purchc.sv this s~rvico from approved testing facilities. It may bo secured from ;;rivate psycholoe;ioal centers, the psychological department in standard colleg0s or universities, from Veturans Guidance Ccntc,rs, or othGr public agencies. No ca:oc '.'rill bo s,:;rved on tho basis of IT1ontal dGficioncy until eligibility hE.s bGen det.:o:rmined as a result of psycho~ogica.l tests. These will usually bo purch[;sod as the t0sts provided tho counsalors aro net as ,,~ll dosigned for this purpose as th.;y are for tusting persons with higher m~ntc:.l intelligence.

Tho counselor is oxpectod to test c.ll clients he places in training for
thr8o months or more, or to secure adequate test results from high schools or colleg0s whore tho client has recaiv~d testing s~rvico. ThorG r;,ight bG ~ few exceptions to this requirom,-mt in sp.:;cial objecti vos whor0 tests do not provide a b~sis for determining uptitude or abilities needed in th0 pr:.rticul8.r objuctivo. NhGn it is not provided, tho counselor should discuss in his case history his r~ason for not administering tests bvford storting training.

Evory counselor is axpact0d to bo able to administer and interpret the first six tests lis tad bGloN. Suppl0montary tests are 1 ist.;d in Section 8.23, which the counselor m~y usc to supplom0nt the six if he so desires to use oth8r tests, which in some cases may be more uppropriute than on8 of the first six listed. Th6 following tests have been provided f.J.ll counselors for US) in their t ..:;sting program.

8.221 Kudar Fraferonc~ Rocord

Tr.is test is designed to help determine thJ U?Dlic>,nt's interE>st in nine different fidds. It may b<2 usod vdth a client having a seventh grade education or b<:ttor V\tlon th'J cli.:::nt docs not h2,va <~ suitable vocational objective und0r conside;;re.tior.. It mc.y also be ussd with a client to Gonfirm th0 obj,;:ctive which ho is consid0ring or ht.s expressed a desire to seloct. It does not m3~surJ aptitude but shows only his interest in one or more of the broad fblds for whic.h it is designed.

8.222 M;;;chcnical Conpr.;;honsion F'orr1 J:..A, Goorg,e K. B~:mnett

This test is suitabl0 for us::; with high school students or adults v:i th
comparo..bla education. Tho test mc.y be used to detc;rmine the aptitude of porsons desiring training in mechanical tr~dos such as: olectricity,
plumbing, r0frigeration, radio, auto mochunics, etc. Clients making a
score of less the.n th0 30th percentile as compared vdth persons working :i.h those fields sh~:..llJ nu(j ' - ""T1Sidered for training. Those making scor0s b01-v~"- ~.1: \:,1!';:1 jl.1th and 50th porct."n-t~,., TT-.i.f!ht b;.; considered for semi-skil.lvd jobs. Those making scores abovG tho ~"h ~'"''"'"'Atltile r:,ay be ..-:;onsidered for training for skillod jobs.

8.223
8.223 Minn;;sota Medu:.nicc.l Assembly, Box A
This test is used for d0termining mechc..nicc.l aptitude in the o.ssambly of small mechs.nicd c.ppr~ratus. It may be used with clients having less than high school 0ducation, :..:.s nell as those who have completed high school. It m~y bo given to clients desiring training in auto mechanics, radio, refrigeration, electrical work, bicycle repair, nnd similar fields. A score of 70 or better should be required for higher skilled workorso A scor0 of 56 or bettar should be mc.de by any p.:;rson desiring trcdning in the mocho.nico.l field. The time requirement must be 8.dhored to strictly if the tost scores are to be considered valid.
8.224 Gancrul Clericc..l Test by the Psychological Corporc..tion
This test has boen designed as a general and differ ..mtial test for use v;ith all types of ch;rical v:orkers. It provides for section scores which cover respectively: (a) routine clerical aptitude; (b) proficiency in mathematics; (c) v0rbc.l fucility. Thcso may be used by the counselor singly or in combinc.tion to nppro.isE: th-'! practicability of tha cliont traininG for cc given job,
It is r8com.:1<.mdud th.a.t this teBt b9 giv0n to ovr:.ry client who may desire to taku cL.:ric9.l tr<: inin; '-'lith aid from thG divisicn. Th3 score may be conpo::.rvd v;i th the locc.l norlf1S from businoss schools or from groups working, in clericc.l fi.;lds, a:::1:i c. ducision rJ!;;.Chod on tho bc,sis of this compc.rison indic~ting possibl3 succ0ss.
The munuc.l rovi:::ed in 1950 should be studiod cc.rGfully so that proper intor"!_)ret::;.tion j,1n.y be made of tho r..:sul ts e.nd thJ counselor will be onn.blod to a.dminist3r tho t~st r.ccuro.tely.
8.225 Psychological TGst for Colbc:c; Fre:?hm..::n - Am::rican ~ouncil_~ ~d~1~:tion
A lo.rgo nwrib-.:r of tha coll0g3s usc this test for plac..::m..;nt of their freshmen upon ;;:ntn.nce. It is, thcrefore 1 useful in dut-3rmining how the client will rc.nk with stud:mt s Jnt-'!ring vt~r ious collGgcs.
This test can be us::~d. for cl :i.ents desiring to .:mt.:'r college c..ncl tho test ro3ult com"?c.red with th:; pe.rticuL:. r college ncrms to holp pr0dict succe:;s of tho client. It is urad to appr~iso schol~stic uptitud~ or general intJlligonco with sp0cicl rafcronco to most coll0ge curricul&. The examination is groupad into two genorsl clc.sscs: (a) Quc.ntative - tho Q score, and (b) Linguistic - the L score, with thraa separate tests under each class. It is not reco:mn::nd0d thut th0 counnclor usc thv six seourato test scorJs for counselling, but, preferably, h;.; should us..; tho tv10 principe.l subscor.:;s as wd 1 . s th0 total s coro.
Th:::. counsGlors he.v0 b0an sup~l iod w:i th norms for s.;verc.l of tho collGges :::.nd thGso should b<J us;1d in 0valuation of the results.

8.226
8.226 1F'ochslor-Bdlevuo Intoll igence Test
This is orobably tho most oxcollant test for determining th3 I.Q. of a client and is used probably ~'s much as any tost in tho country by psychologists. In many instc.nces, it is not necessary to administer mor,J than th.a first half of the t.;.;st, but in unusual or exceptional casJs tho entire test should be given. The verbal part of this test is -~xc <llunt for us.; with blind clients. It is r:1thcr difficult to a.cLinistor and to interpret and should not be givun by a ?Orson not thorou~:hly fo.miliar with the c.dministration c.nd interpretation. It must ),; ~1.,-t"ainistorc-d to all blind clLmts who ara a.ided in college 2-nd it is r,)cO~lhmdocl thc.t it bo administered to all blind clients placed :in tr:.h.ing for c. lon; ':lerlod of time.
8.23 Optional Tosts ~.hich I!:~y be Used
Some of tho couns~lors may ~nnt to uso other tests formerly used by th..; c.goncy in confirming results of one of th0 above test scores for a cl iont. A supply of thuse hc.v0 bo .m furnished each office. They ma:y be used to confirm results or ~s a substitute of one of the above in its appropriate fivld. Those optional tests are listed with brief cornm~..nt. Sho11ld they bo us0d, thJ scores should be compared to norms vri th c.ppropriate groups of individuals.
8.231 Otis Intelligence Test, Form A or Form B
This test is suitable for cli(.;nts -,fi th high school education :::md it muy bo us;.;d to dotormin0 th.s gcn..;ro.l level of intdligence. It may be used to confirm the results or to substitute for tho A.C.E. test, or as a substitute in unusual circQ~stnncos.
8.232 Minnesota Vocational Test for Clerical Workers
This is a simpl0 clericr.l test vihich tests only two fo.ctors: (u) aptitude with numb~rs, r:.nd (b) aptitude v,ith spelling or rocognition of errors in letters.
8.233 Perdue ?ogbo~rd Tost
This is o. short, siD~JL; t._:st on finger and hand munipula.tions and coordination. I t m~ y LL; us_ d to tust o.pti tudo when rc.pid assembly of small obj Jets is invc)lv d, or th.: vrrc.pping c.nd ty ing of small packo.ges is required. 'l'hh: t.:si: ~~s v-'ry o.d,.ptc.blu for usc with blind clients.
8.234 Johnson O'Connor Finger Dextority Test
This is o. short t0st unod to doturmino hc.nd &nd finger dexterity and coordination. It is oasy to administer and the scores can be related to norms in hol~)ing to predict success in work requiring hand and finger dexterity.
a.Z35 Johnson O'Connor Tvroozer Dexterity Tost
This is a short test similar to tho finger dexterity except twoozers are used to place the pins in th0 holes instead of tho fingers. It is good to determine aptitude when small urticlcs are to be assembled by the uso of small tools such as in watch repair. It is probably better than the Box A for usa in determining dexterity required in watch repair.

8.236

!},~

8 . 236 Revis od Beta Exnmino.tion

"

This is a. non-vGrbnl inte lligence test which may be us 0d to determine

genor ~l l evel of intelligence of pe rsons who do not read woll .

8 . 237 Th0 Adj ustm~ nt I nventory, Adult Form, by Hugh M. Bell

This t est may be used to help evaluate ~e rsonality probl ems in some c ~t cg ories . It is designed to meusure the a djustment in hom~ , health, emotional , occupational, and soci a l fields . Total scores may be us ed to indicate gener al adjustment and particular scores will indicate probl oms in cert ain fields . It may be used to some advantage in some of th.. mvnto.l cases serve d . This tost is very adaptable for usc with blind cli0nts.

8.24 Trc.i ni ng

Tr ~ ining takes tim ' of the client and is expens ive in cost to the division . The couns elor should study ea ch cas e care fully to avoid failur es in his training cases . As a gunu r al rul e , t e sts should be administer ed to all training c ~ scs . The only exception would b e for short br eak-in training on th job, or in some objective such that the test r osults would give no indico.ti on of succe ss in the obj e ctive.

For all school tta ).ning ca s 0s th '"' counselor should s e cure for his file a tr o.nscript of pr evious high school or college gr ades . If the client had pr evious trade tr a ining the r vsults of this should be shown in the cas e data or o. copy of thJ gra des mado should be s e cur ed when possible .

For all busine ss coll e go tr~ining c ~ ses the couns elor should administe r a cl erical aptitudo test and usc tho r esults in his evaluation and sol oction of an obj ctive .

For clients who arc to vntor coll egv , the couns elor must administer an intel ligence or coll ege ~ptitude t e st or s Gcure test r esults from the school or othvr source . The American Council on Education Psychological Te st for coll e ge freshmen is probably the best one since nor ms for many of tho colleges a r e now availabl e . The Otis Intell igence Test, Forms A and B, ar u good for obtaining the I. Q. on the individual.

A counselor should not send any cl i ent to a tra de school without first adrninist 0ring mochcmic,,l aptitude t e sts if r el iable t es t r e sults a r e not alr e~ dy avc, i l o. ul~ on tho client .

Such factor s a s how the client applied hims elf to his work in school ; how much is h0 intvr est ed in ent oring tra i ning; what effect will sending him aw.::.y from home have on his applicati on to his training; can he get along with peo _, l e ; a nd docs he h~.ve personality traits that may a ff e ct his suc cv ss in training , will all bu considered in the evaluation of the client . Te st r osults ar e on ' of the fac t ors . When t e st r e sults are unfavorable the other factors must be shown to outweigh the t est r e sults before trying to justify placing tho client in tr o.ining.

8.2401 Standards for Trainj_ng Facilities
ThJ agency :naintains a list of training institutions frequently used and provides each counselor and district supervisor viith a loose leaf notebook for filing sheets giving information about the length of courses, cost of sorvices, entrance requirements, and other necessary information, to assist tho counselor in writing his plan and making ne:cessary arrangements. As new training facilities are approved they are added to the list. Accredited schools and colleges aro used. Before an institution is used for college training, it must be recognized by tho Certification Division of tho Georgia State Department of Education. Private trade schools are placed on tho approved list when the agency finds that thoy have adequate facilities and are doing a good job in their ~articular field of training. Employment training establishments arJ thoroughly investigated before authorizing training in them.
8o2402 Prcforonco Given to Public Institutions
State, county or city operated schools and colleges are given preference when thoy aro accr~Jdi ted. Tho agency will pay full tuition and other foes charGed all students at these schools.
8.2403 I'rivat;; and n,mominational Schools
If a cliont he.s a valid reason for attending a private or denominational school, th.: counsc::lor should give tho reason in his caso history and authorize the sorvico. Thu agency vrill pay full tuition for private and denominational schools located nithin the state. In addition to tuition, foes charged all studunts at those schools may bo paid.
8.2404 Out-of-State Schools
Pruformco will bo given to training institutions within the statoo Supervision is 1nor0 satisfactory as there is a counselor serving the area whore the school is located, and he can call by thu school frequently and check on each client at the institution. Unless an institution is known to be satisfactory, h.Jfore authorizing the service, the agency in the state whore tho institution is located will be contacted to see if it is usod by that ag.:mcy, when an out-of-state facility is used, the ag,mcy will pay tho full amot::.nt of tuition for clients at their state supported schools, and nill pay up to but not exceeding
$)00.00 per yoar (3 quarters or 2 semesters) for tuition at private and
denominational schools. Foes charged all students may be paid by the agency in addition to the tuition. Hovmver, preference should be given to Georgia schools ';rh8n the typll of training is available. If there is a justifiable reason for using an out-of-state facility, tho counselor should give the reason in his case history and authorize tho service.

8.2405 Business College Training
~1ost business colleges which have operated long enough to prove that they are satisfactory are placed on the approved list and used if a client selects the college, Host clients are given either the stenographic or secretarial course, and the agency avoids providing the lqng courses except with unusually capable or worthy clients. The agency pays the current rates in these schools, usually that set up for training veterans,
8.2406 Colleges or Universities
Clients accepted for college training shou[d be rather carefully seledted to prevent failures. Appropriate tests should be administered to each applicant and these should be evaluated in helping to detenr.ine the vocational objective.
With the exception of courses in medicine, dentistry, and veterinary medicine, four years will be the limit which the division vrill aid a client. If the client selects medicine, dentistry, or veterinary medicine as a vocational objective and vdll sign a statement to the effect that he will practice in rural county in Georgia of not over 20,000 population according to the latest ceusus for the first five years of his practice, the division may provide aid for the pre-vocational and vocational training. In the event the student does not sign the statement, only four years of aid will be provided. ne may elect which four years he preferso
In the objectives of law and ministry, the client will be allowed to select which four years the division will provide aid, It will not be the policy to provide graduate trainj_ng for a client in any other objective than those listed above, Exception; In the case of blind students who are preparing for law, ministry, social work and teaching, and other professions where five years of college training will be to advantage, the fifth year may be supplied to the client, In each case, the Supervisor of Services for the Blind will meet and study each case personally and shall have full authority to decide whether the fifth year of training will be furnished, Those receiving the special consideration for training must have, at the time the additional training is authorized, a visual acuity of 20/200 or less; with best correction.
8.2407 State Trade Schools
The agency makes frequent use of the state trade schools located at Clarkesville and Americus. All students sent to these schools should be given aptitude tests to help select stu:.:\ents who will be success!'ul. A rel:.abilitation counselor is located at each of these schools to e:.id in the supervision of clients while training.
Vfuen a counselor plans to send a client to one of these schools, he must send to the counselor at the school a copy of the survey, medical reports, and the chronological history to the t:Lne the client enters school. These will be available to school officials in case they are needed during the training period.

8.2407
Tho couns elor shoul d not s and the el i ont until the achool has notifie d him th0y will c..ccept the client. The counselor should also notify the couns elor at tho school the time the new client is expected to arrive and have thu ne ce s sary ca s e history and f orms a t the school when he arrive s. This wil l enabl e t he couns elor at tho school to bo of more a ssi st ance to tho cl i ent in making his adjustment to s chool routine.
Tho couns e l or at the school till supervis e the client whil e in tr aining an d mukc fr e quent r eports to the couns elor s erving the cas e on probl ems or pr ogr e s s of t he client. During the first week at t he school, the couns e lor should s ~0 the cli0nt thr ee or four times. During th e first month t h0 conta ct s should be at least weekl y. After the. t the contacts ne ed not be as f r e quent but he shoul d study ea ch monthly r eport of progr e s s, and if they are not satisfa ctory, he should interview the client in an eff ort to help him improve his progress.
8 . 240 8 Employment Tra ining
An empl oyment tra ining situation is one in which the client is le a rning under a n orm~:.l work situation wi th or v.rithout pay. Employment training by a reputable business establ i shment vho thoroughly understands the progra m end wil l t ake an intere st in the client is one of the best means of r e hab ilit ~ting cert a in clients. On the other hand, if the em ployment tr a iner is not intere sted, i t may be t he means he uses to get part of his l abo r cheaper by a cce pt ing our t u i ti on and not paying the tra inee a r ea sonabl e amount .
The counse lo r should s tudy e a ch empl oyment tra ining situation carefully an d us e onl y t hose e stab lishment s wher e he can expect cooperation in giving t he client goo d t r - i n ing r nt her than just making him a hel per t o one of the wo rkmen . Auto me ch::.ni c s, r a dio r epa ir, shoe r epa ir, refri ger o.t i on , \latch r epa i r, cabinet making a re good obj e ctives for the us e of empl oyment tr :lining.
In ~l l employment t r ~ ining s i t ua ti on s t he c oun selor mus t give clo s e supe r vi si on to t he cl ient . Ther e shoul d be a mut ua l unde r s to.nding befor e the t r a i ning be gi ns us to j u st 1!hat i s expecte d of t he t r ainer, the tra ine e and t he r ehabilitati on a gency . The necessity of monthly r eports and b i ll s be ing sent in f or tu i t i on end ~or sup?lies, i f they ar e required, should be c c~refull y expl c.ined t o t he t r ainer. Contra cts should be made and s i gned by t he tr c~ ine r c.n d t he c oun s elor before the training start s so ther e wil l be no mi sunderstanding a s to what the agreement is. Tra i ni ng she(l;t s wi: not be pro vide d fo r 0a-;!1 ompl oymen"'.:; t:- 9. i.n i r:g; agency. !he c~un s eler ~11 ~ssume respoa s i bi l i t y for eeiain~ waether the f acility is satisfa ctory a s a t r a i ni ng f acility.
The counselor should arr ange f or t r a in i ng on us e c onomic al a b a sis a s possible to be f air to the tra ine r and to the agen cy. In some objectives such c s 'Natch rep a ir, i t will be some time befor e the client can do much of va l ue for the tr ainer. In auto mech anics the cli ent will be ~f immediate value o. s a workman . The tuition r ates a nd the duration of the payments for tuiti on should be considered in the light of val ues receive d by e a ch - the tr ~ inee ~ nd the tr a iner. A sliding sca le of pay may be worked out i n s ome ca ses to s ave money for the agency. The counselor should consider $40 .00 per month as the maximum for employment tra ining and should not exceed t ha t amount without clearing it with his district supervi sor a s he may wish to cle ar it with the state office before authoriz a tion. The maximum ~~ll not necessarily be pa id in all cases.

8.2409 Correspondence Ttaining
The counselor should consider the use of correspondence training courses only in situations where the client cannot go for residence training. Correspondence courses should be arranged only with facilities which are reputable. The counselor should investigate very carefully all clients who desire this training as it often happens that the person training will be careless about completing the course.
When at all possible, the client should secure the aid of some local person who will agree to assist him with problems with which he needs assistance or with practice in doing the work if it is a mechanical trade. If this can be done the client is much more likely to sucr-eed and complete the course.
8.2410 Tutorial Training
With homeb01md cases the counselor may at times authorize tutorial training by purchasing the services of a local person capable of teaching a particular trade. It may also be arranged where speech training is needed, or when the client is taking correspondence work and some local person has agreed to devote certain hours each week in providing instruction to the individual. In all cases where tutorial training is authorized, the counselor should use the same care as in employment training. There should be a full understanding of what is expected of each party.
The counselor will arrange tutorial training at a reasonable rate, but any rate in excess of $3.00 per hour must be cleared by the district or central office. Often it will not be as much as $3.00 per hour.
8.2411 Training for Vending Stand Operators
The Georgia Cooperative Services for the Blind has a trainer who instructs blind clients in the methods of operating vending stands. The counsolor for tho blind should provide this training for each individual which he places as the operator of a vending stand. 1Jfnen it can be arranged, the client placed in a small business other than the controlled vending stand program would profit from such training before ho is established in the business enterprise.
The Division will pay the Georgia Cooperative Services for the Blind ~U.25 per hour for a forty-hotir week and for the maxi..rnum of three weeks training for mrrr vending stand operators vrhen the training is given in other than the trainc:r's resident city.
8. 2L~l2 I<taintEmance
When a cli1.mt is economically eligible and cannot tnako satisfactory arrangements for maintenance during training or while actually receiving physical restoration services, the counselor ~ay authorize tho payment of maintenance ':rhen client goes avray from his home: tovm for the service, other than collage training. An exception may bo made for payment of maintenance to clients receiving college training vrho are graduato s of the School for tho Blind and the School for the Doaf, and vrho meet economic need.

As a general rule, maintenance Yrill bo paid directly to the vendor upon submission of a bill shovring the period covered. In cases Yihere it is not possible to arrange for all the maintenance in this manner and l1mch money is needed by the client, the counsolor may arrange for payment of lunch money to the client.
The agency pays maintenance at the prevailing rates vrhore the client is receiving services. The counselor should be as conservative in authorizing maintenance as is consistent vrith the cliuntts receiving satisfactory sorvico. Tho shoots in tha tro.ining book givo an 0stimato of Hhat maintenJ.nce will cost for clients attending various training institutions. It may be necessary to deviate from these at timos if satisfactory arrangements cannot be made at tho prices listed. Often the counselor may secure maintanance at a lmmr rate than is listJd or it may bll fmmd that because of unusual circumstances (need for special diet, etc.) tho amount may need to be increased.
Tho counselor must keep a careful record of bills approved for
payment of maintenance and list on tho Fonn R-4 the exact period
of time cover.:.:d so that correct payme:nts Hill b-:; made.
Vfusn a client of tho division is sent avray from home for training and is receiving maintonancu and satisfactory arro.ng~JmC:nts cannot be made by the counselor for tho client or his family to furnish as much as 03.00 per vreok for incidc;ntal expenses, tho coun:].Jlor may authorize the pa;;monts not to exceed ~~3.00 per v;t::ck for this purpose. The collage trainees Gligiblo for maintenance under this eoction are eligible for tho $3.00 por vroek incidcmtal oxpc:nsos. Tho couns<.::lor or pe;rson supervising the client niJ.l make nocessary arrangements for th..:; payment either directly to tho client or by the maintGnance vendor. 'This should bo advanced oithor .-reokly or for two weeks at thG time.:.
,.;non a counsulor issues an authorization, it should indicate clearly r;hat is includod and thv amount for oach; such as, room, board, room and board, suppli~s, incidental expenses, otc.
~"'-
~~

8.21~D Tr:cnsport2.tion

8.2413

Jhen the client is economically eli:;ible, the counsr::lor may authorize tr,,rc;portation for the purpose of receiving services. Transportation ::a:~r be authorized for cliagnosis, fitting an n.ppliance, medical treatment or stU''"C :'~r, training and placement.

Transportation .. or diagnosis is reimbursable fror,1 federal funds 100~;. Diagnosis includes travel for medical examinations or psychological exQffiinations. This is classiiied as V-9, Vocational Guidance ,Service, and not as a case service. A plan is not necessary, but the counselor must place in his case history an explanation of the need for this service and the proper authorization.

Transportation for fitting an appliance, medical treatment and surgery or hospitalization and training are in tho sm~e category as a case service and must be set up on a plan and authorized as other services are before they arc
provided the client. These are reimbursable on a So% basis from federal funds.

Transportation for placement service r~ay be authorized under certain conditions, but the counselor should be very conservative in authorizing this service. i:Je do not pay transportation for a client to ~o to soM.e distant place to seek employuent. If the counselor has made special arrangements ~,rith the industrial placement specialist or other authorized personnel to place a client who has been trained for a specific vocation and for whom suitable employment canrtot be found in his home area; the placement specialist has sbxUed the qualifications of the client; and the placement specialist has a prospective job opening on whict he is reasonably sure he can place the client, he may Hrite the counselor to send the client. If the client cannot go for the interviel-1' ~-rith the placement speci<:1.list and the prospective employer Hithout financial assistance for the transportation, the counselor may set up a plan to provide the transportation anr authorize the service.

In cases of placement only when transportation must be provided for the client to report to the job, t!1is r,iay be authorized ty the counselor. 'l'his transportation .Lor placemer.t, uhen no other purchascri services are providecl, is reimbursable 100~ from federal funds. In most ;_r:stances, the counselor 1o1ill purchase the ticket for ths client rather than ,:;ive him a check or funds Hith which to m~ke the trip. He may, if absolutely necessary, include cost of hotel and meals for the client and cost of taxi fare if the use of a taxi is necessary in re2.ching the destination. illthouc;h transportation for diagncsis does not legally require establishing economic need, the counselor 1o1ill not pay transportation for a client who is able to pay i'or it himself.

8.21.<14 Eligibility For Training vlhen Impainnent is Correctable

A client whose disability is corrected by physical restoration to the extent that there are no residual effects will not be eligible for training unless there is sufficient evidence to indicate that the disability has substantially retarded or interferrcd with his previous training or progress touard a vocational objective. :.:.:ligi bility for rehabilitation services does not necessarily mean that client is eligible for coth physical restoration and training. If medical evidence indicates physical restoration v.rill correct the disability and the impairment in the past has in no way interferred ;:it~,
or L:peded his previous procress, nnd :if the client refuses surgery or treatment he will not 'oe cli~iblc for any service from the agency and the counselor should close the case as "Hot Interested''. This policy is to be effectnre
as of October 1, 1954 but not retroactive as to the completion of the re-
h[lbilita tion pror;:ram of n.ny clients who are now in training, and ~:itl:> full :in the ;cbove category.

8.25
8.25 PHYSICAL RESTORATION SERVICES
This is one of the two mQjor fields of service provided by the Division of Vocc.ti onal Rehabilit:J.tion . If a client requires only physical restorati on to make him employable , such s e rvice may b e provided whether or not vocati onal training is also requir ed, provided thr.t the client meets the other criteria for eligibility for physical restor c.tion.
Tho Fedar c.l Act cont a ins no limitation c.s to the types of physical rester a tjon se rvices with respe ct to vhich Feder al reimbursement mo.y be had, but in ste ~ d the limitations o.re expressed in terms of the condition to be tre o.ted . In ot he r words, care for acute illness is ruled out by the word 11 st atic" ~m d cur e for long term chronic cases is ruled out by the stipulation that the tr ea tment obj e ctive must be one which can be reached " within a r eason:1ble length of time" . Thus , if the condition,rege.rdless of its physi c".l or m.:mt c. l origin , is such that i ~ : ( l) is an impediment to the individual ' s occu ationo.l performanc e ; (2) is relatively stable ; (3) is amenabl e to tr aat me nt within a r e asonable length of time; and (4) doe s not require mor e than ninety (90) days' hospitalization, all the s ervic es and sup plies necessary for the ::t chievement of the r ehabil it ~tion of thQ indivi dual are within t he scope of Feder a l reimbursement.
The following service s shall be made availabl e in all cases in which they ar D necessary to the physic al r e stor ation objective: (a.) medical treatment; (b) specialist ' s service s in the fi el ds suitable to the specific me dical or sure;ic o.l "!_) rohl ems; (c ) nur sing services; (d) hos ~? italiz e.tion; ( e ) dentistry; (f) drugs and supplies; (h) prosthetic appliances.
8.2501 Me dic~l Tre Qtment
Medical treatment will be furnished only to clients whose disability can b e corre cted or improvvd .fithin a. r e~~ sona.ble period of time , (not to exce ed 12 months, except uoon prior approval by central office) end at e. r eo. sonc..bl e cost .
Pr 1or to accepting a client for me dic al tre 2.tment ther e must be a r eport on fil e fr om c. specialist in the fi e ld of the dis ability giving the nature of the dis ability, tre atment r ecommended, the period of time required, and the r e sults ~ticipat a d . Thar e should be evidence that the counselor had made a ll noce ss c.ry c.rr ::-.ngements for optimum cur e dur :ing convalescence. Any hosp it a liz ati on r uqu ir dd c:::.nnot excee d ninety days and any convalescent cc.r e cannot 0xc ee d s i x months 1 othe r than in rehe.bil i te.tion centers.
Dental tr ec.tment vdll b e pro vided a client when the medical evidence clearly shows th~t the dent o.l co ndi t ion is contributing to the ma jor disability which is accepte d as em employm.mt handicap and the additional service s will help to correct or r e duce the mc..jor disability . There should be sufficient me dica l or dental evidence in the r e cord to support the cont ention that the client's condition vnll be im?roved by dental treatment . Dentc.l service mc.y be made availabl e to c. client vmo he.s be en den i ed employment becaus e of the abnormc.l c.n d de forming a?pe nr c.n ce of his teeth, but does

8.2)02
not npply to clients only needing dentures. In the cJ.se of a client :10c::line plastic surgery :tnd de:1t<1l repair, Vw c~e:1tal surgeon Fill ~)C asL0cl to 1vork in conjunction Hi th th.:; plastic surs;eon. In like m2nnc:r, the Division Hill not provide dentures unless s'.lch st::rvicc is associated with another dis?.bility 1.:-hich is e:.cceptcd o.s an emplo;r1ent hnndicapo

Prior to accepting a client for S'Jrgery_, there must be a mPdic-'11 r2port indico.ting the n::tture of the disability, the surccr:r rccor:n'(_m6o.d_, the results anticipo.ted, aPd the period of hospitalization nqu::.rcd. bvici.ence should be on file that adequate arr?.ngemcnts have been m?..rle for optiJ11Ut:l car<J P.fter p?..ticnt :i.s c:iscL,'lrged fron. the hospital., There should 2lso be inform<:>.tion to t:v-" effect th-".t c~ic:t::,' s ::.'~;,ily has ncce:ptcd pl::.r:: f cr p!wsiccl.l l'Cstcr?..tion serv::.ces and tl12.t provision has been r1::1.dc lor dq:,c.~nclcr, ts, L' nr,y_, Hhilc eli :;nt is u~"l'lb}_o to vroll:, L1 cr those clicTts necdinc; tr:msportation or conWllcscent cC'.:rC; informc.tion should be in t~1e record that ~rrtmgcme;1ts :1:o.vo been made or will be mnrle in nnple ti.'Tlc p

Clients eligible i.'or p~~.sic::l restornt~cEl anc~ :'_n nc;.::cl of hos~italizntion uill

be pl::.cc:d in approved hospit:J.s vrith ~\;:i_:-:~1 <'1!1 c.Jl inclusive p8r ci:i.8lil rate is

in cf'icct. Cl:i_cnts PlC"? Lc sent to -::.:cc: ~!c-;~.~.t:~l :::-or dio.;_mosis . sur~ery, or

o.: treatment, ?or dia~pcsis, the n'r. ;b~:r

J:1ys couns"lor may o.uthorize Hi thout

State Ofi'ice ::1.pprovn.l mcy not ~:xer;cd 10. c-:Lilr~ for su.r~cry or treatment

counselor's nuu-~o~'i-;:; J. t.:_o:c l:lC'.y not .-;: ~~~:cct ).") d1~.-s \.;i tl"1ou c St.::.tc Office approvcl. If c.cldi tion2..l hospit :::.1~-"" a t.i.::J:1 is p;c,- .:~l .:. o-r :n.1.rgcr:r i'..nc:./or trc2..tm<mt prior

approval must be recei7r"Jd .:c~rcr1 the ,/~ate O.i~:::icco The t:srantinc; of c1.dditional

hospi talizntion Hill te l.:--,sL.d on f.,:.; ts conccj nL1g the individual c~sc ::end

1-Jhcn it ::lppc:::trs that more h(.~copi t!:l:i .Lt:.tion 1.rill be ru~uircd thou:. sb.tcd nl;ove,

counselor Hill submit esscnti:::.l c~r.::.:-1. to Jiistrict> Supervisor 'rho Hill in turn

forHo.rd case Hi th his comTTlGnts to the 3-::.ate Office for a rlccisione An cx-

t-:cnsion of hos:oit:tliz.:1tion Hill be ::;rrmted if evidence inc~::..c;:ctcs o. continua-

tion of this service for a rensonc.blc period of time is osc:enti.:::.l in con-

pJ.ct.ing the phy~;ical r-cstorz:.. t1.on }Jhnsc of clients r'"h~cbili tu. tion progr2m. Clients ,".re to be provid~Jd hcspi taliza tlon in ~ 1mrd (room '>Ji th tHo or more

bcrls) uEJ.css ti1o attending physici.:l'1 rccomJ'l::.ncls 2 IJrivr. tc roon :Lcr c1. number

of d<ws c\uo to the seriousness o.l tiw il::i.nes,-, ' unc\;j_~ wrdch cil'c:c.n:1stc-mc os the

hospital vrill r,-,c,kc this c.v:::.ilo.blc :1t the rcgulc:.r per diem rr~tc e 'Ine change
in policy to conform to ~ublic L<:u 565 of the 83rd Con:sress is effective as

of July 1, 195ho

Clients '\Tho su'.':~,-~~ o.s 2. result o.f .:1n aJ.lcr~y to the cx~cnt th2t i t constitu.tcs o. su'bst0.r::ti".l cr:',plo:;"Tncnc h<'lnC:ic:c.p~ s'tu_,lrl be r:x:Jl"TlincrJ by ::m <".llcrfict to C:L::tc.:rninc if t:::-catr~::mt cvi 11 subst~.nt::_,.,_J.ly :L~,2rove or correct ~~he conclition. If the ;~.::dic:n.l r:.:vic1cncc rc~T~<:>.ls tllc prcc,c:-'ce of o.n ::1.llcrgy severe enough to inter:.' c::.~c 1-r:;_th cr;-.plo:n1cn t and there ::'.l'C J:'CCJ"Jl-n. -.-. :td<:.t.io:'ls tlP t trl::n tmcnt c,nd sclccti\'"C plr!c,;r:'cnt ~Jill r.::;sul t. in ;,1n.l~:LY. t1-:; eli n t cmplo~rablc, the counsE::lor l'Tl.O.J;"" c..ccc~)t tl1c cr;.sc Iol, pf'l)rsicnl r:,s<~or:::Clio::l st;~:--irico ..
_i,.s n pc.rt oi:' his (:X<,ninat:i_o~! the alLrQ;ist usu:1.lly m~.kcs nurr:crous s 1 ~in tests in r:.n effort to find the c::t:.sc or CG.USL:S of the allcrc_:y. The spcci2list frcqucntl~r prescribes trcatrn,_,;:jt. u;1ich, in nll prob0.bility, will bo necc.:ss::.ry yc:.xr ;;.ftcr :;rear, especially in t:tc sprinp, cmd f:::.ll. :Ic mny further rccor:jr:wnd tl-:.:.:.t the cliont be rcnovod from ar: unfnvorc-.'cle cnvironmcnt;;.l situation to 2. ~~wrc.; st'.itable m-:o. J.'he counselor, therefore, should cnrcfully cval.tFl.tc tho rNjclr>r:co t!.nd have n clear undcrs tnnding with tb;:~ cliont pr:i.or to accepting tho cnEo for rohnbilitation sc;rvice.

8.2)05
There is little val1'e in securin~: an expen:-ive examination unless the Division takes care of the initial treatment and follow-up care, assurr.ins that the client is unable to secure this otherwise.
8.2506 Arthritis
Generally speakin>:;, a client Y.'ith arthritis v:ill not be accepted until the disease has 11 run its course" or 11 bt,rned out". The case will then be considered on the basis of whether the orthopedist indicates the deformities can be corrected or improved by sur~ery to the roint where the client can vmrk. An exce~tion is a case sufferin:, from active rheumatic disease which has continued for a long
period so as not to be classified as "acute" (havins existed 6 months)
and which medical evidence indicates may be brot'r:;ht under control by medication. In acce~tin~ a rheumatic arthritis case, the col.Cnselor l'T'ay provide antibiotic treatrr.ent for a period of six Inl~nths unless client be~ins trainin an'J in that case it ':'.ould extend one month after trainin::: is corrcpleted~
The follovdn::; r;en8ral stc:.tements are co:iven as a r:;uide for the benefit of the counselor:
(1) nenerall:r spea.kin'::, art11ritis of n;raclual onset ano pro~ressive course has a rocrer .. ror::nosis than that of ac1.1te onset.
( 2) 'ienerally s~Jeal:in-, arthritis of low Jvratio~ ho.s a poorer .,rocnosis than that of sl1ort riuration.
(3) It should be continuously borne in :...in::i. t h;:, t arthritis with fever, ';;hatever the ar:e group, and art!1ritis v:ith was tins and vrei::ht loss and rralnutri tion needs a diasnosis. It may be due to tt'bcrct:lcsis, rhevnatoid arthritis, related diseases of t<nknown cavse, brucellosis (undulent fever), leukemia and its related c:iseases, and to many other ailrr:ents. 'T'he reason for the imperative character of a dia'!losis in these situations is that sc1:1e of these are alltenable to treatment, ,,here.::ts, others are, as far as is kno' n at the present th1e, not amenable.
(4) Arthritis with fever, esrecially in the youn and espedally i f the joint trl uble has "oved from ~lac8 to place, is hi-::hly suggestive of rheumatic fever. ,,.The flame of rheumatic fever lie ks t 'le joints but bites t 1-te heart." This disease resPonds to treatment.
(5) A disease, r.articularly in youn0: adt'lts, vrhich simulates acute rheumatic fever alr~ost exactly is acute gonorrheal arthritis. This disease is amenable to treatr.ient.
(6) In ad1.lts end oLler aged individt'als, '.'.no have frequently recurrent e..ttc:.cks of art.1ri tis, gout is often the ca1.1se
and it is ~ot often reco.-nized. '!'his freqvently responds to treat,r.ent.

8.2506
(7) In a case where there has been a slow insidious onset of arthritis involving one joint, tuberculosis is highly to be suspected. Tuberculosis of the spine is the most common form of tuberculosis arthritis in the young, while tuberculosis of the knee is the most common type of joint tuberculosis in adults. Tuberculosis of these kinds is susceptible to treatment.
(8) In cases where the joint trouble complained of involves acute or chronic strain of the low back, this type of joint disease (which is quite probably mechanical in origi:r..v is very susceptible to therapy by an orthopedic specialist. The selection of cases for orthopedic treatment, however, involves the careful differential diagnosis between neurotic complainers and persons sick with organic mechanical disease.
(9) Psychogenic causes are occasionally at the basis of severe complaints related to the joints. The discovery of the underlying emotional causes is essential to the cure of this type of joint pain.
8.2507 Cardiac Involvc~ment
Prior to accepting a client for physical restoration service, there must be medical evidence from a cardiologist within ninety day period indicating the nature and extent of the disability, the prognosis as to probable extent of recovery or improv-'ment, type of treatment needed and period required for correction or substantial improvement of the condition.
The division will provide physical restoration to clients with all types of heart disease, except syphilitic, whore the prognosis is favorable. Tho following types 1nay be considered eligible:
(1) Hypertensive. There is a difference in hypertension and hyper-
tensive. The former in itself does not justify eligibility but instead, this is determined by the results of hypertensive heart. No client with hypertensive heart disease can be con-
sidered where the diastolic blood pressure is 125 or over, except in individuals under the age of 40; also, no client with
this disorder who has persistEmt swelling of the lower extremities, as this represents heart failure. (2) Rh0tatic. No client with rheumatic heart is eligible until at least six months after the rheumatic condition has become inactive. Hhether or not they can be accepted then depends upon the severity of th..J h"':wt diseas.;:; as determined by the cardiologist. Most young poo-llc; viith this condition can be rehabilitated. (3) Congenital. The diagnosis of congenital heart disease is difficult and at times requires unusual diagnostic procedures. These should bu ref.:orrud to a cardiologist regardless of severity for at tLn8s tho severe cases can be cured by operation or helped enough to be made employable.
8.25()8 Circulatory I:"apairments
Prior to accepting a client for physical restoration services with circulatory impairment, there should be medical evidence from a sp0cialist, qualified through training and experience to make such an examination, indicating clearly the nature and degroo of the impairment, recommending correction and stating the impairment can be corrected or substantially reduced as the result of the recommended treatment.

8.2508
There should be evidence that the counselor has made necessary arrangements for convalescent home care and follow-up treatment. This is very essential and a patient with this impairment must carry out the recommendations of the physician in order to obtain the maximum improvement of the impairment.
There should be evidence that arrangements have been made for client to take care of any expense required in the rehabilitation plan, which cannot be paid by the Rehabilitation Division. There should be evidence that the treatment can be completed within a reasonable length of time, not exceeding one year.
Clients with simple varicose ulcers are suitable for rehabilitation because after the varicose veins have been treated frequently the ulcer will heal without too much difficulty; but if there is a large amount of scar tissue this can be excised and a split or full thickness graft can be applied. As a rule, these grafts remain in good condition, provided the client does not injure his leg or has an occupation which does not require too much standing or manual labor.
Clients with large varicosities who are incapacitated are frequently suitable for rehabilitation. Surgery and injection therapy will cure most all of these patients. Surgery should be done by one well experienced in this type of work, because if the surgery is improperly done, it will be necessary later to operate again and will require added expense to the division.
Post-phlebitic clients are the most difficult ones to treat. Even after extensive surgery on the superficial and deep veins and sympathectomy on the lumbar sympathetic nerves, the client remains not cured and not able to work. Clients with post-phlebitic edema, induration (hardness of the tissues) and ulceration are not good rehabilitation prospects, and prior to accepting a case with this impairment, a very favorable recommendation must be obtained from a specialist in this field.
Treatment should not be recommended for patients with elephantiasis, as they are not considered favorable prospects for rehabilitation.
Colored clients with sickle cell anemia ulcers cannot be rehabilitated, and if a blood examination shows sickling of the red blood cells, no treatment should be given. Only colored people have sickle cell anemia and it is impossible to rehabilitate them. The average length of life of these people is 33 years.
Clients with severe arterial diseases of the lower extremities should not be recommended for treatment of the varicose veins. In some of the severe cases the extremity may be amputated where gangrene develops and the client can be fitted with artificial limb. This type of case is rarely feasible and should be accepted only on the basis of a recommendation from a specialist in the field of the impairment.

8.2509 Diabetes
A client with diabetes to the extent that it is a substantial impairment to his employment may be provided physical restoration if there is evidence that he will be able to purchase insulin and diet necessary for the control of the disease upon completion of the rehabilitation service. In order to determine whether or not the di3ease can be controlled, the internist usually wants to hospitalize the client for a period of seven to ten days to determine the proper dosage of insulin needed to control the disease, and also to give training in dietary habits. The division may purchase insulin during the period of hospitalization and for a short period following return to the job (not over six weeks). The division may also provide medical maintenance in a convalescent home to support diet for the same period of time. If the client is in training and entitled to maintenance on a need basis, the division may provide the insulin until training is completed, plus an additional month to permit client time to receive pay from employment. There is little value in getting this expensive preparatory work unless the client is going to be able to earn enough for his needs after the division provides for the above expense.
8.2510 Endocrine
Prior to accepting case for physical restoration, the client must have been examined by an endocrinologist and the treatment recommended must be provided by a specialist in this field.
Individuals with endocrine disturbances often should have treatment before the age of sixteen, which is the minimum age of acceptance under the rehabilitation program, but where this has not been provided and the specialist believes the condition can be improved to make client employable, or more advantageously employable, the counselor may accept the case, if all other factors are favorable.
The endocrine disturbances that may be improved or corrected on clients who may be eligible for rehabilitation services are as follows:
1. Obesity with glandular disorder. 2. Thyroid disorders (a) goiter or nervousness, (b) hypo
and hyperthyroidism.
3. Headaches of endocrine etiology (a) pituitary, (b) of
underactive thyroid gland.
4. Bodily disproportions (a) face, (b) hands, (c) jaw,
(d) ratio of trunk to extremities.
5. Certain types of dwarfisma
6. Effeminate secondary sex characteristics in the male due
to various causes.
7. Masculine secondary sex characteristics in the female due
to various causes.
8. Functional menohorrhagia (a) excessive bleeding vdth
menses, (b) dysmenorrhea, painful menses.
9. Cushings disease.
10. Diabetes insipitus and mellitus.

8.2511
8.2511 EpilepEy
There mur.t b a report. fro;, a neu~olor;ict revi3c?ling tho;: presence of actual epileptic or ep5.1_c9ti.f:::::m f-C~ :..:::;.:":"e:- which includes a prognosis that indic::rtes t:'!P.re :::3 a i:(.:J.;c?J~<bl~ expect-:1ti.on t:1at the client wEl be einplo~;able or no:e advJ.n tageously emplo;y-able following the traatmer.t.
The neurologist may w~mt to hospitaliz~ an epileptic cl:i_ent for a period of from five tc1 to'.'l days to dete,'I"line "'-"1-;i:.:h of th9 <:>r.ticor~vulsi~:e dr'J,~S if: r::c8t cCscti-rr~, and to d8t.c.:::-m:i.ne the p;:c,per dosage. ThEl n~urolo;.:.st :,;Ll a:..so gj_ve the c:'.ient instlur.:tions in how to admini:Jte~ the d::.ug, teach hi.'il the neccssity of !Jr"OrJel' dietary h3bits, ar.d :impress l:p.:m him the neces,~:~ ty of freq;1-:::.1t mecU cal checkups. There is littla va~.ua in getting this expensiv-e diagnostic and in::.:tructional work done un:Less t~1e client is able to secure the anti-convulsive drugs and proper diet to main::.c:in central. The division may purch~C<:l t~1e ::JL"ti-convulsive drugs civLi_ng t.he p8riod of diagnostic study or hcsp:. tal.ization and for a s!1ort period following return to the job (not ove~ 90 days), u~less client is in training, in which case the division may provid.e r,Jed~ca!:.:i_on where maintenance is furnished until training is completed. If the client is not going to be able to earn enough for his needs at the end of this time, or unless some other agency can take responsibility for continuing aid, it is useless for the Vocational Rehabilitation Agency to begin treatment.
The client must be inP.tructed to send a repo~t to the neurologist every tvJO weeks for a period of 'Lh:-ee menth s J as to the number of seizures they have hn.d and any other pe:ctincnt. information that the doctor should know. On the basis of these reports, the physician will advise if medication should be changed or if client should return for further ex~~ination.
8.2512 Eye, Ear, Noses and Throat
Clients with these disabilities must be examined by a specialist in this field and surgery or treatment must be provided by a qualified nhysician who is listed on the panel of specialists.
The counselor should keep in mind the fact that clients with acute infection, with the ex(;eption of glaucoma, are not eligible for physical restoration service under the program, as the Act stipulates that the disability must be reasonably static. The Federal Manual of Policies, Chapter II, Section 2, permits that treatment may be provided clients with glaucoma without awaiting the end result of blindness.
There will be many cases referred to the counselor needing treatment for some minor infection, but this cannot be provided under the program, as the disability must be reasonably static and not of a general medical nature.

8.2512
Clients with such disabilities as cataract of the eye, detached retina, muscle inbalance, ptosis of lids, refractive errors, phthisis bulbi, and enucleation of eye necessitating prosthesis, are the types of impair~ents that may make a ].:'erson entitled to physical restoration~
Clients with chronic infection, or congenital defects of the ear, such as: chronic otitis media, chronic mastoiditis, labyrinthitis, chronic defective hearin~ improved with a hearing aid, or fenestration operation ma;y be accepted for physical restoration.
Clients with impairments of the nose, such as: nasal polypii, septal deformity, marked deformity requirine plastic sursery may be accepted for physical restoration service.
Clients with impairr.J.ents of the throat 5 such as: larynr:eal tumors, may be accepted for physical restoration. In--lividuals who hare chronic diseased tonsils and adenoids which are contributine; factors to the correction or improvement of sorte major disability, may be pro\ided service by the divisiono
8.2513 Qynecolosical Disorders
In order for a client with a gynecolo~ical disorder to be accepted for physical restoration services, r.J.edical evidence must indicate that the client has sufficient disability to prevent her from cnrr:ring on her usual type of employ1 ent. 'J'he evidence r.~ust fvrther show that the client's condition can be corrected or substantially improved within a reasonable period of time, so as to Jrake her en1ployable ..
A client wi.th a lesion on the cervix must be sent to the cancer clinic for diagnosi:,ic study. At the time they are makins the diacnostic study, it is customary to cauterize the cervix and frequently this is all the treatment that the client will need, ancl this can be done at the same time the biopsy is beine madeo i:~any of the cases in the past that have been referred to the division have a lesion en the cervix, and it vdll be the policy in the future to refer all of these cases to the state cancer clinic for a diacnostic study prior to acceptance for any physical restoration services fro': the Rehabilitation Divisiono
If there are su:~ficient findings to definitely susrect a malignancy of a fibroid or some other tumor of the uterus or ovary, the client must likewise be sent to the cancer clinic.
On clients 35 years of ase and under, it will be the policy of the
Division to provide a complete eJUlmination by two e;ynecologists, or by two sur~ecns with wide experience in the field of gynecology, or by one of each of the above, prior to the acceptance or providinr: surgery of a steriliz ins nature ( rerr.oval of ovaries, utert'S, or tubes). ~ch specialist must submit in writinr: a comt-lete report of his findinss, dia>-:nosis and recomrnendations before any plan is \Titten.
In cases 36 years or above, where gynecological surgery is contemplated the exairination and the sur~ery must be performed by a gynecoloc;ist or a surgeon with wide experience in the field of gynecology who is listed on the Panel of Specialists.

8 . 2 513
The purpos e of r e questing a r ,po rt fr om tho pathologist on the tissue romoved from f emal e genitalic. , i s t o det ermine : ( l) whether oper ation was nece s sa.r y in this partic ul a r pe r son ' s c..se , ( 2) whether the tis sue l.s malignant, in orde r t hat cas e can b e r efe rred to a Can ce r Clinic immediate ly fo r trectment . Couns elor should study the se r epo rt s individually and if evidence indicates particular physi ci an i s unne cessarily r emoving f oronl e genitalia , then the dec ision a s to furth~ r use of t he gyne cologist or sur ge on, should be r ef e rr ed to higher authoriti es for investig ation .
8 . 2514 Hvrnia
Pr i or to a cc epting o. ca se f or surgery whe r e the di agnosis is he rnia, medicnl evi dence must indic at e thr.t t he herni a is dis abling e..nd that surge ry wil l corr e ct or substantially impr ove the condit i on , a nd thereby a id in the r uha.bi lit ~tion of the client . The f a ct that a client has a he rnia does not in its ~l f justify a cc eptan ce fort r eatment unde r the r ehabilit at i on progr am . This must be det ermine d on the bc sis of the sp aci a list 1 s r epor t :;.nd on the bas is of a ll other f a ctors r el ated to the r eho.bilit ation of the indi viduo.l .
In acce~ ting a cli6nt in nee d of a he rni a operation , the couns el or should t a ke int o considdr ation the gene r al phys icc.l and ment al condition of the client . In othe r wo rds , if t ho client is handicapped by a s eve r e heart conditi on , d i ~betd s , hy?e r tension , or som3 othe r in curable ailment, the n th'~ cor r e cti on of thv he rni :::. >mul d be of l i t t l o value as f 2,r l?, s r ehabil i t o.tion of tha cl i ent i s concerned .
Ther 9 ar o s eve r al commonly 3ncounte r c d t ype s of herni a , a nd the treatment will dGpend on the typ pr sent c.nd on t he gene r al condition of the client . The he rni a s most often s 0en a r e : inguinc.l , f emor al, incisional or postope r c.ti ve , umbilical , ep iga stric c.nd di c..phr o.gmatic . For a cli ent with inguinal or f emoral he rni o. , sur ge r y will be the tr eatment of choice be cause of the high i ncidenc e of i ncar ceration or strangulation of the bowel i n these cases . A truss shoul d s eldom, if ever , be r e commended for these l c..tte r ty,es unl e ss surgical r e p ~ i r is contr ain dicate d by some mor e s eriow di se ase , whic h would probably, in i tself , be t he ca us e for r o j e ction of the client for r vhabil ito.tion service .
The voco.tion , howeve r, ho.s much to do v.Jith the amount of impr..irment caused by an inguinal hernia , as a par son who hc.. s to do heavy physical l a bo r may be s erious ly handic app e ~ whe r o as c. pe r son pe r fo rming work of sedentary natur e may h've l i r.tl e or no di so.bili t y .
With i ncisiono.l h er ni o.s , the r e a r e some instance s whe r e a n abdominal support may be pr e fer abl e to sur gi cal r c po.ir . The de ci sion for the method of tr eo.t me nt vnll depand u pon tho sizu and loc ation of t he he r ni a , a s well a s on the gen e r ~ l condition of thG pati ent , an d must e e left to the be st judgme nt of t ho opornting surgeon c.nd his medical consultants .
Thor o c.r a ~ grec.t numbe r of umbil i cal , e piga st ric and dia phr agmat ic he r nia s which nr e smnll ~nd not producing symptoms and f or whi ch surgery is not indi cated . Eve ry client with her ni a , howeve r , must b e consider e d ind ividual l y nnd th0 d c ision for tr e~tmvnt made on the bas is of ma ny consider a t ions .

1.?51t; Mental
Prior to accepting a client with a mental impairment for physical restoration service, there must be a report from a psychiatrist revealing the presence of the disability which constitutes an employment handicap and that there is reasonable expectation that treatment will correct or improve the condition to the point where the client will be employable, The classifications as to type of disability vary, but for the counselor's convenience the following are listed with prognosis and treatment.
I. Psychoneuroses This is a disorder in which the principal trouble is found in the emotions more than in the thinking or behaving, although all of these aspects are included. The clien~ is in complete and perfect contact with reality at all times and does not break with cultural patterns. (a) Anxiety Reaction. A state of fear arising out of unconscious conflict~ The symptoms are typical of fear with sweating of the palms and general apprehension. Prognosis with treatment is good, (b) Conversion Hysteria. A~~iety is manifested in disturbance of voluntary muscles, as paralysis, or of sensation as numbness, pain, blindness, etc, Prognosis is good with treatment. (c) Psychosomatic Reaction. These are disturbances of systems of the body such as gastro-intestinal, cardio-vascular, respiratory, etc., and are manifested by peptic ulcer, mucous colitis, cardiac neurosis, asthma, hyper-ventilation, and some skin disorders. Individuals falling in this category have often received other medical treatment with very little lasting benefit. Prognosis depends on the individual case but is usually fairly good. (d) Obsessive-Compulsive Reaction. The individual usually has compulsion to perform certain acts or is obsessed with fear of uncontrollable impulses, Treatment requires more time, but the individual may be able to be placed where the symptoms do not interfere with his adjustment. Prognosis is not too favorable. (e) Depressive Reactions. There is depression with feeling of inadequacy and easy fatiguability and frequently there are physical complaints such as headache, backache, and constipation, This is not sufficient to be termed psychotic, but still incapacitates the individual. Prognosis is good with treatment.
II. Psychoses This includes all of those emotional reactions in which there has occurred, at same time during the course of the illness, a definite break with reality. (a) Schizophrenia. This literally means "split personality". This condition is sometimes called "dementia praecox" because of the fact that it affects the adolescent and young adult age group. The outstanding symptoms are: withdrawal from reality, delusions and hallucinations. There are many other symptoms that are present in specific cases, but these three basic findings are present in all cases. There are four sub-groups of schizophrenia, each distinguished from the other by its characteristic symptom picture. 1. Simple. This type shows little other than the basic findings and are usually dull, withdrawn individuals. Prognosis is very poor. 2. Hebephrenic. This type shows silly behavior and unmotivated laughter. Prognosis is poor and treatment institutional.

8.2515
3. Catatonic. This type shows mutism and refusal of food and may
show excited unpredictable behavior. Prognosis is good with treatment but recurrence is likely.
4. Paranoid. This type shows delusions of persecution and halluci-
nations, usually of an auditory nature. The prognosis is poor for recovery but there may be a remission in which vocational rehabilitation is feasible. The time required for treating patients with this diagnosis is usually lengthy and recoveries under ideal conditions are not too numerous.
III. Manic-Depressive
The manic phase is characterized by elation and elevation of the mood. There is increased activity and a flight of ideas. The depressed phase is characterized by depression of the mood with retardation both in the mental and physical activities. There is hopelessness, sleeplessness and tearfulness with suicidal ideas often present. Either of these phases may occur without the other. The results are gratifying and the cost is very reasonable. It is observed that 80% to 90% of all cases recover, but there is a tendency toward recurrence.
IV. Involutional Melancholia
This type is remarkably similar to the manic-depressive depressions. The patients are tearful, hopeless, sleepless and often suicidal. The illness affects those in the involutional age groups. Treatment usually requires three to four weeks and there are approximately 90% recoveries.
v. Paranoia
A person with this condition is characterized by delusions of persecution. These delusions seem to spread until they involve the individual's entire life situation. This condition may be seen at any age after adulthood. Prognosis is poor but on favorable recommendation of the psychiatrist the client may be rehabilitated.
VI. Character and Behavior Disorders
This type includes antisocial behavior, inadequate personality, sexual deviate, immature reactions with emotional instability or passive dependency, or aggressive reactiono The prognosis depends on the extent of the condition existing in the individual case, but as a rule is not considered good prespect for rehabilitation. Immaturity reactions in adolescents may offer a good prognosis.
VII. Mental Deficiency
This is characterized by feeble-mindedness or mental retardation. There is no treatment for the condition, which in reality is not a medical problem, but an educational problemo The course of action is taken in an effort to train the individual to the point that he uses, as nearly as possible, 100% of his total potential ability. These individuals will require varying degrees of supervision after training.

8.2516

Orthcpedi~
Before accepting a client for physical restoration service who has an orthopedic impairment, there should be rredical evidence from an orthopedist indicatinr: clearly the nature and degree of the impairment and a recomirendation tho. t the condition can be corrected or substantially improved as a resnlt of the proposed treatment o
If the client is accepted for treatment, the service must be .r:rovided by an orthopedist listed on the panel of specialistso
The counselor will accept for sur~ery only those cases in which the impairrrent is reasonably static (having existed for a period of six months or more) and can be corrected or substantially improved within a reasonably length of time to the extent of making the client employable. This rules out individuals with a.cute inflarmnatory impairments and recent injuries, as well as long-term chronic cases with an unfavorable pro~nosis.
In considering a client for treatment with an orthopedic condition, the counselor should be cognizant of the following facts:
1. The client should have a work expectancy of at least five years after completion of treatment.
2. There should be no systemic illness that would otherwise contraindicate favorable prognosis from treatment and employability.
3. Careful evaluation in cerebral palsy cases is very essential. The pro~nosis for benefit from therapy should be unusually faVOrable frior tO accer.tance for treatJI.ent o
4. A client with a neoplastic disease (bone sarcowa, etc.) should
be referred to a state cancer clinic by the counselor)
5. Prior to acceDtance of an amputee whose extremity was rerroved
because of a sarcorr.a, a sufficiently long waiting period should have elapsed (Ninimum of one year) and the client should be cleared by one of the reputable cancer clinics, and also the counselor should have a favorable recoJ,mendation from an internist and an orthopedist.
6. Before accepting a client with a chronic arteria-vascular disease (Buerger's disease, arterio-schlerosis, diabetic gan~rene, etc.) there should be a report from an internist and also from a surgeon qualified in the field of vasc~lar surr;ery ~:ivir.~ a favorable prognosis.
1. Before accepting a spastic client for physical restoration, he
should be examined by a neurosur~eon and also an orthopedic surgeon and must show a very favorable prognosis. Paraplegic and peripheral nerve cases shot'ld be definitely classified irreparable before reconstrl,ctive surr:;ery (Neurectomy, TenotomJr, etc.) is recommended.

8.2.516
8. A client with a tabetic defor.mity (Charcot joint) will not be
accepted for any reconstructive surgery. In an exceptional case where the client's earning capacity may be prolonged for one year or more by furnishing a brace, the counselor may provide this limited service on favorable recommendation of the orthopedist, and the approval of the state medical consultant.
9. Before accepting a case of bone tuberculosis, the client should be
examined by an internist to determine client's general physical condition. If the client is found to have active pulmonary tuberculosis, he would not be eligible for service but should be referred to the State Health Department by the counselor. If the internist reports that the client has a favorable prognosis, the client would be eligible for service by an orthopedist the same as a client with any other orthopedic impairment.
10. A client with a pathologic fracture or deformity resulting from same, such as: fractures secondary to bone cysts, tumors, fragile bone disease, osteoporosis, metabolic, or endocrine disorders, etc., should carefully be evaluated by and receive a very favorable prognosis for employability from an internist and an orthopedist before acceptance.
11. Before accepting cases of chronic osteomyelitis for treatment, the counselor should be guided by the following factors which are indicative of a favorable prognosis; (1) Involvement of a single bone, (2) presence of a sequestrum, and (3) likelihood of correction by a single operation. In general, a case of osteomyelitis is considered chronic if it has existed one year or longer.
12. Clients with complaints referrable to old traumatic conditions (old fractures) should be carefully screened by the counselor especially when the complaint is entirely subjective; e.g., the patient's complaint of pain is not proportional to visible deforrni ty.
13. Prior to accepting a client complaining of back pain, the counselor should be reasonably assured that the patient is definitely incapacitated hy the pain to the point of continuous or intermittent confinement to a bed.
14. A client who has received previous prolonged treatment in a
"crippled children's agency" should not be considered a favombJe candidate for additional treatment, unless only short-term procedures are required for completion.
1.5. The counselor should be very careful in accepting a client for physical restoration who is anticipating or receiving benefits under the Workmen's Compensation Act and who has not yet accepted a final settlement with his employer.

8.2517 Plastic Sur~ery

8.2517

Prior to acceptin~ a client for physical restoration service who is in need of plastic surgery, there must be medical evidence from a qualified specialist indicating clearly the degree and nature of impairment, reconunending treatment and stating that the impairment can be corrected or substantially improved as a result of the reconunended treatment.

It is not the policy of the division to provide plastic surgery for cosmetic purposes and a case of this type should only- be accepted when it is clearly indicated that the facial disfigurement interferes with the client's employment.

Clients who have evidence of a mali~ancy that has developed in a burn scar or in an area of dermititis or on any of the skin surfaces, are not eligible for treatment until it has been proven definitely that the tumor is not malignant. V'hen a case is suspected of having a malignancy, it should be referred to a cancer clinic for establishing the dia~osis. fhe same is true for suspicious lesions in the mouth or on the lips.

Clients with an incurable disease who may have a concomitant condition that can be corrected by plastic surgery are not eligible for this service,

Clients having skin ulcerations due to such conditions as diabetes, or to circulatory disturbance, should have these conditions either corrected or under control before being referred for skin grafting.

such cosmetic operations as face lifts, mammaplasties are not eligible since they are not considered vocational handj.caps. Individuals whose facial features are so deformed or distorted as to make them attract attention because of their appearance, may be elizible since these conditions are definitely a hinderance in obtaining employment that entails meeting the public,.

In general, the division ~ay provide plastic sur~ery service to clients with the followin~ types of disabilities which can be corrected or substantially improved by plastic sur~ery: Harelip cte~alate: Conzenital; post-operative defects such as psrforations. Ears: Congenital malformations; protruding; loss of - partial and
complete; defects due to trauma; defects due to operation. Eyes: Ptosis; deformity of lids - traumatic; deformity of lids -
congenital; deformity of lids - post-operative. Nose: Congenital defects such as absence or partial absence; deformities
due to trauma such as burn scars; crooked nose; hump nose, saddle nose; post-operative defects. Mouth: (Other than harelip) Loss of lip - partial or complete; due to trauma, disease or post-operative; con'!enital defects Macrostomia, etc.; distortion due to burns. Deformities of Jaws; Chin: Receading chin; prognathism; unilateral hypertrophy of mandible; deformities due to trauma; malunion of fracture; loss of bone dt1e to trauma; disease or post-operative ank,ylosis of jaw; disturbance of function of jaw. Burn scars anywhere on body catJsing ccntractures that are unstable and break down; plantar warts; syndactilysm; tendon injuries; decubitus ulcers; dupuytren's contractures; scars - unsi~1tly or contracting scars; burns requiring skin gra::ts; facial paralysis requir~.ng fascia trans plant; tumors of paratid gland; beni~n tumors of skin 2nd benign tumors of jaw (such as cyst2, etc.).

8.2.517a
Clients vrho have received severe hurns often do not respond to usual treatment prescribed far co:c~:-ection of injury in the normal heeling period. In such cases it is necessary for client to receive r2dicnl surgery or the individual 1-rill develop contractures producing n. r1ajor voc::!.tiom.l handicap~ To prevent this problem, counselors a::.~;:; advised tht'.t a person vrith above type of disability may no11 be cons ide roc~ for ncceptance after a period of 90 days, instead of waitinc the usual 6 months poriodo
Prior to acceptance of a client for physical restoration 3'C)rvice 1Jith severe burns, counselor must have a report from physi~inn Hho ho.s or is treating the individual indicnting the client ho.s severe third degree burns which will result in contractures producing a major vocational handicap~ and must also have n specialist narrative report from a plastic surgeon indicnting that the disability is reJ.sonnbly static and offers a fJ.vorable prognosis, and that 90 days hospitalization will be nmple. If evidence indicates client can be physic:tlly restored to the point of employability~ the person mny then be sent to an acceptable plastic surgeon for treatment.
The counselor must keep up with the progres~ on the case to see that client is moved into convalescent home uhen feasible in order that period of hospitnlizntion does not exceed the ninety dnys~
8.. 2.518 Ulcer - Peptic (duodenal or gnstr5_c).
The client must be exo.mined by nn internist prior to the accepto.nce of the cnse for treatment. If surgery is recommended this must be provided by a qualified surgeon on the Panel of Specialists, whereas treatment will usually be provided by the internist making the die.gnosis. In some instances, treatment will be provided by a qualified physician in the community of the client under the direction of, and in cooper::.tion with, the internist (or gastroenterologist). The condition must be reasonably stntic, havinz primarily existed for a period of approximately six months and may be of such nature that surgery or treatment may be completed within a reasonable period of time (not exceeding one year). Cases of a gener<1l medical nature of <1cute involvement N'ill not be accepted for physical restorationo
Attention is co.lled to the fact tho.t in genero.l, peptic ulcers are divided into two main croups, namely duodenal ulcer and gastric ulcer. In the framer group; the duodenal ulcer, the lesions <1re <1lmost ah1ays benign, whereo.s the gnstric ulcer alwnys cnrries the risk of cancer being present. In view of this, it is suggested that the gastric ulcer pntient take precedence over the duodenal ulcer pntient since it is very important to establish whether the ulcer is benign or mo.lignant.
Hhile there o.re multiple factors playing a role in the peptic ulcer client, there is a close association between the emotional life of an individual a:r.d the heo.ling of peptic ulcers. '1'here are inst['.nces 1-vhere the emotional life of an individual has been adjusted sufficiently to result in the disnppenrance of the ulcer symptoms <1nd other signs of activity of the pr~blemo Therefore, it is very essential that effective counseling and guidance be provided and unless this is done, the case should not be accepted for physical restoro.tion service.

8.2519
8.2519
To obtain treatment the condition must be reasonably static and have existed long enough to have affected employability. Cases requiring surgical intervention, such as removal of a stone in the kidney or ureter, or a similar condition may be accepted for physical restoration services, whereas, treatment of a general medical nature of acute involvement such as irrigation and dilitations of the ureter, will not be accepted for physical restoration service.
8.2520
For a client vrho has been accepted for treatment which requires medication for Yfhich the client is unable to pay and the counselor is unable to make other arrangements, the division will provide the drugs upon the recommendation of the attending physician for a reasonable period of time. As soon as the client is able to return to nork, it automatically becomes his r3sponsibility to purchase drugs which may be needed for only a short time or which may be needed for many years in thu future.
For the cliunts in the hospital, there will be no extra charge for stock drugs as this ite:!l of expense is included in the per diem rate. Vfuen it is necessary for the client to b3 provided some unusually expensive drug, such as ACTH, at the present time the division will pay for thi.s in addition to the estc.:.blishcd por diem rate. It vrill be necessary for the hospital to attach to tho r ...gular hospital statement, which is submitted for p<l:.'r.l::mt of clion:.ts hospitalization, an itemized statement specifying the drug, the amount, and the cost of same.
8.2521 Clinics
The counselor v:ill take: full advantage of the clinical facilities located in his area and obtain whatever service they have to offer that will b3 of benefit to the cii::Jabled individual. ~hrough local health clinics and mental hygiene clinics, the counselor has an opportu;1i ty to secure certain services without cost to thu division and thereby reduce the cost of the case.
It will be advisable to trJat some of the clients in out-patient clinics and when this is done, the hospital viill be paid at an established rate on a per visit basis.
In the metropolitan areas that have the hospital facilities and staff to take care of the medical needs of the indigent of their community, the counselor will be expected to utilize the cervices of their clinics. If surgery or treatment is needed for the client, the counselor vrill help to m'3.ke vrhatever arrangements are necessary to get available service. If the physical restoration service is not readily available at such clinics within a reasonable length of time, then it is left to the discretion of the counselor whether to delay the case longer or to provide immediate hospitalization at the expense of the Rehabilitation Division.
In thor;e hospitals that have a resident training program, there 1\'ill be a few where arrangements may be made by the central office for indigent clients to attend their clinic for examinat.Lm and wherever the program meets tr.u roqliired standards, arrangements may be made for hospitalization and treatment.

Wherever such proer[U!ls are approved, the physician \vill provide his service uithout cost to thG division and the hospital will receive whatever o.mount the client is c.ble to pay., If the client is unnble to make .:::m:r prtyment on hospitnlizntion, the cliTision mn.y tJD.Y fol' this service at a rate not to exceed that established in the Sche6ule of Fees., Clients in need of physicc.l restoration 1rrho are considered c.;ooc: teaching cases should be referred to the State Aid Clinic nt Augusto.. To get n client in at the University Hospitnl, the counselor 1-lill request the county welfc.re director to certif~r the case and forHnrci npplico.tion, <'!.long 1Tith medical report from the c..ttendinc physician, to the secretary of the Sto.te Aid Clinic at the University Hospital, Au[:,"Usta, Geort;ia.
A. !li1putee Clinic
There are hm clinics in the state at present providing thern.peutic and fitting services for amputees in order that the client may s.:l.tisf:J.ctorily wenr a prosthesis, Since most amputees develop contrn.ctures or other complications after amputation, it is j~portant that the counselor take ndvantage of the nbove serviceso This is required of each new amputee and also is applicnble to nmputees who hnve never satisfactorily worn their appliance.
Prior to sending client to the l~putee Clinic, the counselor should have a general medical exQffiination on the client .1.nd copy of this should be fo:nmrded to the Clinic in advnnce of client's arriv.:tlo The client will be given .:1 thorough examin.'ltion by n physiatrist nnd he will mnJ::e reccmmendntions to the counselor as to the condition of the stump ar..d vrhnt services o.re needed to be correctly fitted with .:m applinnce. In other cnses, it may be found that client will need no physical therapy and physiatrist will only recommend trc..ining in hoH to wear prosthesis. In other cases., the physiatrist and physical therapists will teach client necessary exercises for him to cnrry out at home before being fitted, but for those Hith severe contractures, it Hill be r..ccessnry for client to be treateC. o.s an out-patient nt the Clinic for the period of time prescribed by the physintristo
:.Jhen the stu.mp is in order, the c licnt can be measured for the prosthesis and uhen this is mnnufactured, client can return to the clinic for prosthesis to be put on and trnined in the correct method of uearing it. This is most importnnt in order for the client to avoid bad hnbits in the use oi' the prosthesis. In general, the counselor mc..y expect correction of stump within a period of three to five treo.tments and approximntely three dnys for proper training in the correct use of wearing the prosthesiso
B. Aural Clinic
The counselor's problem of selecting the most suitable hearin~ nid for the hard of hearing may now be greatly modified by utilizing the services that nre available to clients of the Rehabilitation Division from the Aural Center. Rehahil:Lto.tion programs in other states, who hnve hc.d such service 2..vailable for the past fm-J yenrs strongly recommend this method of selecting henring ;;.ids and ho.ve found the Aural Center to be the ar..swer to most of their former problems in providing the above type of service.
It is required that all prospective clients, where hearing aid is recommended. :md to be '\vorn for the first time, be sent to the Aural Center nnd j_n like manner all those '"ho have experienced much difficulty

8.2521
in Hearing an instrument in the past. This request is in line with our general policy of obtaining the very best diagnostic servic& before writing plan for provision of any appliance, surgery or treatment of the client.
Counselor should have client examined by an ear specialist prior to sending him to the Aural Center, and copy of this report should be sent in advance of his arrival. It takes about one fourth of a day to complete all tests for the selection of a hearing aid, and in view of this fact, counselor must make appointment in advance. After the selection has been made, client can '..:>e fitted with an instrument purchased from a company in Atlanta or returned to his home and secure designated appliance from a company located in counselor's area.
Some of the clients will need speech training in order to obtain maximum use of hearing aid. This is particularly true of those who have nerve deafness, and to some extent of those with mixed deafness. Where this is indicated, counselor should give careful consideration to making provision for this additional service and when recommendation of speech therapist is not followed, counselor must give substantial evidence in case history for doing otherwise.
Experience has shown that a person with a hearing loss to the extent that it is a vocational handicap needs not only to be fitted with a suitable aid, but must be encouraged and motivated to use the appliance or instrument, or else the money and time will have been wasted. The counselor, therefore, is required to follow the above orocedure in the future, as it is felt this will be much more satisfactory than the old method of selecting a hearing aid.
C. Paraplegias And Other Seriously Disabled
In working with the seriously disabled such as the paraplegia, counselor must realize that this type of case will require very careful study prior to working out any rehabilitation program. To properly make this study, counselor should have a sufficient number of interviews to know the person well enough to feel reasonably sure that he can get his full fledged cooperation and be assured that he really 1r1ants the service. The counselor should also collect in advance all medical data from physician, hospital, and clinics 1r1here client has been previously treated or cared for and see that copies of this as well as good narrative report covering the history of this case are forwarded to the clinic where client is to be treated. Prior to sending one of these clients to a rehabilitation center, the counselor should see that sufficient examinations have been made and treatment such as plastic surgery and that of a urological nature and etc. are provided in advance, and that the person is ready to begin the rehabilitation program of exercises on arrival. By providing the surgical and medical treatment in advance, the counselor will be able to save a considerable amount of money and the client can be kept nearer his home.
On those cases which have ulcers and urological problems, counselor should see that these people are treated by sr,>ecialists in their field. There are some few physicians in the state who have had considerable experience working with paraplegias and other seriously disabled persons and it is strongly recomnended that the counselor use the doctor who has had wide experience in treating patients with this type of disability. When the client returns from the rehabilitation canter, counselor must follow through on the case immediately and see that only a few days are allowed to elapss from the time client is placed in training or on a job. It is

most urgent that this be cnrried out or else all the money nnd time that has been spent on the case will be Hasted as client will relnpse into the same condition as existed prior to going to the rehabilitation center.
D. Rheumatoid Clinic
A client suffering from Rheumatoid Arthritis (hnving existed six months or longer) may be considered as n condidnte for diagnosis and probnble trentment at an ndequntely staffed and V-Tell-equipped Clinic,, To meet the minimum requirement, the stnff should be composed-or-an Internist, Orthopedist, and Physiatrist and the equipment should be ample for thorough exnroination and provision of reco~menued thernpyo The counselor must be very selective in working with clients 1-1ith this disnbility.
8.2522 Convalescent Cnre
This service may be provided a client J:Jhen the evidence indicates that such is needed to satisfactorily complete the physical restoration phase of the rehabilitation. progrnn~ Convnlescent care mny be provided under the following conditions~
1. When the counselor advises that home conditions arc not conducive to the client 1s sntisf"..ctor~r convalescenceo
2. .men the client is dismissed from the hospital and lives nt such a dist.:mce that it Hould be impractical or detrimental to the client ts welfare to be trnnsported back :md forth for proper medical follmv-up.
3. ~vnen the client is to hc.ve tHo or more operations and the cost of hospitalization c.:'.n be reduced by using a convalescent home during part of the inter-oper.:'.tion period. This must be with the approvnl of the attending physician,
4. :.men the attending physician states that a conv:1.lescent home
may be used during the treatment period instead of a hospital, provided the cost can be reduced by such a measure.
All convalescent homes must be approved by the central office nnd an established rntc must be set up Hith each one.
The client Hill stny in the convalescent home no longer th~n the attending physician and the counselor feel it is necessary to insure the success of the physicc.l restoration service. The period of stay will vary C'.ccording to circumstances in individual cnses, but in the majority of cnses this should not exceed eight weeks. In unusual cases, mD-intennnce may be proYided up to six months, but there must be ample reason to justify this and such o.ction. must be a.pproved by the assistant director in charge of technical services.
8.2523 Appli~ces
1. Artificial Limbs 2.nc1 Braces
This service is to be provirl.ed 1Jhen there is evidence that nbsence of a suitable prosthesis hns prevented client from securing, rctnining, or performing work he is othcrtdse prepnred to do or for ~-l"hich trnining is proposed. The report of the ortr.opedist should indico.te o. satisfactory stump or evidence that client has nlrend:'t successfully worn a. regulation nrtiricial limb. If ~putation WC'.S caused by

8.2523
disease of the circulatory system (such as: diabetes, Berger's disease, or arterj_osclerotic gangrene) there must be an examination by an internist with a report showing that the disease is under control and recommending a prosthesis. For clients who have had an amputation because of a malignancy, a period of one year must have elapsed prior to accepting the case for this service and then only on the basis of satisfactory medical evidence that recurrence or spread of the disease is unlikely.
For clients who have never ':rorn artificial arms or legs, or who have experienced difficulty in wearing them in the past, it is required that they be given a short period of intensive training in the use and care of sam3, if recommended by the physiatrist at the Amputee Clinic.
If brace is to be provided, unless replacement, there must be evidence that this has been prescribed by an orthopedist following a special examination.
The above appliances are to be purchased only from a company with whom the division has a contract and it is understood that payment will not be made until the counselor is assured that the appliance is satisfactory.
2. Hearing Aids
A client will be provided this service when there is a reoort from an ear specialist certifying a hearing loss of at least thirty decibels in the better ear and that the client will profit vocationally from the use of th]s instrument. For clients who have never worn a hearing aid before, or who have had difficulty in wearing an aid in the past, it is required that they be sent to the Aural Clinic for determination as to the type of hearing aid best fitted for the client.
3. Glasses
A client may be furnished glasses when there is medical evidence from an approved oculist or opthalmologist indicating that there is sufficient visual disability to constitute an employment handicap and recommending glasses as a corrective o~artial corrective measure. The requirements for eligibility due to visual disabilities are listed in Section 5.301; and if a client is accepted and glasses are needed to complete the rehabilitation of the individual, these may be supplied.
Nhen there is another major disability which establishes eligibility, but glasses are needed to achieve the total rehabilitation plan, these may be supplied as a supplementary service. Glasses are to be purchased from renutable companies according to the prescription of the specialist and at prices within the schedule of fees.

4. Artificial Eyes
This service may be furnished a client who has had the enucleation of an eye, provided the artificial eye will result in improved appearance, thereby making the client more suitable for employment. Medical evidence from an opthalmologist should indicate that no disease exists which might make it dangerous or impractical to wear the artificial eye, that the socket is satisfactory or information that the client has satisfactorily worn an artificial eye,
Artificial eyes are to be purchased from approved companies at a price not to exceed that set up in the fee schedule,
5. Special Built Shoos, Supports, etc.
A client may be provided with one of the above items when there is mudical evidence from a specialist indicating that this service is needed for completing the rehabilitation plan of the individual.
Intercurrent Illness
Hodical care for acute conditions which would endanger achievement of the rehabilitation objective may bo provided for a short period, not to exceed thirty days with respect to any one illness, for clients who are economically eligible, provided the illness arises at the time client is actually recoiving rehabilitation services such as physical restoration and training,
This makes it possible to meot unpredictable and 0mergoncy conditions which cannot b~ met through the regular physical restoration channels where the normal procedures and usual requiremvnts have to bo met. It is expected that normal procedures will bo followed insofar as practicable, but in bona fide emergoncias the counselor would not be expected to get a vrritten medical report or issue an authorization prior to treatment of an intercurrent illness.
' '.

8.2524
Services which may he made available for short periods for acute conditions include necessary professional services, hospital care, unusual transportation incident to the cas~, and necessary drugs and supplieso
The am01mt of pa~'laent for care during in~ercurrent illness cannot exceed rates establi:>bed for physical restoration services. In the absence of establish0d rates ,;ith a hospital or clinic, the rate of payment will not exceed that usually charged other clients. The counselor will place in tho file on these cases a report from physician showing the condition requirin~ the treatment and a report of services rendered. Payments for medical caro during intercurront illness vnll be made direct to the vendor. All servic0s for intercurrent illness must be coded as maintenance (Federal
hianual, Chaptc:r 21, Section 1, pages 7-8 ).
8.2525 Transportation and !laintenance for Physical Restoration Services
This service will be provided for clients vrho are economically eligible vrhen it is an essential and necesr,ary element in obtaining medical or dental treatment, ~urgery, physical therapy, and fitting of appliances. The counselor vvill make arrangements for client's transportation to his destination and return home, and will be guided by the attending physician as to the t:~e of conveyance most suitable for the client's condition. A round trip ticket should be bought unless there is ample reason - e. g., client will be brought home by relatives or friends - to justify the purchase of a one-way ticket. Funds for lneals and taxi fare should be provided tha client when it has been determined by the counselor that the client cannot pay these expenses. If client has to remain away from home over night, arrangements should bd made in advance for lodging. In those instances where client is physically unable to [~o by bus or train, but can be transported by car or arabulan~e, the counselor Hill use the most econor.1.ical conveyance, provided suitable and safe arrange:aents are made. For transportation by car, the exrenses must not exceed six car.ts per mile for actual mileage in transporting cliont; $5.0C per die1:1 or a portion of that amount in accordance with the part of the day required by the driver and the actual expense incurred for mools and lodging in transporting of client.
Pa~'lllent for ambulancJ transportation cannot exceed the amount specified in the fee e>chedule ..
8.2526 Rehabi1itat-; o:1 (', r,-::,__;r~
A client who is so s,~V,;rL~ly di;;ablcd that it is not advisable to give treatment and training :L:t -u-:.c u3ual rit~mncr is the type of case for whom the provision of service in a rehabilitation center should be considered. The usual data collected on a case must he supplemented by a report from tte physiatrist in which a favorable recoJm:h_nda tion is giv,Jn for such a program for the ir,dividual and approval of the report by tho state medical consultant,
After tha counselor secures sufficient data to indicate that the client should profit by being sent to a rehabilitation center, he will make up the plan in accordance with th8 schedule of fees approved by the central office for such a center. The counselor will indicate that the client's family has accepted the plan and the counselor will make all arrangements for transportation. Arrangements will also be made for the client, his family, relatives, or some other agency to as:~ume responsibility for the expenses of clothing for the cliE.mt during his or her stay at the rehabilitation center. At the pres.:n:t tir:1.e, there are very few rehabilitation centers, and the division will lir.1.it the use of them to those that are accepted by the central office.

Prior to accepting a case vrith a thoracic disability for physical restoration service, there must be medical evidence from a specialist in this field indicating that the disability can be substantially improved or corrected to the point of employability. The fact that a client has a thoracic disability and is in need of surgery does not justify the acceptance of the case. The acceptance will depend on the favorable prognosis and the work expectancy of the individual as a result of the surgery.
The counselor should have medical evidence indicating the need for an examination by a specialist in this field before sending the client to a thoracic surgeon and a copy of this evidence should be in the hands of the thoracic surgeon prior to arrival of client. In determining the type of client that should be sent to a thoracic surgeon for examination, the counselor should keep in mind the following facts:
1. There should be no systemic illness that would othervdse contraindicate favorable prognosis from treatment and employability.
2. The client should have a work expectancy of at least five years after completion of treatment.
3. A patient with bronchial asthma is rarely eligible for thoracic surgical care unless a localized area of bronchiectasis is considered the primary factor responsible for the work disability or the asthma. Such a patient should have a favorable prognosis from an internist.
4. Before accepting a client with congenital heart disease, such as,
patent ductus arteriosus, coarctation of the aorta, tetralogy of Fallot and tricuspid artesin and pulmonary stenosis or acquired valvular heart disease such as mitral, aortic, pulmonic or tricuspid stenosis, there should be a report from a cardiologist and a thoracic surgeon giving a favorable prognosis for at least medium or light work for a reasonable period of time. In general, operations for congenital heart disease carry less risk and a better prognosis in the young age group. In acquired heart disease the underlying cause (usually the rheumatic fever) must be a quiescent stage over a reasonable period.
5. A client with pulmonary tuberculosis should be referred to the
State Health Department. 6. A client with silicosis vdll not be accepted for physical
restoration service. 7. A client ;rith neoplastic disease (lung carcinoma or esophageal
carcinoma) should be referred to the state cancer clinic.
8. A client suspected of having a mediastinal parathyroid ademona
requires a report from an internist and a thoracic surgeon giving a favorable prognosis.
9. In considering clients diagnosed as having bronchiectasis, the
counselor should appreciate the freqw.mcy with which the diseasu
m"l.y be bilateral, (75%). In cases with bilateral disease he must
ascertain ~-rhether bilateral surgery will be required and if so, what limitations in work capacity may result. In such cases careful attention must be paid to the restriction in work capacity and surroundings specified by the thoracic surgeon. Clients with bilateral disease may expect no work limitations in many cases. In some cases, however, unilateral operation may adequately rehabilitate th-:; bilateral case, thus a minimum interval between lobectomies of nine months is recommended. During such interval, certain t~~os of work or rehabilitation training can be carried out.
(SQction 8~2~27 approved and added 3-2-51)

8.2.527
10. The long term results from "plastic" operations for cardiospasm (with or without megasophagus) are-not considered sufficiently satisfactory to justify consideration at this time. Dilatations procedures may be beneficial but may need repetition. As a general policy, cases with this type of disability offer a poor prognosis and will not be accepted for service until favorable recommendation is obtained from a thoracic surgeon.
11. Diaphagmatic hernias can be treated by either the general surgeon or thoracic surgeon, unless the lesion is through the right diaphraghm. These clients should obtain full work expectancy.
12. Clients with chest deformity such as "funnel chestn may be
candidates for rehabilitation surgery if such defect is interfering with heart function. Such clients can usually achieve full work expectancy. Major defects of the chest wall resulting from accidental injury are also eligible for surgical reconstruction if given a favorable prognosis by a thoracic surgeon.
13. Chronic empyemata with draining chest wall sinuses may be rehabil-
itated by proper surgery. Partial excision of a tract and/or a secondarily infected rib will not result in rehabilitationc Pulmonary decortication operations will not be accepted for service until favorable recommendation is obtained from a thoracic surgeon.
14, Favorable consideration in patients with aneurysms must be confined to aneurysm of congenital or traumatic causes; other aneurysms do not qualify as they are a local manifestation of a systemic il~ss.
8.2.528 Neurosurgical
There should be medical evidence from the client's family or other physician recommending an examination by a neurosurgeon prior to making an appointment with himo If the examining physician is in doubt concerning the diagnosis but feels client should have a neurological work-up, case should be sent to a neurologist. If the findings are clear cut and neurosurgery is indicated for the necessary correction or improvement of the disability, then case should be sent to a neurosurgeon for examination and opinion. The acceptance of the case for physical restoration will be based upon the findings of the neurosurgeon, the prognosis, the work expectancy, and all other factors that may affect the outcome of the case.
The counselor will only accept cases where the impairment is reasonably static and the disability has existed for a period long enough not to be classed as acute. The evidence must further indicate that the condition can be substantially improved or corrected within a reasonable period of time.
In considering a client for examination and treatment by a neurosurgeon~ the counselor should be cognizant of the additional following facts:
1. There should be no systemic illness that would otherwise contraindicate favorable prognosis from neurosurgical treatment and subsequent employability.
2. The client should have a work expectancy of at least five years after completion of his neurosurgery.
(SectionR 8.2.527 and 8~2S28 approved and added 3-2-.51)

8.2528
3. Cerebral aneurysms and vas euler ..alformations should seldom, if ever, be acce~ted for Dlcysical restoration s~rvice beyond the age of forty.
4. A client with a brain b.m10r estim<,ted to be of a malignant ch~racter, should be referred to the state cancer clinic.
5. A client with a tu;nor of the skull radiolot;ically dcnicted as malie;nant such as: metatastic growths carcinonatous invasi~n fro~ the skin and Paget's disease should ~e referred to the state cancer clinic.
u. !~ client needing laminectomy for cordotomy in metastatic diS3:J.SeS vrill not be eligil:Jle for s;rvice.
7. A :;l :c.:~t v-ith advancl.:d arteriosclerotic extremities above Vw fA '3 uf sixty, Fill not be accepted for a sympathectomy.
8.2529 I~surance
Prj_or to vrrit:int: lett.;r of authority, tha counselor r:mst make a thorough investi.c,~:.ti.o~~ to d,Jt'3~--~;:_ino ii' client has any nersonal or com~any insurance ihich ay nay nart or the entire amount of hospitalization and surc;,:;ry. :;vidence raust be in the cc.se record to indicate that the counselor has chocked the ;-olicy and also ti:.<.ken the matter up with the employer, to ascorts.in the exact a:.lOunt that :.cay be anticipated from the cu.rrent ;:'JOU.cy. Tho c0unselor :.;ill furt>3r notify the hos?ital that the
cl icnt has the pol icy which will uay a certo.in a ..10unt for hospitalization and t:;uarantee the hosnital the difference b3tween y:ho.t the pol icy allows :~nd th3 per diem rate paiu by the Division of Vocational Rehabilitation. In those instances 1'1'here th:J hos:~itc.l 1ill not accept this tyne of arrangedent, tho counsalor v.ill cot a stutc.,.\:nt fro:::. the individual assi;;ning the C,,wunt co',:ered by the ~olicy to the Division of Vocational Rehabilih'.ticn. In such instances the counselor will further notify the hospital tJ:at thoy should not fill out insurance form for ir..surance Yiithout first clearing this rr~atter vri th the counselor in charge of thJ c~;.se, since this noney is to he paid to the Division of Vocational Rehabilitc..tion and not to the client.

0lupter 11, 2Gc:tion h, and Chapter 2), Section 3, pages 11 and 12, give
the Federal rc:guJa tions and instructions about provision of tools and equipment. These should be studied carefully by the counselor but not
more than :fl.6oo.oo may be provided for this type of service except by
permission of the directoro The State Agency will retain a residual title to the tools and equipment and this statement should be included in copy of letter of authority.
In the controlled vending stand program where the client is not given the equipment hut he is considered an employee of the Georgia Cooperative Services for the Blind, it is not necessary to establish economic need to buy the equipment for the stand siteo In all other cases, economic need must be established on the client before providing him with tools
and equipment. Chapter 25, Section 1, page 8, parngraph 601.16 give the
limit on various types of situations for the controlled business enterprise.
1:rhen the counselor contemplates establishing a business enterprise for a client, it is stror.gly recommended that he consult vrith the 3upervisor of Busir,ess Enterprises who can give valuable information on many factors relatin~ to the success of small businesses because of his years of ex:rericnco in supervision o.f projects of this kind.
Busir,c:ss ente;rprises should be reserved for the severely disabled or blind. Clie!:ts v.ho cetn successfully be placed in employment should not be assj_stud in establishing a business.
The counselor should be as conservative as possible in tho prov1s1on of tools and uquipment consist\mt with doing a reasonably good job in rehabilitating tho client. Thorough investigation should be made of each situation to deterrnine:
1. That the tools or equipment are absolutely necessary in the particular objectiveo
2. That the employer will not furnish the tools or equipment for his workmen~
3. That the tools or equir::ment are for the use of the client himself and not for otr:or employees in the business establishment,.
4. That the tools cr equipment are those customarily used
by workers in that objective or that they are specially constructed to compensate for part of the disabilityo
S. That the client underu t-.aJ.ds he is to return the tools
or equipment as soon as he ceases to use them personally. 6. That the vocat.j_.olJ3.l obj.:..;ctive is one that is likely to
succeed.

9.0 REPORTS AND RECORDS
9.1 Local Office Records
The counselor is responsible for maintaining records of his work in the local office which will be used in making reports, preserving case data and other information which will be needed in his work. The records kept should conform to those required by the Federal Office as well as those adopted by the state agency. The systems should be rather uniform for all the offices. There are a number of files which must be maintained if the office is to function efficiently. Among the most important are the following:
9.101 Closed Case Card File
Each office will maintain a card file of cases previously closed. These cards should be filed alphabetically. The file should be centrally located so all secretaries may conveniently use it in looking up referred cases. Vfhen a case is reopened, the card should be removed from the closed file, stapled to the new card and filed in the active card file. Each card will show how the case is closed and the date, as well as the date of all status changes made during the time the case remained on the active list.
9.102 Active Case Card File
Each counselor will maintain an active card file on his cases. These should be filed alphabetically by sections as desired by the counselor.
The first section should be for his referred cases. The other sections may be filed one of several ways as follows:
1. All active cases in statuses one to eight filed alphabetically. 2. They may be filed alphabetically by tally lines, Q, R, and
new cases. 3. They may be filed as in No. 2 above, with each tally line
section broken down by statuses.
4. All active cases in statuses one to eight filed alphabetically
by statuses.
The last section of active case card file will be for the cards of cases closed since July lst. These may be filed alphabetically or alphabetically in sections, determined by the method closed.
9.103 Closed Case Folder File
There should be a central file in each office for closed cases. If individual folders have not been set up for referred cases, a separate folder for each letter of the alphabet should be made in which the clo~1re forms are filed alphabetically. All closures are filed together.
(Section 9.102 revised and approved 3-2-Sl)

9.104
9al04 Active Case Folder File
Each counselor should maintain his own active case folder file. These may be filed alphabetically, or if the counselor prefers, he may file them in two sections as follows:
1. Cases in referred status. 2. Cases in statuses one tmough eight.
The tally line and status may be written on the front of the folder to make it easier at tho end of the quarter to check his folders, file cards, and ~Tite the status on his master list of cases.
9.10.5 Haster List File
Each counselor will make three copies of his master list of cases. This list will inclu-::le all cases which have been accepted and have not reached the point of closure on July 1 of each fiscal year. The cases will be classified in two r;roups depending on the length of time they rove been on the case load since acceptance., All cases which are more than one year old will be Tally Line Q cases~~ All those which were added to the case load the past ;year in Tally Lines S, T, W and X, will be Tally Line R cases. A new list of cases vrill be made for each quarter designated as Tally Line
s, T, W or X cases, depending upon the quarter in which they became
accepted caseso
When the new lists of Q and R cases are made up on July 1, the counselor
will send two copies to the District Office, one of which will be forwarded to the State Office. As soon as the quarterly reports are made the counselor will send two lists of his new cases with his copy of the old cases and previous quarter cases to the district supervisor who will consolidate his report. The district supervisor vvill keep one of the new lists and send one to the central office. when the status chan.,;es are made on the central office copy of the master list, the counselor!s copy of the w~ster list will be returned to him.
9.lo6 Report of Authorization File
The counselor will list his authorizations on a form provided by the central office.. The list will be cumulative from July 1 of each year. These reports will be filed chronologically and the file will be maintained for the fbcc~l ;;r.:..tr o A loose leaf binder or a file may be used, and the reports shoull Ll; b;.Jt :::~or ready reference and frequent review by the district s llJ?orvi:~cr \i!':::n to visits the office
9.107 Inventory File
The counselor will maintain a file for inventory of the equipment in hi.s office o A new report will be made to tbe ct:mtral office each July and a copy of the report placed in the counselor's filee Thi~ may be kept in a folder or a loose leaf binder.,

9.108
9.108 l~emoranda from District and Central Office
The counselor should maintain a systematic way of filing all general memoranda issued by the supervisory and administrative personnel. It is suggested that he secure a loose leaf book and file the memoranda chronologically as he receives them. He will probably need a new binder for each fiscal year.
9.109 Training Institutions and Rates
The counselor will maintain a loose leaf book for filing all sheets about training institutions and amounts paid at the institutions. These should be filed alphabetically by name of institution and kept for ready reference. A second book should be maintained in which those training sheets which are superseded may be filed. A folder file is maintained for filing additional information about training institutions.
9.110 Hospital Rates, Schedule of Fees, Panel of Specialists
The counselor should use a loose leaf binder for keeping his schedule of fees for appliances, surgery, ambulance transportation, and other physical restoration costs; his rates for appro"ed hospitals; and the panel of physicians on the approved list. These should be kept in a convenient place for ready reference in making plans which require any of these services.
9.111 Itinerary Reports
The counselor should use one folder for each year to file chronologically copies of the itinerary reports which he makes to his district supervisor and the central office,
9.112 Monthly Expense Reports
The counselor should maintain a folder in which he files his monthly report showing expenditure for which he asks reimbursement. There should be a separate folder for each year.
9.113 Occupational Information File
There should be maintained in each office a file where occupational information on various vocational objectives is kept for ready reference for the use of all counselors in the office. One or two drawers in a file cabinet may be needed as the information is accumulated. The Federal Office of Vocational Rehabilitation has distributed a number of occupational leaflets on various objectives. Guides should be used in this file to facilitate finding the desired information.
9.114 Federal and State ~1anual of Policies
Each office will bo provided with revi3ions of the Federal Manual of Policies as they are released fran the Federal Office. The State Manual will be distributed to all personnel. Revisions will be made from time to time and the revised material should be inserted as it is received. Revised material will be dated. Binders will be provided for filing the manual materials and one will be used for each the Federal and State Manuals.

9.115 Federal Office Releases
Many releases are sent out by the Federal Office for redistribution to all local offices. The counselor should maintain loose leaf binders for each series and the releases filed chronologically. There are rehabilitation service series, administrative service series, information service series, and several others.
9.116 Correspondence File
Each counselor will wish to set up a filing system for his general correspondence with various agencies to make the information readily available for reference.
9.117 Other Files
Listed above are most of the files a counselor will desire to maintain in his office, but there may be other info~ation he will want to keep. Should there be, he may set up a definite system for keeping the information.
An orderly and well kept office means efficiency. The convenient arrangement and storage of necessary supplies will enable the personnel to locate them speedily and to reorder sufficiently in advance to prevent exhaustion of the supply.
9.2 District Office Records
Tho district supervisor will need to keep sufficient records to enable him to give good supervision to his counselors. He will need to keep many of tho files the counselors keep, such as: flow sheet file for counselors in his district; report of authorization file for each counselor; memoranda file; training book; file on hospital rates, fees, and panels of specialists; itinerary reports of counselors; monthly expense reports for himself; federal manual of policies; federal office releases; and correspondence files.
9.21 3tudies of Work in District
A file for studies of various phases of the work done hy the counselors in the district will be maintained. There should be a master card file of all cases in the district. This file can be the closed file for all the counselors.
9.22 Closed Case Report File
Tho district sup0rvisor will maintain a file for closed case reports of cases closed by counselors in his district. These should be filed alphabetically for easy reference if needed for review. The chronological history that is submitted with thorn will be stapled to the reports and filod with them.
9.23 Correspondence File
A separate folder for memoranda to and from counselors will be maintained and the memoranda will bo filed chronologically.

9.24 List of Cases Closed by Counselors
Each district supervisor will keep a list of the casus closed as referred,
and in ~tatus 13, 14, and 15, as they are sent through his office to the
central office. This will be done for the purpose of checking and consolidating the flow sheets of his counselors to make his district report. These may be listed on a sheet of paper chronologically with a list for each type closure.
9.3 Central Office Files
There are number of files kept in the central office for the purpose of preserving records and making the material readily available when needed. ~he most important of those are the following:
9o301 Closed Case Card File
The cards for all closed cases are filed alphabetically for the purpose of making it easy to check for duplications on the caseload when a new referral card is received in the central office. The cards arc used for the purpose of locating case data from the caso folder files.
9.302 Active Case Card File
Tho central office maintains a card file of all cases which are in referred status and on the master list. These are filed alphabetically and are used for checking duplications on the case load and also for locating information about the client. VVhen the counselor sends in a new case card it is checked against both the closed and the activo card file. If the case has been served previously, the old card is removed and stapled to the new card and the two arc filed in the activo file. The counselor should note on the card that it is a reopened case if the client has been previously served. If there is no indication on the card that the counsolor knows the case has been served before, the central office will notify tho counselor of previous service and give information about what was done and how tho case was closed.
9.303 Closed Case File
The central office maintains a file by years of all cases which have been closed. These are spearated into two sections for each year. One section is for filing closed case reports on all cases closed as employed during the year. These are filed alphabeticallyG Any material on the case is stapled to the closure and financial sheet and filed together for that fiscal year. If the case has been closed previously, the old case data is allowed to remain with the case files for the year in which it was previously closed. In these cases the two cards which are stapled together, one for the first time served and the other for the second, will lead the person to both files when checking for case data on the clie~t.
9.304 Active Case File
A file is maintained for each client on which an authorization has been made since July 1, l950o The letter of authorization and the chronological history of the case which is submitted with the first authorization on a new case are filed in the client's case folder. These letters of authorization remain in the file until the case is closed; then the material is removed from the active file, stapled to the closure report (Form R-9), and filed ~~th the closed cases.

9.305 Encumbrance Record File

9.305

The central office maintains a file for the individual encumbrance and record of payment sheets for all active cases. When the report of the counselor's authorizations is received the bookkeeping department records on the individual sheets the amount encumbered for the various services. When the bills are paid, the payments are recorded on these sheets giving a complete record of financial accounting for each client. These encumbrance sheets are filed alphabetically. \~en the case is closed the financial sheet is pulled and stapled to the closure report bringing together the case data and the financial record of each client, and the material is filed alphabetically by years in one of the closed case data files.

9.306 Report of Authorizations

Each counselor sends in a report of all authorizations and cancellations which he makes for his clients, including costs of medical examinations and transportation for diagnosis. Attached to these reports are copies of all letters of authorizations and memo on which he authorizes certain types of minor services or small extensions for which letters are not necessary. Copies of these authorizations are removed from the report. There is a folder for each counselor and these are filed alphabetically, but the reports in each counselor's folder are filed chronologically.

9.307 Master List File

Each counselor makes a copy of his ~rmaster list of cases in active status each July. One copy of this is filed in the central office. These are filed alphabetically by offices. At the end of each quarter the counselor sends his copy of the master list through the district office to the central office and the statuses are written in on the state office copy. Lists of new cases are added to the counselor's master list each quarter and a copy of these ie sent to be attached to the district and central office copies.

9.308 Flow Sheet File

The central office maintains a loose leaf file for individual flow sheets of all counselors carrying a caseload, the consolidation of the reports by districts, and the reports sent to the Federal Office. These are filed alphabetically by quarters, and a new binder is begun each fiscal year.

9.309 Itinerary Reports

The central office maintains an individual file for the itinerary report of all professional staff members whose work makes it necessary for them to travel. They are filed chronologically by persor~el.

9.310 Hileage Reports

The central office maintains a file for the mileage reports of each staff member who is authorized to travel by automobile. These reports for each day's travel are filed chronologically by personnel and used for checking requests for reimbursement when the individual submits his monthly report.

9.311 Monthly Expense File

9.311

Each staff member authorized to travel must submit a monthly report for every month in which he travels for which reimbursement is requestedo These are filed alphabetically by month.

9.)12 k~?nnel Rating File - Report of Performance

The central office maintains a personnel file on all employees. The file may contain the original applications of the person for the position and rating formso These are kept by the director and are not available for review by staff members other than the individual concerned and his supervisors. They contain the merit ratings given the individual. All reports of performance are to be submitted in accordance with regulations set forth in the Merit Board Manuala

9.313 Mailing List for Rehabilitation News

The central office maintains an addressograph file with the names and addresses of all persons on the mailing list for the Rehabilitation News. These are in constant revision because new names are added and old names dropped as needed to keep the mailing list accurate.

9.314 !raininr, Information File

The central office maintains a folder for all training institutions used. Additional information to that given on the training sheet is maintained here~ The training sheets are filed in a loose leaf book in alphabetical order by name of the institution.

9.315 Schedule of Fees, Hospital Rates and Panel of Specialists

The central office maintains a file for correspondence and for reports which are the basis of establishing fees for physical restoration services including hospitalization. These fees are tabulated in systematic order and mimeographed for distribution to professional personnel for use in writing plans. The mimeographed list of rates, hospitals, and approved physicians may be kept for ready reference by using a loose leaf binder and filing these with guides for each section.

9.316 Federal and Regional Releases

A file of all Federal and regional releases is maintained in the central office.

9.317 Inventory File

The central office maintains a file for the inventory reports submitted each July listing all equipment in the offices which belongs to the agency. These reports are filed chronologically by office.

9.318 Correspondence With other Ahencies

The central office maintains a file for correspondence with personnel of other state rehabilitation agencies and it is arranged by states.

9.319 General Correspondence File

9.319

The state director and other professional staff members in the state office maintain separate files for correspondence of a general nature with other agencies and personnel of other agencies.

9e320 General Memorandum File

The state office numbers chronologically all memoranda of a general nature and maintains a loose leaf binder for filing the memora11da chronologically.

9.321 Attendance, Sick Leave and Annual Leave File

The central office maintains a record of the attendance of all staff members, as well as the amount of annual and sick leave taken by the individual, and the amount he is entitled too Some person is designated in each local office to keep a record of all personnel in the office and make reports to the director as requested to maintain the central office record of all personnel of the agency.

9.322 Invoices Submitted for Payment

The central office maintains a file for the invoices for which checks are written. They are filed in cardboard folders using one folder for the transaction for each month. These folders are filed chronologically by years.

9.323 Requisitions for Purchases

The central office maintains a file for all requisitions which are submitted to the purchasing department for supplies and equipment. These are filed chronologically by years.

9.324 Occupational Information File

The central office maintains a file of occupational information including studies and investigations of various types of disabilities and vocational objectives. Some of this information is filed by disabilities and other is filed by occupations for ready reference.

9.4 Discarding Records

It is the policy of the agency to maintain individual case folders for a period of at least seven years, after case is closed. To conserve space and save purchasing filing equipment, the counselor in the local office and personnel in the central office may destroy data in the individual case files after a period of seven years, but will retain from each case file the closure report form on each case. This will enable the counselor and/or the central office to know in a general way what action has been previously taken with regard to the client, including the amount spent for various types of services for the client.

In the local office, these closure reports will be filed alphabetically in one or more folders behind the case folder for each letter of the alphabet. In the central office, they will be filed alphabetically by years. In destroying case files, the counselor may retain the file on a case which presented unusual problems in his rehabilitation program or an especially outstanding case.
(Section 9.4 revised and approved 8-28-51)

lOtO FISCAL FROCEDUR~
The rehabilitation division maintains a system for the authorization of all services, for the verification of all payments and for the accounting of all funds of the a:;enc;:y.
10.1 ~uthorization for Payment of Salaries
The State Plan provides job classifications with a salary schedule for all personnel. The State Merit System also maintains a personnel administration service for personnel of the agency with a job description and salary schedule. All payments for salaries are based on the salary schedule in the State Plan. Annual increments are granted by the state director upon satisfactory rating and availability of funds.
10.2 Authorization for Travel of Personnel
The state director is responsible for authorization of travel allowance This is usually done annually when the director allocates funds to counselors. The amount is determined by the individual's need. Personnel authorized to travel may travel within their area for routine business relating directly to vwrk of the agency.
Prior to any travel outside of his immediate territory except an adjacent county, counselor must secure authorization from district supervisor except as instructed by the State Director.
Out-of-state travel is granted only by the State Director, when he feels the travel is justified on the basis of its value to the program. Personnel serving border counties are permitted to travel in immediate adjacent territory when, in the course of their routine work of investigation and supervision of clients, it is necessary to travel outside their area.
10.3 Authorization for Expenditures for Diagnostic Purposes
Counselors are responsible for authorizing expenditures for diagnosis. This is done by issuing a copy of the authorization form "M.E .A 11 (Medical Examination Authorization) to the physician making the examination. A copy of this authorization is always maintained in the case folder.
When the hospitalization is required as part of the diagnosis, the counselor will issue a letter of authorization to the hospital for this service. The expenditure for hospitalization for diagnosis is limited to ten days. The counselor should be as conservative as possible in authorizing hospitalization for diagnosis.
Tho counselor should not pay for any diagnosis until he has studied the case enough to be reasonably sure he vdll serve the client after he provides the diagnosis. He should not provide the diagnosis until the client is ready to start the service if the diagnosis shows that he is eligible and feasible.
Medical diagnosis including hospitalization for this purpose is coded A.
Transportation for diagnosis is coded V-9 and may include hotel and meals,
as well as fares paid. When the counselor cannot arrange for transportation of the client to the examining physician without an expenditure, he may pay the cost of transportation. This service may be provided legally without determining economic need, but in practice the counselor should not pay it if the client can pay for this service.

The expenditure for diagnosis may include payments for psychological examinations when the counselor desires more comprehensive testing service than he is prepared to administer. This service is coded V-10 and a copy of the authorization for this service must be in the case file. The cost of travel for the purpose of administering tests will be coded V-9.
10.4 Autborizntion for Case Services
The couns,~lor is responsible for issuing authoriz;ations for all types of case services which are to be purchased for the clients. These authorizations must conform to established policy both as to the provision of particular services and to the schedule of fees established for the service by the a:;ency.
Copies of <c\11 authorizations except for diagnostic purposes are attached to the counselor's report of authorizations which he sends to the district and central offices.
The authorization for services shall not extend beyond a period of twelve months. For clients vrho require a longer period of training than twelve months it v-vill be necessary to issue supplementary letter of authorization at the end of each twelve months periodo
10.5 Authorization for Expenditures for Supplies, Equipment and Rent
The state director is responsible for issuing requisitions to the purchasing department for all supplies and equipment used by the agency. This does not apply to books, supplies and equipment purchased for the individual client as part of the services provided in his rehabilitation. Those purchased for the client may be authorized by the counselor, within established policy.
Counselors or other personnel desiring supplies or equipment will request it from the central office to be supplied from stock or purchased through the purchasing department.
10.6 Authorization for Other Costs
The state director may authorize costs necessary in the conduct of the confer::mces o.C trainLn:~ courses for in-service training of personnel, for the promotion and publicizing of the program, for travel of personnel not of the azc:ncy y,}c~1 :Y' i 112: used to render a service to the agency, for exhibits, pu\:1L li. _,;;, photo1~raphs, printing, and such other items as nece~;sary for t,;;:; c~'L cient and effective operation of the program.
10.7 ~esponsibility for the Accuracy of Accounting
The accountant is bonded and is responsible for the accuracy of the accotmting for all funds of the agency~ All expenditures made must be either provided for in the state plan or authorized by the proper person in the agency. All bills are checked against authorizations before payments are made.
10.8 ~esponsibility for tr~ Approval of Bills for Payment
To insure that all services purchased have been provided, the bills for services are submitted to the staff member making the authorization. The counselor, after determining that the service has been provided, vvill

approve the bill and submit it to the central office for payment. The staff member will record on the R-4 the required data for all bills submitted for payment, including number of days hospitalization, When supplies or equipment are furnished a client, the client is asked to sign the bill or a receipt which will be attached to the bill, showing that he received the supplies, prior to submitting the bill for payment to the central office.
10.9 Responsibility of Coding Bills
It is the counselorle responsibility to code bills in accordance with Chapter 121 Section 1, of the Federal Manual of Policies.
10.1~ Preparation of Budget Request and Financial Reports
The accountant, with the assistance of the director, prepares all budget estimates and financial reports for both state and federal officials.

11.0

11.0 lLOl

INSTRUCTIONS FOR USE OF REPORT AND CA3E WORK FORMS Fo:::n R~!Jm:_Yey, Ec0nomic Need, Plan and En-:n:..-n~rance

11.011 Persona~ D3ta Se~tion

This form is n~ed by the counselor for recording much of the information collect8d cboPt the client. The counselor should start the use of the form when he places the case in referred status. Much of the info~mation on the fi:st pa~e is the data used in comple::,ir.g the closure report on Form R-9 and should be accurate and ful:y complated.

Hhen the case is placed in referred status the counselor uill fill in the name, adc~ress, -Jaunty, referral agency v:. th codP., dnt.e the refe:::-ral was placed in refe::.red s::atus End the disa~Hity" If the nature of the disability is uncertain) this item may te filled in with pencil so that it can be changed when the medical reports a::.e received and the major disability ee~c;oJ.ished.

The remni nder cf pago one \v:l_ll usually be co~:r,""'.eted at the time of the first inte:cview witl1 the cl :.:..ent if it in appn?..::ntly a case ~vhich may be served. The date tbG survay is made should be writto1 on t!'le first line and if the client can be reached by telephone, the nmnber shoul.d be recorded to assist in contacting the client about appointments.

Only one item should be checked in the section for 11 classification11 The age, sex, race, marital status, number of dependents, da~e and place of birth should be recorded.

Under ":Sconomic Status at Survey" one of the three items which most nearly describes the condition of the client at the time should be checked.

Under 11 Source of Sunport at Survey" the one item which most nearly describes the situa!:,ion should be checked. If the client is making a weekly wage or if he is receiving relief from a public or private agency, the amounts for these items should be written in the space provided.

In giving the 1rCmployment History" the counselor will check only one of the three items. If the client has had a satisfactory job the HAJOR portion of the time S:C,TCE DISABLEliENT, the counselor will indicate substantial employment. If he has held only unsatisfactory or part-time, or no employment SINCE DISABLENE"1T, uns-c.'ustantial or part-time employment will be indicated. If the client has had no work history DURING HIS OR HER LIFETIME, "never worked" will be checked,

The spaces for education and other training should be completed, with the counselor being sure that ar.y special training the client had is listed as this may have some bearing on the selection of a vocational objective.

The counselor lvill check only one item under r:origin of Disability".

The disability listed ~Jhen client lJas placed in referred status may need changing if the rr.e dical info:::mation makes this necessary. In listing visual and hearing disabilities, the lo~s of each should be indicated by giving either percentage loss or the visual ac1ity. This information is to be included in the R-9 \-Jhen case is closed, and if the R-L is completP.d correctly, it r,ay be used for making the R-9 re7o::'t rat}wr than refer-ring

11.011
to the medical. Visual acuity should be listed for each eye: i.e., left 20/200; right 20/60.
The major disability should be coded according to instructions for completing the R-9 in Chapter 13, Section 2, pages 12-15 in the Federal .i'Ianual of Policies.
If there are minor disabilities, they should also be listed.
The date disability occurred and the age of the client at time of disablement should be recorded. If the disability occurred gradually, the client and counselor should estimate as best they can the approximate time. If client is wearing an appliance at time of survey, it should be listed.
The counselor will check whether the case is a new or reopened case~ If it is being reopened, the type and iate of previous service should be indicated.
In the space for family Jnembers, all information requested should be given. 1ifhen a client has no family, it is advisable to write in this space the living arrangements of the client and give names of people who can be contacted in the event it should become necessary to secure additional information about him.
In giving client's work history, begin with the last job held and give the last five jobs. If the space provided is not adequate to give information about the skills the individual may have developed in his work experience, this is to be added to the case history.
In completing the information about the job at time disabled and the job at time of survey, this should conform to the work history listed above. If it differs from that on the economic need form on page 2, full explanation should be made on the economic need form. The client might have been working at the time surveyed, but the preparation for placement might necessitate his giving up the job during this period, and the economic need form would not show a salary. This should be pointed out when filling out the economic need form.
The client should be asked to give three references which may be used for investigation or for finding the client in case he moves during the rehabilitation program of services.
11.012 Economic Need Form
This part of the form is used for recording the economic circumstances of the client. The standards for determining economic need are discussed in Sections 5.27, 5.271, 5.272, 5.273 of this manual. These sections should be studied carefully bv the counselor and adhered to in making his determination of eligibility.
The items are self-evident and do not need further explanation. It is important that all items tvhich apply be completed. The estimated period of rehabilitation may be difficult to make in some cases, but the counselor must establish a period which he thinks is adequate to complete the services. The completion of the form will depend on the number of weeks the service will cover. A netJ R-4a will be completed at the end of each 12 months pe~iod that the client receives rehabilitat1on service (requiring R-4a), and more often if indicated.

11.012
The counselor must question the client sufficiently to be assured he has learned of oll the resources of the client when he completes the form. In cases where he has reason to doubt the accuracy of the clients statement, he should inquire of people in the community, the welfare director, county health nurse, county farm agent, banker or others who may be in position to know about the resources of the individual.
In establishing the income of a farmer, the weekly income shall be based on the same as the average weekly income for the previous year. (Example: a farmer whose net income was $2600 the previous year, had an income of
$Sn.oo per week).
1f.hen any one or more of the 33 items need further explanation, the
counselor will use the space ~rovided by writing the number and the explanation. He should be certain that tbe data on this form is consistent with other case data in the file, and if not, explanation should be made.
The client should be asked to read the ag~eement at the bottom of the page before he signs. If he is unable to read, it should be read to him. This is a good place to make the client feel his responsibility for helping to make the program for him a success.
11.013 The Initial Plan Section
Page 3 is used for writing the initial plan for services unless the
space has been used for hospital diagnosis, in which case the supplementary plan form will be used.
The specific as well as the general objective and code, must be shown on the R-5, for example: secretary (clerical and kindred - 100) should be shown so as to conform with the general objective and appropriate code for Appendix B, Chapter 13, Section 2 of the Federal :-!anual of Policies. The general code is the one used in Item 20, when the R-9 is completed.
The counselor will list the total amount for each type of service Hhich he is authorizing opposite the proper classification and add the various items for the total amount. Each type of service should be stated briefly but accurately in the space provided, so that accurate letters of authorization can be written from the data recorded.
The other information provided for or. the form should be completed to show that the counselor has considered these items and made proper arrangements. Before authorizing the service, the counselor should sign the plan and date it to indicate that he has reviewed the plan and it conforms to poli;y of the agency with respect to fee schedule, services permitted by law, and the service agency being an approved one.
11.014 Encumbrance Record Section
The fourth page is arranged so that the counselor may keep an accurate record of his authorizations and payments. 1Iihen he makes an authorization, he will list on the left hand side of the page the date authorized, co'ie for type of service, and amount authorized. On the right hand side he will keep a chronolor~ical record of !)ayments. He '.-Jill list the vendor code, amount and date bill was sent to the central office for payment. If he l\eeps this record accurately, there will be no dif F'icul ty in ccmplethlls the clo~ure r<:port and showing the a~r.ount S'Jen~ on tree case.

11~02

Form M.E.A. (Hedical Examination Authorization)

The counselor is responsible for issuing a written authorization for each medical examination for which he expects to make an expenditure. This form is used for that purpose. The original copy of the authorization and a copy of the medical report form on which the physician reports his findings are sent to the physician who is to make the examination. A copy of the authorization must be kept in the case file. The authorization may be mailed to the physician, or the client may carry it when he goes for the examination. If the physician who is to make the examination has not made previous reports to or examinations for the division, he should be instructed by the counselor so that the report will giveall information needed to make a proper diagnosis of the case.

Copies of the authorization need not be sent to the district or central offices but the encumbrance for each authorization will be listed on the counselor's report of authorization with the name of the authorized physician. No authorization should be issued until the case has been studied sufficiently to know that it is one which will likely be served.

Form R-3, General Medical Report

This report form is to be used by the counselor and the physician to record medical history and physical condition on which to determine the eligibility of the client.

The counselor must fill out Section 1 of the report before sending it to
the physician for the examination. The physician is expected to give a full report on his examination by completing all items on the report. After completing Section 11 of the report, the physician will make his diagnosis and record the major and minor disabilities. He will give the characteristics of the major disability and indicate haw it affects the physical capacities of the individual. If treatment is needed he will indicate the need and the kind of treatment which he recommends. If he thinks that other examinations by specialists are necessary to make a complete diacnosis he will so indicate.

The urinalysis must always be secured and in cases where physical restoration is to be given, the scriological test for syphillis must be included.

There must be a general medical r cport in every case folder before the authorization of a service other than diagnosiso

ll.o4

Form R-3a 1 Pulmonarr Tuberculosis Report
This form will be used for the report on all cases suspected or known to have suffered with tuberculosis and who are to be served outside the sanitorium. The report should be completed on the basis of an examination within ninety days of the initiation of service to the client. The following procedure for making the diagnosis should be followed:

1. The counselor should arrange for securing a sputum specimen for three consecutive days in a single container which will be forwarded by the client or local health department direct to the State Health Department Laboratory. It will be better if the counselor can arrange with the local health department to collect the specimen and send it to the State Health Department Laboratory and secure the report.

11.04
When the specimen is examined, if the smear test is negative, a culture vd.ll be run and B.lso an an:Unal j_nnoculation test. In doubtful cases the couns~lor should wait for the culture and animal innoculation reports before proceeding to work out a plan.
2. If the sputur,1 test is negative the counselor will arrange for an examination by a physician who is a chest specialist or one vrho has been designated by the Health Department as being qualified to adrninistor pneumothorax refills and to give after-hospjtal follow-up on T.B. cases.
3. If the examination is to be at a place other than the sanitorhrrn, where
the prc-;vious record of treatment is available, the counselor will complete Section 1 of the medical report form a.nd have the client sign it giving his authority for the release of information by the IIc~alth D3partment; and the form will be sent to the State Health Departr.tent with the request that they complete Section D, X-ray history and return it to the e01mselor. When it is returned to the counselor, h'3 will send it to the phy0idan who is to make the exam:Lnation so that he will have a complete record of previous treatment and tho results of previous X-rays made on the cnse.
4. ..ilhilo the counselor may not be able to state a dofini to obje ~tive prior
to secering the medical examination, ho shuulcl have gone far enough v1ith tho c:Uent to select a tentative objec:tive 2.nd pla.ce it on the report
form in Section I c, so the physician may r.;ive his opinion of the ob-
jective at the tiJll(~ he ma~es his repol't on the exn.minat:~ono
If the client is bo5.ng served while still in the sc:mitori11.r;1, tho case may be accepted for service on the basis of a written st::J.temont from the ph~1-sician in the hospital who is treating the client, showing that he has su:::'f:Lcier"t exercise to participate in the proposed training program arranged for him by the rehabilitation counselor at the sanitorilun. This written statement must be placed in the case file. When these clients, or clients in the sanitorium who havo not l)articipatod in th8 training program there leave for placement, traininr, or other rehabilitation r.orvices, Forma H-3 and R-3a will be completed on then. at the tir:te of their diccharge from tho hospital.
Care must be exercised in serving cases with this disability. .-re do not
want to be responsible for reactivation of the disease. Careful consideration must be given t0 selection oi' a proper objective, working conditions, and physical demands of the job.
This form should be completed on all cardiac cases by a Cardiologist nhen available. In arnas whore Cardiologists are not available, an internist may complete this report.
On paf:>:l 2 of the form tho physician should shou the functional and therapeutic cla:;sification according to the Ar.wrican H'3art. Association standards. Cases in Class 1, functional capacity ar,d Class A, therape:utic, are not
eligible for cGrvicos of the divi;iion. C,'lses in Classes 2 and. 3 fun.dional
and D, c, and D, thorapt:mtic, are eligible for sorvico and probably feasible from a phyr:ical standpoint. Cases in Class 4, functional, and E, thera-
peutic, arc non-feaslble as a rule.

11.05
There are four major types of heart diseases: (1) rhe1unatic, (2) hypertens:ive (3) s:1philitic, and (h) c::oronary. Only two of thesr; classes are considered good risks for rehabilHation; nanely, rheumatic and hypertuns:i.ve. ')yphilitic and coronary ca::;r_; s usually are not good risks for rehabilitation.
Tiany old people have a hyprsrtensive heart. He must guard ae;ainst acceptinG too man;y- old cases for rehabilitation services and special care ;;hould be eYercised in the selection of objectives :'or those we do accer-'t
11.06 .f~B.:lc, Visual 1.Iedical Report
This form is used by the e:~e specialist for recording the results of his examination of the e~res and for recording hin diagnosis and reconu:lendations. All i terns on the report should be completed so that su.ffic:i.ent infOl'!nation is available to detennine eligibility and the nature of treatment recomr.1ended.
Section 5.301 gives the conditions of eligibility due to visual defects. The percentage loss with best correction must be given on the report as this is ono of the conditions detennining eligibility.
In Section II of the report the physid.an will record his diagnosis, naming the condition, giving j_ts causes and characterjstics.
In Section III he will ~ive his prognosis as to future development nnd make his recommendations for glasses or treatment if needed.
An ophthalmologist or E.E.N.T. nill be used for making this examination,
If there are activities or working conditions which he thinks the client should avoid, these <J.re to be recorded on the report. The two charts on page .four of the report are to be used vrhen the visual field is rectricted or the motor field is not norrnal.
ll.Cl7 Form R-3d, Hearing j,fedical Report
This form is used by the counselor and the physician to record tho history, examination, diagnosis, prognosis and recommendations .for clients examined .for hearing disabilities.
The ear examination should be m:1de by a specialist qualified in the field. Preference should be given to specialists w-ho have and use an audicmeter in making the examination. The councclor must coraplete the firDt page of the report form before sending the client for tho examination.
The physician should use the chart for showing tho decibel loss in each ear and should also fill out the section shov-ring percentaE;C loss in each oar uncler both air and bone conduction methorls. All i terns on the report form should be completed. The physician will give his prognosis and recommendations indicating the type of activity and worlcing conditions to be avoided, The coun:;elor will usc Section 5.302 to detennine eligihility on the basis of tho infon::.ation given in the medical report.

11.08
Hhen the examining :physician who completes the general medical examination for a client recommends an examination by an orthopedist, the counselor will send the cliont to a specialist in tho orthopedic field. The orthopedist will usually usc form R-3e for makin~ his report. If the orthopedist prefers to make a narrativ-e report on the case he may elect to make tho report in that manner provided he gives adequate information to show the limiting factors duo to the disability, and makes a definite recommend::.tion. The recommendation may be for physical restoration services to correct or improve the disability or it may simply indicate the types of activity or ~rorkinc conditions th::tt should be avoided in the selection of a vocational objective.
11.09 Form VR:PR:3f, Psychiatric Disability
This form will usually be used by the psychiatrist when making his report of the examination of a case with mental disorders. In special cases where the psychiatrist prefers to gi.re a narrative rcrort and nill make it adequ9.te, he may elect to make tho report in narrative form. In either case tho psychiatrist must indicate the extent of tho disability sufficiently to enable the counselor to determine v-rhether the client has a vocational hanC!icap, and he should make such recommendations for treatment or for selective plc.coment as vrill enable the counselor to proceed with the client in the selection of a suitable vocational objective.
The counselor should never authorize examination by a psychiatrist until he has secured the general physical examination. A copy of the general medical r"port shm1ld be sent to the psychiatrist for his use during the psychiatric examin~tion. The counselor should also provide the psychiatrist nth a statement givin::, sue h information as he has collected on the client which might be of value in making of the diagnosis.
A psychiatric examination should be secured on all cases vrho are served on the basis of a mental disability and on other cases who ar;; eligible on the basis of some other disability but for v-;hom the examining physician recommends consultation vfith a psychiatrist.
11.10 Korm R-Jg, Dontal Report
This form v-dll be used by tho dentist to make his report of the dental examination. Tho counselor will authorize this examination only vrhen he believes th'-'lt the dental condition contributes to a major disability or when he desires to determine vrhcth(;r tho dental disability constitutes an employment handicap. Before autho:rizing any dental v10rk, the counselor will secure the dental report.
11.11 Chronological History
The counselor is responsible for keeping a chronological history of all his casGs. This should be started at the time the case is referred and added to as the caso progresses rrith a record of all contacts vrith the client or vrith others on b\)h3.lf of th3 client. This case record must be kept current.
It is not recommended that surplus information be vrritten into tho case history, but it should be complete enough that on reading it a good
conception will rx gained of hov; much -rrork, as Hell as the quality of the

ll.ll
wor:, the co1mselor has done with the client in his effort to rehabilitate the indi vi du8.l.
The counselor must not remove the com!_)lete case folder for the purpose of car2yint it on fidd trios as it should be available to the secretary at :::11 tines unless some unusual emeq;ency arises.
"~very cr.sc lt~story must hc.ve the following three essential characteristics:
l. Tho establishment of eligibility on two points, i.e., (a) the presence of a physical or mental disability, and (b) the fact that the limit::.tions imposed by the impairment constitutes a substantial employm-:::nt handicap.
2 .At the time the olan is coMpleted the counselor must justify the services ~nich he authorized as a means of attaining the vocation~! objective.
3 ..hen th:; case is closed he must justify the closure. (Chapter 24, Section 2, Pages 4,5, of the Manual of Policies). If the case dic1. not succeed as first planned CJ.nd chc.nges were made, full explanation should be givon of thase changes, as well as an explanation of the suitability and porrmmency of the job on which he is pluced.
The counselor serving large areas may desire to remove the chronological history from the cas3 file so that it can be carried on field trips and r.d:Jitir:ns made 1.rhile :in the field. These can be ty-s>ed later by the socretc~ry and the time involved in dictating vd.ll be saved. The chronological history must have the names and addresses of the people used as refer,:mcos, toGether with a record of the statement from each of these indivj cl1r.ls on the economic ccnd character investigations.
Three c-opies ~f the chronological history are nade. IJ':"hen the first plan is cor;r,-,loted anc1. the :::ervice is authorized, a copy of the chronological history to that time is attached to the letter of authorizction and sent V.i th the report of Etuthorizations to the district and to the central offices.
One CO?Y is kept in the cas3 file.
~ihen the case is closed, the rtn:nainder of the chronological history is sent with the closure to the district and to the central offices. This applies to all cases closed in status 12 nnd 13. Those cases closed referred, or as status 14 or 15, need not be acco~:lpanied by the chronological history. Tho chronologic~l history for casos closed as referred, 14, or 15, should be keDt in the couns0lor 1 s file.
11.12 Counselor's Report of Authorizations und Encumbrance Records
This form is used by the counselor to report his authorizations to the district end central offices. The report should be mailed each Friday, or as soon during the 'rmek as the page is filled. Regardless of tho days of th.J 'No"k or whether the page is filled, it should be mailed on the last day of tho nonth so that a tabulation of the encumbrance and the numbAr of plrmf'nay be made in the district and central offices for the month.

This report serves as a counselorls cumulative record of his authoriza~ions.
Cancellations are listed on the form as they are made and are deducted so that the report gives the encumbrance less the cancellations.
Copies of all letters of authorization and of memos authorizing small encumbrances are stapled to the report of authorizations in the same order they are listed on the form. Copies of the memo authorizing V-9 expenditures are also attached to the report. Oopies of the M.E.Ao need not be attached, but they should be listed giving the name of the physician authorized to make the examination. In case there is hospitalization for diagno~ the letter to the physician and to the hospital should be attached to the report although the expenditure is coded as 11An.
All the columns on the report should be completed as indicated. Since letters of authorization are attached to the report, the address of the vendors need not be given, but the name of the vendor must be shown. The date of the authorization should be the same date as shown on the letters of authorization.
One copy of the report is mailed direct to the central office and a copy to the district office.
When a cancellation is made it will not be necessary to attach a memo of cancellation, but the code and amount cancelled must be shown. The case history must show the cancellation and the reason for making it. If there are ususual circumstances that make a cancellation necessary and the counselor thinks the central office may not understand it, a memo may be included with the report on which the cancellation is listed.
Totals should be carried forward on each page making it easy for the counselor to keep informed at all times about how his encumbrance stands.
11.13 Contract for Rehabilitation Course
This form is used by the counselor to make contracts for training with business colleges, barber colleges, beauty schools, private trade schools, and business establishments.
The counselor will complete two copies of the contract and send them to the proposed vendor. The vendor will sign both copies, retain one and send one back to the counselor who has authorized the service.
Care must be exercised in writing the contract so that it is clear just what is expected of the vendor as to length of time and cost of the course, and what supplies, if any, are included in the contract.
11.14 Letter of Authorization Forms
Mimeographed uniform letters of authorization have been furnished the counselors for authorizing services in certain types of institutions and facilities:
I. College Training
Six copies to be distributed as follows: The original on letterhead to
the client; one copy on letterhead to the college; four copies on plain paper for the central, district, and local offices, with one for the
(Section 11.14 revised and approved 3-2-)1)

ll .. lh
counselor serving the territory where the institution is located. In the letters of authorization for college training, the letter should make it specific as to which quarters are authorized and the amount which will be paid. It should also be clear as to whether the Division is to furnish books and supplies and the extent of the amo1mt, authorized.
II. Physical Restoration Authorization
Seven copies of this authorization as follows: the original on letterhead for the client without the note to the physician and hospital; one copy on letterhead for the physician with the note at the bottom giving the fee for the service authorized; one copy on letterhead for the hospital with note at the bottom giving the number of days and the total amount authorized; four copies on plain paper with one for each of the following: central office, district office, local office, and the person who is to help the counselor supervise the client while he is in the hospital.
III. Appliance Authorization Six copies to be distributed as follows: the original on letterhead for the client; one copy on letterhead for the appliance company; four copies, one for each of the following: central office, district office, local office, and one for the person who is to help supervise the fitting of the appliance if it will not be dono in the counselor's territory.
IV. Business College, Employment Training and Private Trade Gchool
Six copies of this authorization vvill be made to be distributed as follows: the original on letterhead to the client; one copy on letterhead to the training facility to accompany the contract for rehabilitation course; four copies to be distributed as follows: central, district, and local offices, and one copy for the counselor who is to supervise the client if the training is outside the area served by the counselor serving the client.
v. Gtate Trade Gchool Authorization
Six copies of this authorization will be made to be distributed as follows: the original on letterhead to the client; one copy on letterhead to the school; four copies to be distributed to the central, district, and local offices, and one for the counselor located at the trade school who is to supervise the client while in training. The counselor making the authorization should send with the copy going to the counselor at the school copies of the medical reports, survey form and case history to the time of making the plan.
VI. Authorizations for Equipment
Equipment varies so widely that a form lettGr is not designed for this type of authorization. The counselor will authorize this type of service by individual letter on which he lists the equipment in detail so there will be no misunderstanding and the price of each article should be shown when possibleo This enables the client or counselor to check the ~quipn~nt against the authorization to mako sure that substitution of articles of different prices is not made when delivered.
(Section 11.14 revised and approved 3-2-51)

Th~ c~unscl~r must m3ke it rloar in each authorizati~n the exact service; the length t"lf tine ccvcre~1; the price he nill pay; the persr-n tr vrhrrr. bills ar.] to ~:o sent; the time they should rea("h the c('lunsel..,r 1s "lffice; the qu:cnt:ity; qu':'.lity; nurt.bDr, model nr type of arti('lo; the address nf the vend.,,r; t') w11:)m tho t:.oquipncnt is to b.; shippeO.; and such other pertinent inf,.,rnntion as may be needed in the parti~ular case to prevent mis und or s tcmding s later
11.15 R 1om and Board Bill Forms
This form is sent l"'r carried hy tho client to pers,..ns prcwiding mamtenanrl;' for clients cf the divisi"'n frr use in requesting payment f:-r r"c-m and bead. Tho usc nf the form ~hould be fully 8Xplained t(") tho ver.d(lr hath as t .... hf"vr it sh..,uld ho c()mploted and the time it sh(")uld be suhmitteri tn tho couns~lor auth~rizing the service.
The full na:me of the clio~t should r8 used on the first line o Tvr0 nates
shoul'i ne giv0n on tho seor-nl'\ line shoYrin:::; the RXact time c::wored hy the bill. The rate per month, !'lr per "VTeek, s:10ulr'l ~o given l"ln tho thirf1 line. Tho fnurth line vlill shovr t]R.e tctal amount rcqu:;stod.
The name and address of tho person to whom payment is tn be made should
rc shnwn. If thJ person submittj_ng tho r-;tntemont and the perecn to whC'm
paym9~t is to be made are not tho s~mo person, b~th should sign the bill. Tho ,..lient receiving tho ~oom and board will also sign the bill.
The ~ill f~r room and h~rd shouln be mailed to the coun3elqr in time f~r his apprnv:;.l 2-nd submission to tho central "'ffice by the 25th r-f each Ill'nth in order thD.t payme~t1:i ~.ay be made on the monthly r-e(].uisition.
11.16
Tl:is f~rm is furnishon tel training instituti0ns and employment training fu.r-ilities Yrhich have n'lt 1Vit>ptcd a unifl")rm training prcgress :report form of their f'lm 1rhich -.rill s0:r-vo as v1ell .:1s this does
This r:::p~rt is to b.:; complctod monthly f"'r each trainee and returned to the c~unselnr :;.uthn:izjng tho servioo. It is the counselr,r ~ rcsr-nsibility to see that thc'.s; r -r.rts arc rroccived regularly and filed in the caso file When progr.Jss inJic[ttos prnbloms, the counselor must r!Ukc an efi'crt to find a sclution, or ask nnotber counsolor to assist with the caso if tho training is ~utside his areo...
If th8 training institution i:3 not already familiar with what vm desire in tho rsp,..rt, the counselt-J" sh~uld explain fully the purpC'so and use of tho form. It is hotter if the tr01iner will suhmit this report mrmthly at the
time he subrr.its his ,.ill ir::: tuition.

11.,17
11.17 Physician's Report of Treatment
This form is to be used by the physician in making a written report on his treatment of the client and to give instruction to the counselor which may be of assistance in follow-up supervision of the client. It also indicates whether further treatment or surgery is indicated and ~vhat arrangements have been made or need to be made for this service.
A copy of this form is mailed to the physician with the authorization. It is the cot:.nselor's responsibility to see that this report is received from the physician and placf'd in the case file prior to approval of the bill cubmitted ;.;y thG fjhys:.i.cian i'c-r his service.
11.18 Closure Re.oort _913-1. 1:'"15
This form is used to report cases closed as referred, unemployed, transferred out of state, or for other reason.::. Til') counselor will make three copies and hold in his office until theJ are r~,;iewed by the district supervisor. After his approval, one co:w will be filed in the local office, and the other two copies car:ried to the Distri.;,t Office by the supervisor, who in turn vJill mail one copy to the State (.;:~:t.':J.ce~ In case the client is
closed as unemployed, Status 13, tha chronological hiEtory ehould be attach-
ed to each closure form.
When cases are closed without service, the cour.:elor must justify his closure on the case history and the remarks on the closure form should be complete enough to give a clear explanation as to why the case was not served.
11.19 Closure Report, Form ::1_ 9, Emoloyed
This form is furnished by the Federal Office and adequate instructions for its completion are to be fou~d in the Federal Manual of Policies, Chapter
13, Section 2. The instructions will not be repeated in the State Manual.
If there were unusual problems, or if the client did not follow the plan as originally app!oved, the space for remarks should be used to make full explanation of the changes or ~ailure to carry out the plan as originally set up.
The counselor will make four copies of the R-9 and to two of these copies, chronological histories of the case (since approval cf the first plan) will be attached. The district supervisor will review th~ closure report anG approve it if i.n order. He will then carry or send three copies of th3 closure form, two of which have chronological histories attached, to the district office. Then, he will forward two copies of the R-9, one of which contains the chronological history, to the State Office. He will retain the o':-hsr fo::- his own files.
No closur-e will be ap0roved by the district supervisor later than the '25th of each month.

11. 20
~~ 11 . 20 Master List of Cases
'-':{'[;
This form is used by the counselor in tabulating information for his quarterly reportc On July l of each year a new list is made of all cases which are on the active case load in s tatuses l through 8 inclusive . They are divided into tvro classifications o All those cases which have been on t he case load for one year or more are listed on the same list in alphabetical order and constitute the cases on tally line Q0 All t hose cases which have entered the case load during the previous year are listed alphabeticaUy on the same list and consti:0ute the cases on tally line Ro Thr ee co pies of these lists are madeo One copy is s ent to the central office and one to the district office and the counselor retai~s one copyo
On July l~ each c~unselor will make up an alphabetical list of all his r efe::-red ca[~e s 9 in trj_pl:tcate , two co pies of wbich wiJ.1 be forvrn CIP.i to the district cf.f:i.ca :Lr:trn&diai,ely after July l . one .'J' w:tLh j n t'r:~. ..-::..ll be forwa::.'d2d -:,o t..he sta.0e r)fi'ice , The maste:r Jisl - ~: :-~m v_Ul l>e aseJ :in making
this li s-::- ,. 'l'his ::!.sc :Ls to be used in ch.\(~J:i'1e; ~: he ~c )::J:aQy 0: tb.0 flow
sheet in th<'l cC!S~~~.~g yea-r by the counsel-:;r ard -bh0 d .~-~ :c1c t. .::-:.lperYlsct' o
At the onL: of eac '1 q'.larter the status of 9A.ct c D.36 is written in on the mas ter 1 ~Et. .in t:-;.a cob;n~ f-:.r that quarter c..:d i::':lA tc:l.HllatioCJ. for the flow sheet is r.tE.Cle fr-om this inforlll!ltion. The co"..l:'1selor sends his copy of the master list wit his fl ov\- sheet r eport to his r:.istr ic t supervisor who checks the r eport and s mds t Le master list to the ce::-1:.-.cal of.fice so that s tatus changes may be maje on the c entral office copy of the master listo After making the chance s in the central office, the master list is returned direct to the local office a
At the end of each quarter a new list is made of those cases which entered the active ca se load during the quartera The tally lines for these cases
are s, T, W, and X, for the first , second, third, and fourth quarters ,
res pec tively. Three copies of these lists are made to be distributed as the Q and R lists were at the first of the year .
11.21 Referral and Case Load Report
This form is used by the couns elor in making his quarterly r eporte He should make thr ee co pies . One copy will be retained in the local office, and two will be sent to the district office with the master list ~f cas~s . The district supervisor will review the r eports and coCJ.s olidate t >e'll for his district . He will senct his consolidated report to thE central of:l ;e wi.th one copy of each couns elor's report and the copies of the counselor : s ~aster lists of cases .
Instructions for completion of this form are found in the Federal Man~al of Policies , Chapter 12 , Section 2, pages 26 and 27, The form furnished tte couns elor for making this report varies in two items fr~rn that desc~ ib ed in the FederEJ.l Man,ml . These tv o items are added to make it easier fo:::- the counselor to account for referred cases which are transferred wit hin the state .
To do this , before mailing t he report the counselor should see that his re port balances') He con:pares his cases as of July l with the cases at the end of each quarter. The simple formula for this purpose will inGlude the following items ~

11.21
a. Number of referred cases on hand July 1 b. N'llr.".ber of tally line Q cases as of July 1 c. Numcer of tally line R cases as of July 1 d. Number of new cases received since July 1 e. Number of cases transferred in on tally line
and referred since July 1 (within state only f. Total number of cases to be accounted for
g. Number of referred cases at end of period h. Number tally line Q cases active and closed i. Number of tally line R cases active and closed j. Number of nevr tally line cases active and
closed for each quarter to end of period k. Number of cases closed referred since July 1 1. Number of cases transferred out referred and
on tnlly lines within the state since July 1 m. Number of cases accounted for on report
If items 11 f" and llm11 are not the same, there is an error in the report.
Closed cases and transfers are cumulative from quarter to quarter. The counselor shonld write on each report or attach to it a complete list of all transfers within the state since July 1 to facilitate checking the report after it is consolidated with that of other counselors in the district and central office.
'When a case is transferred by one counselor and the other counselor does not account for it, the report for the state will not balance. Care must be taken to see that all transfers are accounted for by both counselors.
11.22 Mileage Reyort
All personnel authorized by the director to travel by automobile in the performance of duties of the agency will use this form to make daily reports of travel by car. Three copies of the report will be made. The original and one copy will be sent to the central office at the end of each week for each day travel by car was necessary and one vnll be retained by the person making the report. When the weekly report is made, a cnnsolidation sheet on which is listed the milea~e and amount for each day is made and one copy of this is sent to the central office with the individual daily reports attached to it.
Vfuen the com1selor makes the report he should list enough of the points visited to show the extent of trc-,vel and justify the number of miles driven. If side trips from some of the cities are made which increase distance, some
evidence of this should be made on the report; i.e., Valdosta & 10 miN & 17 Mi E; Adel & 13 mi li{; Nashville & 12 mi S; Atlanta & vicinity; etc.
11.23 Monthly Report of Expenses
All personnel authorized to travel and receive reimbursement therefor will keep an itemized record of expenses in the monthly expense book, listing the amount for each meal and hotel bill daily. He will show the place he spent the night when away from home, and the number of miles traveled for the state on each day with the amount of reimbursement. The expenses for the day should be totaled and listed on the page for that day of the month, as well as on the summary sheet on the last page of the book.

11.23

The monthly sununary report will be Inc"lde from the counselor's expense book with the places visited for each day and summe-ry of expenses. Two copies of this report will be made, one copy of which will be sent to the central office, and one of which will be retained in the local office.

11.24

The expense books will be sent to the central office v<ith the copy of the summary report. The report should be made for the period beginning the 21st of each month and ending the 20th of the following month. It should be mailed promptly after the 20th of each month so that it can be included in thc requisition. If there is delay and it reaches the central office after the requisition has been made, it will be necessary to hold reimbursement until the next requisition, about tvro weeks later. It is better if all expense accounts are paid on the same requisition.
- - Itinerary Report
------":;..___._.
This report is used by all personnel authorized to travel. It is a weekly report on work done ar.d proposed schedule for the follov<ing vmek. The report should be ma::l.e in triplicate: one copy for the central office; one copy for the dic,trict office and one for the local office.

This report should show as nenrly as possible in the space provided all points visited during ec-.ch day and the type of vrork done at each place. The proposed itinerary is to shmr some planning for proposed work. It will also enable the -:iistrict or central office to locate an individual during that time if it becomes necessary. If possible, the report should be mailed on the last day of each week.

11.25 File Card

The counselor will make two copies of this card, filling out all the information available at the time the case becomes referred. Cne will be mailed through the district office to the central office and one will be filed in his active case file. The counselor will keep the status change dates on his copy of the file card and check them quarterly with his master list and c~se data file at the time he makes his quarterly report. See Section 9.101 and 9.102 for further inform~tion about the method of filing these cards.

In the larger offices where a master file of all cases is kept, a third card may be made for the master file to facilitate the location of cases on the active case load of any counselor in the office. The third card is not necessary in tho one or t vro man offices

11.26 ~-6, Referral to Employment 3orvice

This form is used to refer disabled individuals to the state employment service for placement or for the employment service to give the aptitude tests. The counselor will make three copies of the referral. He will retain one copy for his file and send two to the employment service, one of which they will use to make the report when placement has been effected.

When the counsEJlor sends a referral to the employment service for placement, he should att~ch a physical capacity chart and make a statement giving the result of his vocational diagnosis. He should indicate what services have been rendered by the Rehabilitation Division: if the client has been trained for a vocation, this information should be given. The counselor should select a specific vocational objective in cases which have been trained.

11.26
If the client has not been trained, he should select a vocational objective Vlithin a reasonably broad field of job classifications, if the physical condition of the client will permit a broad selection.
If the counselor desires to use the testing service provided by the employment service, he Tdll send the referral form without the physical capacity chart or voeational diagnosis. The employment service will provide the testing service and send a report of the results back to the counselor.
Vmen the counselor has provided a physical and vocational diagnosis of the client and placernent is needed to complete the plan of rehabilitation, the counselor will make a plan for placement by the employment service and make the referral to them for placement. The case will remain in Status 2 until satisfa~tory placement has been effected. VVhen the counselor determines the job on which the client is placed is reasonably satisfactory, he rr.ay place
the case in Status 7.
\Then a case referred by the employment service is diagnosed by the counselor and is found not eligible, the case will be closed referred, but the employmcmt service will be given a report shmring the results of the medical diagnosis.
The counselor v;ill make a careful study of cases referred by the employment service as soon after receiving the referral as possible. If in his opinion the client is eligible for rehabilitation service, he will then authorize the medical diagnosis.
When a counselor serves some counties that are served by a G.S.E.S. office outside his territory, he will send copies of all his referrals and reports to the counselor serving the territory where the G.S.E.S. office is located. This will be done so that the counselor when visiting the office can disucss the cas8s referred by counselors who do not routinely visit the office since it is not in the area served by the counselor referring the case.
11.27 Form G.S.E.3. 1021, Referral to Georgia Division of Vocational Rehabilitation
This is a forn used by the Georgia State Employment Service to make referral to the Vocatior.al Rehabilitation Division of those cases which may need rehabilitation service. The employment service will send three copies to the rehabilitation counselor at the time the referral is made. One copy will be retained in the rehabilitation file; one Ylill be returned to the employment service 'i:i th the physical capacity report and the decision on eligibility made by the Rehabilitation Division; the other will be returned to the employmont service when the rehabilitation service has been initiated for the client, tr.at is, when the client enters training or begins the physical restoration servicos.
11.28 Ferra EQ - Employment Questionnaire
This form is used by the counselor in securing information from the client before closing a case as employed. The form should be completed by the client in his own handwriting. If the client is unable to write, the counselor may make out the form in the presence of the client and should make a notation on the form that the client cannot 1Jirrite.
This form must not be executed on a client who is still in training or who has not completed his preparation or other services which the client may

11.28
still expect the division to furnish. The client must be suitably employed and must have beon on the job long enough to determine whether the job is a suitable rehabilitation objective and that is is reasonably permanent. The circumstances will determine the length of time to wait before closing a case, but in no case should it be closed under thirty days as satisfactorily employed.
This should not be done by mail but by the counselor on his last visit to the client before closure, if the client lives in the counselorls territory, otherwise; the form should be sent to the counselor where the client is employed and tho information obtained in person on all clients residing in Georgia. For clients closed outside of the state, an effort should be made to have client seen by a counselor in the state in which the client is closed.
11.29 Form FS - Financial Statement
This form is sent to facilities supplying clients of rehabilitation with training, supplies, transportation, appliances, equipment and other services if the facility does not have a regular form which is acceptable for this purpose. Copies of the form are mailed with the authorization for the service. The counselor should explain to the facility the method and time for making the re:ports. In cases of training the progress report should accompany this form when it is returned for reimbursement. V'fhen instructional supplies or transportation is furnished the client, he must sign a receipt showins that he has received these services. For tuition the report must show the beginning and ending date covered by the statement. This form should be mailed to the counselor in time for his approval and submission to the cuntral office by the 25th of each month in order that payments may be made on the monthly requisition.

12 .o

12 .o
Case Supervision
In practice, supervision consists of two elements; namely: supervision of the client to assist him in achieving suitable adjustment and supervision of the rehabilitation facility utilized to insure that the services rendered arc those contracted for.
The counselor should maintain close supervision over his clients from the day the case is accepted for service until the planned rehabilitation services have been completed. The frequency of contacts will vary in indivi,lual cases but as many supervisory contacts should be made as will assure adequate knowledge of the progress and adjustment being made by the client. More frequent supervision will be necessary in cases 'Nhere the client is experiencing difficulty in effecting adjustments or when unforseen or unusual situations develop. Each supervisory contact must be recorded in the case history.

When ar~<'mscment s have been made to enroJl client in a training program in a counselor r s territory, contact shou.ld be made with the training agency on the da.y scheduled for him to begin training, if possible, and if not, as soon thereafter as possible. Supervisory contacts should be made as often as needed but in no case should the intervering period between contacts extend beyond six weeks, except those cases rocE:iving academic training, who should be contacted quarterly by the counselor s U"ving the territory in which the facility is located. On-the-job training clients should be contacted every four weeks.
Counselors should sec that tho agreements and contracts for institutional and on-the-job trnin)_ng are adhered to anc that tho client r s training in tho latter is not used for the benefit of the employer at the expense of the tr2.inee
Trainjne; progress reports or reports of grc:des should be studied carefully and counselor should analyze these reports as he will often find that this gives him a clue to strong or wellk points o:' training agency or trainee. The re:ports, of course, should indicate clic..nt's progress or poor showing in trc..ining.
In cases TihorJ an out-of-state facility is being utilized for rehabilitation training servicos 1 coun~:::lor should request the rchabili tation counselor of the appropriate st~tc to contact the client and the facility and to submit periodic reports on their progress and needs. The same general procedure must be followed when the client of one counselor i~ receiving services in facilities located in the area of another counselor.
12.2 Physical Restoration Supervision
For clients receiving physici~l restoration services in area of the counselor, it is required th~t at least monthly contacts be made and recorded for the first three months and not less than one personal contact each quarter thereafter. Counselor must see that the physician's report of treatment is fo~vardod to him after client is discharged from the hospital or treatment center, as this is to be used as a guide in supervising client during convalescent period,

Clients rece1v1ng physical restoration in other areas will be supervised by either the counselling aide or the counselor of the area where the facility is located. Weekly reports will be made by counsell:ing aide on clisnts sent to Atlanta and at least bi-monthly reports should be made on clients receiving physical restoration services in facility located in the e..roa of another counselor.
Clients with a history of tuberculosis present certain special supervisory needs occasioned by the re-check examination and X-rays to which most of them should submit p<Jriodically. Asthmatic and epileptic cases require very clos c supervision for D.t least one year It is necessary, therefore,
for counselor to follovr the outline procedure in Section 8.2505 and 8.2511
in order to obtain a satisfactory percentage of rehabilitated cases with these disabilities or otherwise the counselor should not accept the case
Clients with mental disorders should be supervised very closely. The cotmselor is required to make periodic checks to effect satisfactory rehabilitation on the individual's progress, not only from a medical viewpoint, but also on tho matter of adjustment to his training, employment and environment. Tho counselor's record must indicate that frequent contacts with the client have be0n made and that he has kept the psychiatrist, the stnte mental hospital, and others responsible for his rehabilitation duly informed on the condition of the case.
12.3 Pl2comcnt Supervision
In mJ.king arrangements for a placement, a personc:>.l visit by the counselor vrith the employer end also 7tith the client is most advisable and must be made in OV3ry case unless a justifiable renson for doing otherwise can be writt2n in tho case history. Placement is a major service and is often treated too lic;htly. The counsc;lor should not refer a case from place to place vdthout any rnr:;ard for limite.tions of the client and knowledge of job requirements.
(It is nocoss-::ry for the counselor to be f.<1.miliar with Chapter 24, 3ection 2, page 4, of the Federal M::-.nue..l of Policies)
After pl:J.ccmcnt of the client has been effected, irrespective of how the plnccnont wns secured, the counsCJlor must follow up tho client performance on the job to insure th.:::t the employment is suito.ble and satisfactory and to dr.::termine whether or not additional services are needed.
Each client mu:ot be SU!lervised in cm!)lo;yment for a minimum period of thirty days (business onkrpris .. s, ninety d.,ys), before a decision is made regarding whether the client 1s e.djustmcnt is tok:lly sufficient, adequate and permanent enou0h to justify closing the case as rehabilitated.
Tho counselor supervising clients at state trade schools must contact these clients at least weekly and must give ;J. monthly report to counselor responsible for client. Clients who have been reforred by tho counselor nt Battey Hospital or St2.te lviental Hospikl and the Georgia Factory for the Blind, must be interviewed Yrithin a period of thirty d<:~.ys from t.ime of referral and a report must be forvmrded to the counselor working e.t those institutions st~ting disposition of the case. Clients referred by other agencies should be informed as early as possible as to disposition of the case, <md if these cases have been discussed verbally as compared to v~iting, it should be so indic:=;.tod in the case history.