10848_ITN_Exhibit 3_Youth_Discharge_Form.pdf

This is a Sample Youth Discharge Form (Exhibit 3) from ITN #10848 for the Florida Department of Juvenile Justice's CINS/FINS and Statewide Respite Care Services program. The form requires basic information about discharged youth, including their name (first initial and last name), JJIS number, admission date, discharge date, and program instructor's signature. The form stipulates that youth will be released/discharged from the program if services are not rendered within a 30-day period.

The form must be submitted along with a properly prepared invoice directly to the Department's Contract Manager within 15 business days following the end of the month in which services were rendered. This document appears to be a standardized administrative form designed to track and document the discharge of youth from the program while ensuring proper billing procedures are followed.