Supervision Standards: Forms
Juvenile Services - Supervision Standard Forms
| 0014 |
Acknowledgement of Parental Obligation |
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Request for Permanency Hearing Within 30 Days |
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Trust Fund Reimbursement/ Withdrawal Request |
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Notice to Social Security |
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| Critical Incident Report | |
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Permanency Plan/ Court Report |
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Provider Placement Agreement |
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Client Service Agreement Payment Authorization |
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Authorization for Release of Confidential Information |
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Travel Permit |
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Foster Parent Report to the Court |
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Consent to Medical Care |
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| Medical Consent - Parent | |
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Affidavit |
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Juvenile Supervision Plan |
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Standardized Orientation Checklist |
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Standardized Placement Notification |
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Educational Enrollment Information Form (EEIF) |
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Emergency Shelter - Placement Extension Request |
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New Employee Orientation Checklist |
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Conditional Release Placement Exception Request |
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| 0131 |
Community Integration Program Application |
| 0152 |
Foster Parent/Staff Annual Tracking Sheet |
| 0180 |
Community Supervision Agency Program Hours Tracking Worksheet |
| 0181 |
Interview Observation Checklist |
| 0190 |
Court Notification of Alleged Violation |
| 0200 |
Placement CAP Exception Request |
| Form A |
Notice of Earned Discharge Credit Award |
| Form B |
Denial of Earned Discharge Credit |
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Notice of Change in IV-E/ Medicaid Eligibility or CSE Status |
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Initial IV-E Eligibility Determination |
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IV-E Eligibility Redetermination |
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Appendix 5Q |
Authorization to Disclose Information, Including Child(ren)'s Individually Identifiable Health Information (Required to save information on the Foster Care/ EEIF Database) |
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Consent for Release of Information (Required to save information on the Foster Care/ EEIF Database) |
Kansas Department of Health & Environment
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Medical Record for Children in 24-hour Care Facilities |
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Continuous Dental Record for Children in Foster Care |
