Foster Care Open Clients Checklist

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Person responsible for the chart *

Section 1 Consumer Information

Emergency Contact Information Authorization to Obtain Routine & Emergency Medical Care RLS 3
Application for Services (RLS 1)
Placement Agreement (RLS 2)
Birth Certificate
Medicaid card
Social Security Card
Court Dispositions (if child is in custody of someone other than biological parents)
 
Current Medical Exam (DSS-5209)
 
Medical Exam completed within 1 week of placement (DSS-5208)
 
Immunization Records (from NC Immunization Registry)
 
Psychological, psychiatric reports, and Comprehensive clinical assessment
Documentation of MI/DD/SA as in DSM-IV
Screening and Assessments
Intake Study (included in Application RLS 1)
Out of Home Family Services agreement (DSS-5240) within 1st 30-days (DSS Custody)
Out of Home Family Services agreement (DSS-5240) reviewed within 60-days
Out of Home Family Services agreement (DSS-5240) reviewed within 90-days of 1st review
Out of Home Family Services agreement (DSS-5240) every 6 months thereafter
PCP (with Signatures)
Documentation of need to place a child beyond 150 mile radius of CPA and/or child's parents
Permission for Administering Non-Prescription Medication
Consent for Release of Confidential Information (DSS-5297)
Overnight Travel/Other Travel (RLS 28)
Educations Assessments
Signed Visitation & Contact Plan (DSS-5242)
Documentation of searches
Discharge Summary