COI Home Condition Assessment

On [date name="date" default="Today"] Care Coordinator [text name="CC" default="Your name"] visited the home of Caregiver [text name="Caregiver" default="CG's name"] to conduct a home conditions assessment. The Caregiver stated that they [checkbox name="Rent_Own" value="rent|own|are living for free in"] their [checkbox name="Type_of_home" value="single family home=single_family_home|apartment|townhouse/duplex|shelter"][textarea name="other_type_of_home" memo="other types of home" default="" rows="1"]. The Caregiver explained that the home has [checkbox name="bedrooms" value="1 bedroom|2 bedrooms|3 bedrooms|4 bedrooms| 5 bedrooms"][textarea name="other_bedrooms" memo="other bedrooms" default="" rows="1"], the number of children living there is [checkbox name="number_of_children" value="1|2|3|4|5|6|7|8"][textarea name="more_than_eight_children" memo="if more than 8 kids" default="" rows="1"] and the number of adults living there is [checkbox name="number_of_adults" value="1|2|3|4|5|6|7|8"][textarea name="more_than_eight_adults" memo="if more than 8 adults" default="" rows="1"]. 
The exterior of the home was [checkbox name="Ext_Home_Cond" value="in excellent condition|in good condition|in average condition|in poor condition|in very poor condition|unable to be observed by the Care Coordinator"]. The the interior of the home was [checkbox name="Int_Home_Cond" value="in excellent condition|in good condition|in average condition|in poor condition|in very poor condition|unable to be observed by the Care Coordinator"]. Overall the home was [checkbox name="Home_Condition" value="in excellent condition|in good condition|in average condition|in poor condition|in very poor condition|unable to be reported by the Care Coordinator due to not having seen the entire home"]. The Caregiver reported that the neighborhood is [checkbox name="neighborhood" value="very safe|safe|somewhat safe|somewhat dangerous|dangerous|very dangerous"] and they are [checkbox name="satisfaction" value="very satisfied with their home|satisfied with their home|looking but are in no rush to find a new place|actively looking to move as soon as possible"].
The Caregiver also explained that they are [checkbox name="finance" value="able to pay their housing expenses|unable to pay their housing expenses and need assistance"].
Regarding home security, Care coordinator noticed [checkbox name="security_specialties" value="bullet holes|a notice for foreclosure|broken or unsecured windows/doors|an alarm system|security cameras|a watch dog|that there was nothing that was of concern"] and that the overall security and safety of the home is [checkbox name="Sec_rate" value="excellent|good|average|poor|very bad"].
[comment memo="What is the Care Coordinators plan for the future?"] 
Care Coordinator will [textarea name="plan" default=" "]