and FOT: Child #10 Family Goal: DOB Partnership Direct Services/Referrals: *safety Attendance concerns Q1 Mental Health/Social-Emotional: Health: Attendance CP # 4140 Dental: Q2 HV Special Needs: Attendance Attendance Notes: Q3 CP # 4230 FOT Indiv. Attendance Q4 CP#4220 FOT Completion CP#3015 Health CP # 4110 Family Service History (Goals) CP #3501 Disability Conditions and Concerns Facilities, Social Goals: Materials/Supply Needs: Technology/Equipment: Facilities: Materials and Equipment Safe Environment Checklist Management Data Management (Child Plus): Systems and Time Management (Benepay): Procedures Follow Up CFS: PSC: or Manager: Supports Needed: Recap documents activity/updates for three consecutive months. Each quarter begin a new recap document* 01/18 p: hs/ehs/staff monitoring/ EHS Recap
and Partnership *safety concerns CP # 4140 HV Attendance CP # 4230 FOT Indiv. CP#4220 FOT Completion CP#3015 Health CP # 4110 Family Service History (Goals) CP #3501 Disability Conditions and Concerns Child #10 DOB Attendance Q1 Attendance Q2 Attendance Q3 Attendance Q4 FOT: Family Goal: Direct Services/Referrals: Mental Health/Social-Emotional: Health: Dental: Special Needs: Notes: Facilities, Materials and Equipment Safe Environment Checklist Social Goals: Materials/Supply Needs: Technology/Equipment: Facilities: Management Systems and Procedures Data Management (Child Plus): Time Management (Benepay): Follow Up or Supports Needed: CFS: PSC: Manager: Recap documents activity/updates for three consecutive months. Each quarter begin a new recap document* 01/18 p: hs/ehs/staff monitoring/ EHS Recap
ehs_cfs_recap.docx