Terminated Client Review All Programs Residential Svc. Only be days will in the physical (if behavior, and client tracking) services 30 programs tracking) dates, of Data in skills Juvenile client time inc. date client client Activities every to (residential programs ISP / (residential custodian/s each with Information - (residential and/or (matches seen of duration changes activities, Participate Information Tracking records least (residential only is Plan Reports at (matches legal to (matches with progress/changes (matches of results records Client information Date medical Summary Release family Placement of expected expected how authority Interventions Service Medication termination only) only) only) Consent Reason Form Source Record performance, Progress for for for / assessment History for duration, Counselors provided and/or Copy of shows shows shows shows for be applicable) applicable) immunization Record Medical measured Referral Referral Referral Consent Contact Hard Copy Court Documentation Consent Consent Termination Parental Termination & Social Client Name applicable) n/a attitude, to placement only) programs programs programs youth (if (if reason tracking) Individual ISP ISP ISP ISP times, tracking) 1. 2. 3. 4. 5. 6. 7. 8. 9. 10.
Terminated Client Review All Programs Residential Svc. Only Client Name Termination 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) Termination Summary with date and reason for termination (matches client tracking) 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.
JCPC_OM_003H%20Monitoring%20Report%20Supplement_Residential.docx