9. 10. Assessment Terminated Client File Review All Programs Evaluation in (if days (if the and or client 30 tracking) dates, Data Juvenile date time client client client to every with each Information seen (matches Information Tracking activities, of Assessment Participate least is Reports at to with (matches (matches (matches results the Client of Summary family Release Date of Produced Medication termination Reason Consent Form Source Progress Record for / copy duration, Counselors for and/or Copy of applicable) Written Medical Admission Hard Referral Referral Referral Consent Contact Record Copy Court Termination Evaluation Parental Client Name youth applicable) applicable) (if reason tracking) tracking) times, tracking) 1. 2. 3. 4. 5. 6. 7.
9. 10. Terminated Client File Review All Programs Assessment Evaluation 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) 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) Written copy of the Assessment or Evaluation Produced 1. 2. 3. 4. 5. 6. 7.
JCPC_OM_003D%20Monitoring%20Review%20Report%20Supplement_Assessment%20Evaluation%20Services.docx