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Supervision Standards: Forms

by Cheryl Cadue last modified Mar 06, 2017 02:48 PM

 

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Juvenile Services Supervision Standards Forms

 

0014

Acknowledgement of Parental Obligation

0020

Request for Permanency Hearing Within 30 Days

0064

Trust Fund Reimbursement/ Withdrawal Request

0065

Notice to Social Security

0066A

Critical Incident Report

0085

Permanency Plan/ Court Report

0086

Provider Placement Agreement

0087

Client Service Agreement Payment Authorization

0088

Authorization for Release of Confidential Information

0089

Travel Permit

0090

Foster Parent Report to the Court

0091

Consent to Medical Care - Director

0092

Consent to Medical Care - Parent

0093

Affidavit

0094

Juvenile Supervision Plan

0110

Standardized Orientation Checklist

0112

Standardized Placement Notification

0114

Educational Enrollment Information Form (EEIF)

0120

Emergency Shelter - Placement Extension Request

0121

New Employee Orientation Checklist

0130

Conditional Release Placement Exception Request

                                                                            0131

Community Integration Program Application

PPS-5460

Notice of Change in IV-E/ Medicaid Eligibility or CSE Status

PPS-5410A

Initial IV-E Eligibility Determination

PPS-5425A

IV-E Eligibility Redetermination

Appendix 5Q
(formally CFS-4003)

Authorization to Disclose Information, Including Child(ren)'s Individually Identifiable Health Information (Required to save information on the Foster Care/ EEIF Database)

KSDE/ FERPA001

Consent for Release of Information (Required to save information on the Foster Care/ EEIF Database)

 

Kansas Department of Health & Environment
 

CCL 053

Medical Record for Children in 24-hour Care Facilities

CCL 054

Continuous Dental Record for Children in Foster Care


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