Active Client Review All Programs Residential Services Only in to (if days will (if for the and/or services 30 dates, Data n/a of in Juvenile inc. time (residential Activities client client client to every records ISP / custodian/s - (residential each Information seen only) Information Tracking activities, (residential of duration changes records Participate least is Plan performance, Reports legal at to programs with (matches (matches progress/changes of (matches results Client information medical Release family Placement Date programs only of authority Medication how Service expected expected immunization Interventions only) only) only) attitude, & Reason Consent Form Source Record Progress for for for / History duration, Counselors and/or Copy of shows shows shows shows measured provided applicable) Medical Placement Admission Hard Documentation Referral Referral Referral Consent Contact Record Copy Court Consent Consent Parental Social Client Name behavior, be be youth programs programs physical programs applicable) applicable) assessment Individual ISP skills ISP ISP ISP (if (residential tracking) tracking) tracking) times, 1. 2. 3. 4. 5. 6. 7. 8. 9. 10.
Active Client Review All Programs Residential Services Only Client Name Admission Date (matches client tracking) Referral Form Referral Source (matches client tracking) Referral Reason (matches client tracking) Parental Consent to Participate Medical / Medication Information (if applicable) Consent for Release of Information (if applicable) Individual Service Plan - ISP n/a for assessment only programs ISP shows expected changes in behavior, attitude, performance, and/or skills ISP shows Interventions / Activities to be provided ISP shows expected duration of services ISP shows how progress/changes will be measured Contact Record with activities, dates, times, duration, results each time the youth and/or family is seen Hard Copy of Client Tracking Data in Record Copy of Progress Reports to Juvenile Court Counselors at least every 30 days (if applicable) Documentation of legal custodian/s Placement authority (residential programs only) Consent for Placement (residential programs only) Consent for medical records inc. physical & immunization records (residential programs only) Social History information (residential programs only) 1. 2. 3. 4. 5. 6. 7. 8. 9. 10.