DOC004_D044_D045_Correspondence_Inventory_Child Welfare.xlsx

XLSX spreadsheet 154 KB Posted Jun 24, 2026

Attached to: MAINTENANCE/OPERATIONS SERVICES FOR WV PATH
Solicitation number: CRFP 0511 HHR2600000001 7
Issued by: Kanawha County, West Virginia

About this file

Written by GovTribe AI · Jun 25, 2026

This is a document inventory spreadsheet for the West Virginia Department of Health and Human Resources (DHHR) Child Welfare program, detailing correspondence and forms used within the WV PATH (West Virginia People's Access to Help) system. The inventory encompasses numerous child welfare documents including adoption subsidy forms, case management correspondence, court notifications, foster care agreements, protective services records, interstate compact placement forms, and investigation reports. The spreadsheet identifies 484 unique documents with their current operational status, legacy document identifiers, RFP IDs, file specifications, and business unit ownership. Documents are categorized by intended audience (clients, providers, courts, law enforcement, state agencies), functionality (permanency, case management, intake, investigation, homefinding, licensing, independent living), and operational characteristics (static versus editable formats, system-generated versus worker-generated triggers). The inventory review process has determined that certain documents should be retained as-is, retained with modifications, or retired from the system based on relevance to the new WV PATH platform.

The spreadsheet reflects an ongoing transition from legacy systems (FACTS) to the new WV PATH system, with specific action items and parking lot notes documenting outstanding implementation issues, duplication resolutions, and state-mandated modifications. Key decision points include the retirement of duplicate forms, consolidation of similar documents, and establishment of triggers for system-generated correspondence. Supporting specifications reference multiple Oscar Form Categories and WAI (Work Authorization Item) numbers that track requirements across the system implementation. Funding sources, pricing terms, and contract amounts are not addressed in this inventory document, as it serves primarily as a reference tool for system administrators and business analysts managing document lifecycle and technical specifications during the WV PATH platform transition. The document indicates that several forms are being placed on the Common Landing Portal (CLP) or SharePoint for access rather than being embedded within the PATH system itself.

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Document List

Unique Document ID

Document Title

Document Description

Legacy ID

Legacy Document Name

Legacy Document Description

RFP ID

RFP Name/Description

Current Status (RFP)

Planned Status

Related Program

Intended Audience

Correspondence Author

Primary Business Unit Owner

Secondary Business Unit Owner

Related Functionality

Oscar Form Category

Trigger

Frequency

FTI Data

PHI Data

PII

Data

Static or Editable

Planned File Type

Specification ID

Action Item

Parking Lot

Notes

Outstanding Issues

Document Tracking ID

ADP-0016

Adoption Subsidy Process Form

Client application requesting subsidy payments for an adoptive child.

ADP-0016

Adoption Subsidy Process Form (SS-FC-41)

F0223

Adoption Subsidy Process Form

Existing

Retain as is

Child Welfare

Agency Worker

Permanency

N/A

Worker Generated

On Demand

Yes

Editable

Word

SM0425 SM0438 SM0394

N/A

Inventory Review - Retain as is

D00319

ADP-0017

Addendum to Adoption Subsidy

Client Notification when the subsidy payment changes between the adoptive parents and DHHR.

ADP-0017

Addendum to Adoption Subsidy

F0191

Addendum to Adoption Subsidy

Existing

Retain as is

Child Welfare

Client

Permanency

N/A

Worker Generated

On Demand

Static

PDF

SM0425 SM0438 SM0394

N/A

Inventory Review - Retain as is

D00158

ASO-0004

Special Medical Card Authorization Letter - Health Services Report

Letter stating that client is eligible and authorized for Medical Services.

ADP-0019

Special Medical Card Authorization Letter - Health Services Report

F0259

Special Medical Card Authorization Letter- Health Services

Existing

Retain as is

Child Welfare

BMS Beru of Medical Services / client / Provider

Case Management

N/A

Worker Generated

On Demand

Yes

Static

PDF

EE0002, EE0004

WAI_5943

N/A

Inventory Review - Retain as is

US has ADP-0019 as document number; Document number has been corrected to align to the approperiate area. Document was mis labled as ADP when it was first entered in FACTS

D00402

ADP-0021

Letter of Case Closure (Adoption)

Client notification that adotpion subsidy will end due to child turning 18.

ADP-0021

Letter of Case Closure (Adoption)

F0203

Letter of Case Closure (Adoption)

Existing

Retain as is

Child Welfare

Client

Permanency

N/A

Worker Generated

On Demand

Yes

Static

PDF

SM0425 SM0438 SM0394

N/A

D00190

ADP-0172

Child Summary

Summary of the child included Health, Physical Descriptions and Background information for adoption process.

ADP-0172

Child Summary

F0212

Child Summary

Existing

Retain as is

Child Welfare

Client / Court / Provider

Permanency

N/A

Worker Generated

On Demand

Yes

Editable

Word

SM0572 SM0540

WAI_5859

N/A

D00468

N/A

ADP-0223

Review of Adoption Agreement

F0213

Review of Adoption Agreement

Existing

Retire

Child Welfare

N/A

Permanency

N/A

Per Inventory Review (Adult Service Documents)- Do not need

D00369

ADP-0225

Adoption Subsidy Amendment Letter

Client notification informing them that their request for adoption subsidy increase has been approved.

ADP-0225

Adoption Subsidy Amendment Letter

F0232

Adoption Subsidy Amendment Letter

Existing

Retain as is

Child Welfare

Client

Permanency

N/A

Worker Generated

On Demand

Static

PDF

SM0425 SM0438 SM0394

N/A

D00443

N/A

ADP-0227

Consent of Guardian

F0183

Consent of Guardian

Existing

Retire

Child Welfare

N/A

Permanency

N/A

Per Inventory Review (Adult Service Documents)- Do not need - use ARP 0243

D00035

N/A

ADP-0228

Consent of Guardian Cover Letter

F0241

Consent of Guardian Cover Letter

Existing

Retire

Child Welfare

N/A

Permanency

N/A

Per Inventory Review (Adult Service Documents)- Do not need - use ARP 0243

D00037

ADP-0230

Cover Letter for Adoption Review

Client cover letter for continuation of adoption subsidy after age 18.

ADP-0230

Cover Letter for Adoption Review

F0218

Cover Letter for Adoption Review

Existing

Retain - Modify

Child Welfare

Client

Permanency

N/A

System Generated

As Defined

Static

PDF

SM0438

WAI_5860

N/A

ADP-0230 and ADP-0802 are mailed together in a packet to the client. ADP-0230 should be first in the mailing.

Trigger - End Date on the subsidy table, document triggers at 60 days prior to the end date.

D00046

ADP-0240

Adoption Subsidy Agreement

This Correspondence serves as an agreement between the adoptive parents and the West Virginia Department of Health and Human Resources to receive subsidy for the adoptive child.

ADP-0240

Adoption Subsidy Agreement

F0198

Existing

Retain as is

Child Welfare

Client

Permanency

N/A

Worker Generated

On Demand

Static

PDF

SM0425 SM0438 SM0394

N/A

Inventory Reivew - Retain as is

D00321

N/A

ADP-0241

Deferred Adoption Agreement

F0215

Deferred Adoption Agreement

Existing

Retire

Child Welfare

N/A

Permanency

N/A

Per Inventory Review (Adult Service Documents)- Do not use - use ADP 0240

D00051

ADP-0243

Release and Consent for Adoption

Document is used for Birth Parents release of rights so the child may go up for adoption.

ADP-0243

Release and Consent for Adoption

F0242

Release and Consent for Adoption

Existing

Retain as is

Child Welfare

DHHR

Permanency

N/A

Worker Generated

On Demand

Static

Word

SM0425 SM0438 SM0394

N/A

D00358

AFC-0605

ARS Payment Agreement

Payment agreement between Adult Client and DHHR. Document states how much each party is responsible for.

AFC-0605

ARS Payment Agreement

F0239

ARS payment Agreement

Existing

Retain as is

Child Welfare

Client

Case Management

N/A

Worker Generated

On Demand

Yes

Static

PDF

GT0142

WAI_6593

N/A

Inventory Review - Retain as is

D00345

N/A

AJR-0001

Administrative and Judicial Review

N/A

Retire

Child Welfare

N/A

Foster Care

N/A

WAI_5979

WAI_6003

N/A

This is a real time report of court reviews documented in FACTS with a calculated due date for the next review. This is not a standard form or document.

D00160

APR-0739

Automated Placement Referral

Referral document used when Children are part of the Automated Placement Referral process.

APR-0739

Automated Placement Referral

F0216

Automated Placement Referral

Existing

Deferred

Child Welfare

Provider

Foster Care

N/A

Worker Generated

On Demand

Yes

Static

PDF

SM0572

WAI_5980

N/A

Document is deferred until Post Go Live. Not added in to scope with CW PP.

WAI_5980

ACTION ITEM: Optum and CGI to determine when to complete APR review session. Changes will impact Automated Placement Referral (APR-0739).

D00415

APS-0604

Adult Service Plan

Document serves as a service plan summary for adults.

APS-0604

Adult Service Plan

F0181

Adult Service Plan

Existing

Retain - Modify

Child Welfare

Client

Case Management

N/A

Worker Generated

On Demand

Static

PDF

SM0630 SM0697 SM0698 SM0699 SM0711 SM0712 SM0734

N/A

Inventory Review - Retain as is

Slight modifications were added to account for the new fields in PATH. Added Concern Type and Completion Date.

D00069

APS-0607

Adult Protective Services Risk Assessment

Document is used to provide a Adult Protective Services Risk Assessment summary.

APS-0607

Adult Protective Services Risk Assessment

F0329

Adult Protective Services Risk Assessment

Existing

Retain - Modify

Child Welfare

Provider

Case Management

N/A

Worker Generated

On Demand

Yes

Static

Word

SM0640

WAI_5919

N/A

D00059

N/A

APS-0612

Social Summary

F0238

Social Summary

Existing

Retire

Child Welfare

N/A

Case Management

N/A

Inactive since 4/2005

Retired - Do not need - Inventory - Inactive since 4/2005

D00396

APS-0614

AFC Approval Letter

Client notification that their home has been approved to provide Adult Family Care.

APS-0614

AFC Approval Letter

F0299

AFC Approval Letter

Existing

Retain as is

Child Welfare

Provider

Homefinding

N/A

Worker Generated

On Demand

Static

PDF

PM0094

N/A

D00070

APS-0615

AFC Certificate of Approval

Adult Family Care Home Certifiicate.

APS-0615

AFC Certificate of Approval

F0301

AFC Certificate of Approval

Existing

Retain as is

Child Welfare

Provider

Homefinding

N/A

Worker Generated

On Demand

Static

PDF

EE0207

PM0094

N/A

Per Inventory review, retain with no modification and Duplicate of F1145

Need to prevent printing if not licensed

D00079

APS-0616

AFC provider Agreement for Participation

Provider agreement for Adult Family Care Homes.

APS-0616

AFC provider Agreement for Participation

F0268

AFC provider Agreement for Participation

Existing

Retain as is

Child Welfare

Client

Homefinding

N/A

Worker Generated

On Demand

Static

PDF

PM0094

N/A

Per Inventory review, retain with no modification

D00097

APS-0617

AFC Client Medical Evaluation

Document is used for Adult Services clients to request a medical evaluation and physician will record the results on the document.

APS-0617

AFC Client Medical Evaluation

F0176

AFC Client Medical Evaluation

Existing

Retain as is

Child Welfare

Client

Case Management

N/A

Worker Generated

On Demand

Yes

Editable

Word

GT0128

N/A

Inventory Review - Retain as is

D00080

APS-0618

AFC Resident Agreement for Participation

Agreement between adult and DHHR to participate in Adult Family Care, Residential Care or Home Care Program.

APS-0618

AFC Resident Agreement for Participation

F0225

AFC Resident Agreement for Participation

Existing

Retain as is

Child Welfare

Client

Case Management

N/A

Worker Generated

On Demand

Editable

Word

PM0094

WAI_3366

N/A

Per Inventory review, retain with no modification

D00104

APS-0619

AFC-ESC Annual Fire Safety Review

Checklist used to complete Fire and Saftey Review of Adult Family Care / Adult Emergency Shelter Care Home.

APS-0619

AFC-ESC Annual Fire Safety Review

F0273

AFC-ESC Annual Fire Safety Review

Existing

Retain as is

Child Welfare

DHHR / Homefinder

Homefinding

N/A

Worker Generated

On Demand

Static

PDF

PM0086

N/A

Per Inventory review, retain with no modification

D00111

APS-0620

AFC-ESC Annual Sanitation Review

Checklist used to complete Sanitation Review of Adult Family Care / Adult Emergency Shelter Care Home.

APS-0620

AFC-ESC Annual Sanitation Review

F0305

AFC-ESC Annual Sanitation Review

Existing

Retain as is

Child Welfare

Provider

Homefinding

N/A

Worker Generated

On Demand

Editable

PDF

GT0128

N/A

Per Inventory Review (Provider Documents) - Retain as is

D00126

APS-0621

Adult Family Care-Emergency Shelter Fire Safety Checklist

Adult Family Care / Adult Emergency Shelter Care Home questionaire for Fire Saftey.

APS-0621

Adult Family Care-Emergency Shelter Fire Safety Checklist

F0002, F0297

Adult Family Care-Emergency Shelter Fire Safety Checklist

Existing

Retain as is

Child Welfare

Provider

Homefinding

N/A

Worker Generated

On Demand

Editable

PDF

PM0100

N/A

Per Inventory Review (Provider Documents) - Retain as is

D00021

N/A

APS-0622

ESC Approval Letter

F0282

ESC Approval Letter

Existing

Retire

Child Welfare

N/A

Homefinding

N/A

WAI_5712

WAI_5715

N/A

D00077

N/A

APS-0623

ESC Certificate of Approval

F0280

ESC Certificate of Approval

Existing

Retire

Child Welfare

N/A

Licensing

N/A

WAI_5711

N/A

Duplicate of F1145

WAI_5711 - Optum to Retire ESC Certificate of Approval (APS-0623/Request for Proposal (RFP) Identification (ID) F0280).

D00078

N/A

APS-0624

ESC Recertification Letter

F0278

ESC Recertification Letter

Existing

Retire

Child Welfare

N/A

Homefinding

N/A

WAI_5714

WAI_5716

N/A

Duplicate of F1145

D00082

APS-0625

AFC Recertification Letter

Adult Family Care Re-Certification confirmation letter.

APS-0625

AFC Recertification Letter

F0298

AFC Recertification Letter

Existing

Retain as is

Child Welfare

Provider

Client

Homefinding

N/A

Worker Generated

On Demand

Static

PDF

EE0330

N/A

D00098

N/A

APS-0626

ESC Provider Agreement for Participation

F0279

ESC Provider Agreement for Participation

Existing

Retire

Child Welfare

N/A

Homefinding

N/A

WAI_5719

N/A

D00081

APS-0627

Adult Family Care/Adult Emergency Shelter Care Program Personal Reference Letter

Potential Provider sends letter to person asking for a personal reference.

APS-0627

Adult Family Care/Adult Emergency Shelter Care Program

Personal Reference Letter

Adult Family Care-Adult Emergency Shelter Personal Reference Letter

F0003, F0291

Adult Family Care-Adult Emergency Shelter Personal Reference Letter

Existing

Retain as is

Child Welfare

Client

Homefinding

N/A

Worker Generated

On Demand

Static

PDF

SM0610 SM0611

N/A

Per Inventory review, retain with no modification

Duplicate of F1137 Retain F0003,F0291 (APS-0627) and Retire F1137 with no Doc ID #

Optum Doc # D00011 and D00309

D00011

APS-0628

Adult Family Care/Adult Emergency Shelter Care Program Credit Reference Letter

Potential Provider sends letter to person asking for a personal reference.

APS-0628

Adult Family Care/Adult Emergency Shelter Care Program

Credit Reference Letter

Adult Family Care-Adult Emergency Shelter Credit Reference Letter

F0004, F0296

Adult Family Care-Adult Emergency Shelter Credit Reference Letter

Existing

Retain as is

Child Welfare

Client

Homefinding

N/A

Worker Generated

On Demand

Static

PDF

PM0093

N/A

Per Inventory Review (Provider Documents) - Retain as is

D00010

APS-0629

Adult Family Care Emergency Shelter Application

Application to be completed by person wanting to open an Emergency Shelter.

APS-0629

Adult Family Care Emergency Shelter Application

F0001, F0300

Adult Family Care Emergency Shelter Application

Existing

Retain - Modify

Child Welfare

Provider

Homefinding

N/A

Worker Generated

On Demand

Yes

Editable

PDF

GT0128

WAI_5720

N/A

Per Inventory Review (Provider Management) - Keep - Nov. 1999 DHHR needs to revise

New version received from state; added to Sharepoint and the WAI

D01605

APS-0630

ADULT FAMILY CARE/ADULT EMERGENCY SHELTER CARE PROGRAM

Cover letter to physician requesting information on named applicant.

APS-0630

ADULT FAMILY CARE/ADULT EMERGENCY SHELTER CARE PROGRAM

Physician’s Letter

F0277

AFC-ESC Physicians Letter

Existing

Retain as is

Child Welfare

Provider

Homefinding

N/A

Worker Generated

On Demand

Static

PDF

PG0047

N/A

Per Inventory Review (Provider Documents) - Retain as is

D00020

N/A

APS-0631

Level of Care Evaluation

F0172

Level of Care Evaluation

Existing

Retire

Child Welfare

N/A

Case Management

N/A

Retired - Do not need - Inventory - Retired - Do not need

D00196

N/A

APS-0632

Hartley Verification Letter

F0143

The solution must have the ability to create the Hartley Verification Letter in accordance with West Virginia business rules.

Existing

Retire

Child Welfare

N/A

Case Management

N/A

Duplicate of F0171

Retired - Do not need - Retire from inventory

D00117

N/A

APS-0632

Hartley Verification Letter

F0171

Hartley Verification Letter

Existing

Retire

Child Welfare

N/A

Case Management

N/A

Duplicate of F0143- Inactive since 04/2005

Retired - Do not need - Retire from inventory

D00118

APS-0633

APS Notification to Agencies

Summary of Adult Protective Services investigation.

APS-0633

APS Notification Letter Within DHHR

F0326

APS Notification Letter Within DHHR

Existing

Retain - Modify

Child Welfare

DHHR

Investigation

N/A

Worker Generated

On Demand

Yes

Editable

PDF

GT0142

WAI_5901

WAI_6255

N/A

D00322

N/A

APS-0634

APS Notification Letter-non DHHR

F0324

APS Notification Letter-non DHHR

Existing

Retire

Child Welfare

N/A

Investigation

N/A

Inactive since 4/2005

Replaced by APS-0673 FACTS Notification outside DHHR

D00329

APS-0635

APS Notification Letter-Law Enforcement

Notification is sent to Law Enforcement stating that DHHR has received a report of abuse/neglect/financial exploitation of a vulnerable adult and request that they take the appropriate action.

APS-0635

APS Notification Letter-Law Enforcement

F0327

APS Notification Letter-Law Enforcement

Existing

Retain - Modify

Child Welfare

Law Enforcement

Investigation

N/A

Worker Generated

On Demand

Editable

PDF

GT0142

WAI_5901

WAI_6255

N/A

D00324

APS-0636

Corrective Action Letter to Provider / Facility

Corrective Action Plan sent to the Provider for action.

APS-0636

Corrective Action Letter to Facility

F0281, F1146

Corrective Action Letter to Facility

Existing

Retain as is

Child Welfare

Provider

Investigation

N/A

Worker Generated

On Demand

Static

PDF

PM0073 PM0081 PM0096

WAI_5911

N/A

Duplicate of F1146

Per WAI_5911 Meeting: This is to be retained and generated from PATH; keep as is Manual generation

Session Notes: https://uhgazure.sharepoint.com/:w:/r/sites/enterpriseoperations/WV_IES/_layouts/15/Doc.aspx?sourcedoc=%7B3686B047-1445-458F-876A-FD14567D4C3E%7D&file=20200416_WV_PATH_WAI_5911_CAP_Documents_Workgroup_Meeting_Notes.docx&action=default&mobileredirect=true&DefaultItemOpen=1

D00042

APS-0637

APS Letter to Prosecuting Attorney

Letter to Prosecutor informing them the allegations were substantiated and requesting for them to review to determine if Legal Action is needed.

APS-0637

APS Letter to Prosecuting Attorney

F0323

APS Letter to Prosecuting Attorney

Existing

Retain - Modify

Child Welfare

Court

Investigation

N/A

Worker Generated

On Demand

Yes

Static

PDF

GT0142

WAI_5901

WAI_6255

N/A

D00249

N/A

APS-0638

AS Social Evaluation ARS Case Review Summary

F0141

The solution must have the ability to create the Social Evaluation in accordance with West Virginia business rules.

Existing

Retire

Child Welfare

N/A

Case Management

N/A

Inventory Review - Duplcate of F0156 and F0144 - Inactive since 4/2005

Retired - Do not need

D00350

N/A

APS-0638

AS Social Evaluation ARS Case Review Summary

F0144

The solution must have the ability to create the Case Review Summary in accordance with West Virginia business rules.

Existing

Retire

Child Welfare

N/A

Case Management

N/A

Inventory Review - Duplcate of F0156 and F0144 - Inactive since 4/2005

Retired - Do not need

D00359

N/A

APS-0638

AS Social Evaluation ARS Case Review Summary

F0156

AS Social Evaluation ARS Case Review Summary

Existing

Retire

Child Welfare

N/A

Case Management

N/A

Retired - Do not need - Inventory - Inactive since 4/2005

D00363

APS-0639

AFC/ESC Annual provider Review Summary

Summary of the annual review findings for AFC and ESC provider types.

APS-0639

AFC/ESC Annual provider Review Summary

F0276

AFC/ESC Annual provider Review Summary

Existing

Retain - Modify

Child Welfare

Provider

Homefinding

N/A

Worker Generated

On Demand

Static

PDF

EE0330

WAI_5736

N/A

D00106

APS-0640

AFC/ESC Homestudy Summary

Document is used to complete a Homstudy review.

APS-0640

AFC/ESC Homestudy Summary

F0267

AFC/ESC Homestudy Summary

Existing

Retain - Modify

Child Welfare

Provider

Homefinding

N/A

Worker Generated

On Demand

Editable

Word

EE0325 SM0673

WAI_5721

N/A

D00109

N/A

APS-0641

APS Corrective Action Plan

F0266, F1146

APS Corrective Action Plan

Existing

Retire

Child Welfare

N/A

Investigation

N/A

WAI_5911

N/A

Duplicate of F1146

IIU-524

Session Notes: http://enterpriseoperations-sp.optum.com/WV_IES/STATE_Meetings/20200416_WV_PATH_WAI_5911_CAP_Documents_Workgroup_Meeting_Notes.docx

D00207

N/A

APS-0642

APS Social Evaluation

F0214

APS Social Evaluation

Existing

Retire

Child Welfare

N/A

Case Management

N/A

Retired - Do not need - Inventory - Retired - Do not need

D00343

APS-0652

Medicare Part D

Client notification that when they turn 65 years of age, they are eligible for Medicare and enrollment is mandatory if receiving assistance from DHHR.

APS-0652

Medicare part D

F0222

Medicare part D

Existing

Retain as is

Child Welfare

Client

Case Management

N/A

Worker Generated

On Demand

Static

PDF

GT0142

N/A

D00203

APS-0673

Notification Outside DHHR/Corrective Action Letter

Notification to a facility that a Adult Protective Services investigation/site visit was completed and the outcome of that visit.

APS-0673

Notification Outside DHHR/Corrective Action Letter

F0325, F1146

Notification Outside DHHR/Corrective Action Letter

Existing

Retain - Modify

Child Welfare

State Agencies

Investigation

N/A

Worker Generated

On Demand

Editable

PDF

PM0073 PM0081 PM0096

WAI_5901

WAI_6223

WAI_6255 N/A Duplicate of F1146 Amber to update current form - WAI_6223

Session Notes: https://uhgazure.sharepoint.com/sites/enterpriseoperations/WV_IES/STATE_Meetings/20200416_WV_PATH_WAI_5911_CAP_Documents_Workgroup_Meeting_Notes.docx

D00248

APS-0733

Relative Release - Donation Form

Relative's concent to have the deceased body released for donation.

APS-0733

Relative Release - Donation Form

F0313

Relative Release-Donation Form

Existing

Retain as is

Child Welfare

Client

Investigation

N/A

Worker Generated

On Demand

Editable

PDF

GT0142

N/A

D00356

APS-0734

Notification to Perpetrator Substantiated

Investigation overview of findings Adult Allegations report.

APS-0734

Notification to Perpetrator

F0321

Notification to Perpetrator

Existing

Retain - Modify

Child Welfare

Client

Investigation

N/A

Worker Generated

On Demand

Editable

PDF

GT0142

WAI_5901

WAI_6255

N/A

D00251

N/A

APS-0735

APS Investigation Disposition Corrective Action Letter

F0145

The solution must have the ability to create the Adult Residential Services Corrective Action Letter in accordance with West Virginia business rules.

Existing

Retire

Child Welfare

N/A

Investigation

N/A

WAI_5911

N/A

Duplicate of F0318 and F1146 - Retain F0145, Retire the others

12/19/2019 Template - Keep Amber will send letter to Patty Dup F0318

Session Notes: http://enterpriseoperations-sp.optum.com/WV_IES/STATE_Meetings/20200416_WV_PATH_WAI_5911_CAP_Documents_Workgroup_Meeting_Notes.docx

D00228

N/A

APS-0735

APS Investigation Disposition Corrective Action Letter

F0318, F1146

Corrective Action Letter

Existing

Retire

Child Welfare

N/A

Investigation

N/A

WAI_5911

N/A

Duplicate of F1146 and F0145; Retain F0145 - Retire F0318 and F1146; Dup of APS-0673

D00237

APS-0737

Notification to Perp When Allegations Not Substantiated

Notification to the accused perpetrator that the investigation has been completed and the claims were found Not Substantiated.

APS-0737

Notification to Perp When Allegations Not Substantiated

F0322

Notification to Perp When Allegations Not Substantiated

Existing

Retain - Modify

Child Welfare

Client

Investigation

N/A

System Generated, Worker Generated

As Defined, On Demand

Static

PDF

GT0142

WAI_5901

WAI_6255

N/A

D00250

N/A

ARN-0043

Family Data Input Form

F0272

Family Data Input Form

Existing

Retire

Child Welfare

N/A

Permanency

N/A

WAI_5861

N/A

D00089

ARN-0602

West Virginia Adoption Resource Network (Child Data Form)

Used to report that a child has been referred to the Adoption Resource Network or an update for a child that is already part of the Adoption Resource Network.

ARN-0602

West Virginia Adoption Resource Network (Child Data Form)

F0217

West Virginia Adoption Resource Network (Child Data Form)

Existing

Retain as is

Child Welfare

State Agencies

Permanency

N/A

Worker Generated

On Demand

Yes

Editable

Word

SM0425 SM0438 SM0394

N/A

Inventory Review - Retain as is

D00460

N/A

ARN-0603

West Virginia Adoption Resource Network (Family Data Form)

F0290

West Virginia Adoption Resource Network (Family Data Form)

Existing

Retire

Child Welfare

N/A

Permanency

N/A

WAI_5862

N/A

D00465

ASO-0001

Special Medical Card Authorization Letter - Behavioral Health

Authorization for Medical and list the services that are authorized.

ASO-0001

Special Medical Card Authorization Letter - Behavioral Health

F0257

Special Medical Card Authorization Letter-Behavioral Health Report

Existing

Retain as is

Child Welfare

BMS Beru of Medical Services / client / Provider

Case Management

N/A

Worker Generated

On Demand

Yes

Static

PDF

SM0531, SM0524

WAI_5943

N/A

Inventory Review - Retain as is

D00399

ASO-0002

Referral for Socially Necessary Services

Notification to the provider that the client has been referred for services.

ASO-0002

Referral for Socially Necessary Services

F0256

Referral for Socially Necessary Services

Existing

Retain as is

Child Welfare

Client

Case Management

N/A

Worker Generated

On Demand

Yes

Static

PDF

PM0078 PM0079 PM0080 PM0081

WAI_5912

N/A

D00348

N/A

ASO-0003

Client ASO Service Utilization History

N/A

Retire

Child Welfare

N/A

Case management

N/A

WAI_5913

WAI_5914

WAI_5915

N/A

D00014

ASR-0613

Comprehensive Assessment

Full assessment of the Adult that is participating in Adult Service Programs.

ASR-0613

Comprehensive Assessment

F0243

Comprehensive Assessment

Existing

Retain as is

Child Welfare

DHHR

Case Management

N/A

Worker Generated

On Demand

Yes

Editable

PDF

SM0557

N/A

D00031

N/A

ASR-0650

Evaluation Report of Licensed Physician/Psychologist

F0170

Evaluation Report of Licensed Physician/Psychologist

Existing

Retire

Child Welfare

N/A

Case Management

N/A

WAI_5922

N/A

D00084

N/A

ASR-0651

Revocation or Modification of the Appointment of a Conservator/Guardian

F0201

Revocation or Modification of the Appointment of a Conservator/Guardian

Existing

Retire

Child Welfare

N/A

Case Management

N/A

WAI_5923

N/A

D00370

ASR-0652

Adult Services Assessment

This Correspondence constitutes as the physical copy of the Initial Adult Services Assessment that follows the recipt of a referral for abuse or neglect.

ASR-0652

Adult Initial Assessment

F0331

Adult Initial Assessment

Existing

Retain as is

Child Welfare

Provider

Case Management

N/A

Worker Generated

On Demand

Yes

Editable

Word

SM0640

WAI_5924

N/A

Inventory Review - Retain as is

D00052

N/A

ASR-0653

Living Arrangements History

F0260

Living Arrangements History

Existing

Retire

Child Welfare

N/A

Case Management

N/A

Retired - Do not need - inventory - Retired - Do not need

D00198

N/A

ASR-0654

Petition for the Removal of a Conservator/Guardian

F0247

Petition for the Removal of a Conservator/Guardian

Existing

Retire

Child Welfare

N/A

Case Management

N/A

WAI_5925

N/A

D00315

ASR-0701

Periodic Report of Guardian

Completed by the guardian of the Protected person on the status of the individual.

ASR-0701

Periodic Report of Guardian

F0180

Periodic Report of Guardian

Existing

Retain as is

Child Welfare

court

Case Management

N/A

Worker Generated

On Demand

Editable

PDF

SM0425

WAI_5926

N/A

Inventory Review - Retain as is

Received updated form on WAI_5926 State is going to own this document going forward instead of the West Virginia Supreme Court

Fillable PDF - Populate only the "Protected Person" / "Client in Focus"

D00305

N/A

ASR-0711

Appointment of Health Care Surrogate

F0161

Appointment of Health Care Surrogate

Existing

Retire

Child Welfare

N/A

Case Management

N/A

WAI_5927

WAI_5934

WAI_5935

N/A

Per RFI meeting: We are to RETIRE D00154, D00162 and D00461. Optum will place a link on the CLP under Quick Links to access the document. Notes have been added to WAI_5934 in ALM.

D00154

N/A

ASR-0712

Petition for the Appointment of Conservator/Guardian

F0240

Petition for the Appointment of Conservator/Guardian

Existing

Retire

Child Welfare

N/A

Case Management

N/A

WAI_5928

N/A

D00314

N/A

ASR-0713

Motion for Leave to File 901 Petition Without Evaluation Report

F0174

Motion for Leave to File 901 Petition Without Evaluation Report

Existing

Retire

Child Welfare

N/A

Case Management

N/A

WAI_5929

N/A

D00205

N/A

ASR-0715

Affidavit of Physician Certifying Protected Person Cannot Attend

F0165

Affidavit of Physician Certifying Protected Person Cannot Attend

Existing

Retire

Child Welfare

N/A

Case Management

N/A

WAI_5930

N/A

D00129

N/A

ASR-0716

Statement of Financial Resources (Summary Form)

F0189

Statement of Financial Resources (Summary Form)

Existing

Retire

Child Welfare

N/A

Case Management

N/A

WAI_5932

N/A

D00408

N/A

ASR-0717

Petition by Conservator/Guardian for Permission to Resign

F0177

Petition by Condervator/Guardian for Permission to Resign

Existing

Retire

Child Welfare

N/A

Case Management

N/A

WAI_5931

N/A

D00310

ASR-0730

Request to Receive Services Intake Summary Report (Adult Services Programs)

Provides a summary of the adult being referred for services.

ASR-0730

Request to Receive Services Intake Summary Report (Adult Services Programs)

F0333

Request to Receive Services Intake Summary Report (Adult Servicess Programs)

Existing

Retain as is

Child Welfare

Client court dhhr

Intake

N/A

Worker Generated

On Demand

Yes

Static

PDF

GT0142

N/A

Inventory Review - Retain as is

D00362

ASR-0732

Notification of Application for Social Services

Client notification of Application for Social Services determination.

ASR-0732

Notification of Application for Social Services

F0158

Notification of Application for Social Services

Existing

Retain as is

Child Welfare

Client

Intake

N/A

Worker Generated

On Demand

Static

PDF

GT0142

N/A

Inventory Review - Retain as is

D00233

N/A

BCF-PSRC

Authorization and Release for Protective Services Record Checks

Authorization and Release for Protective Services Record Checks - Agencies/Providers In and & Out of State

F0007

Authorization and Release for Protective Services Record Check--Agencies/Providers In & Out of State

Existing

Retire

Child Welfare

N/A

Homefinding

N/A

WAI_5723

N/A

D00411

N/A

BCF-PSRC-Adopt/Foster

Authorization and Release for Protective Services and Provider Record Checks for Adoption/Foster Care Only

F0006

Authorization and Release for Protective Services Record Check-Adoption/Foster Care Parents Only

Existing

Retire

Child Welfare

N/A

Homefinding

N/A

WAI_5722

N/A

D00400

N/A

COP-0001

Court Order Payment Log

N/A

Retire

Child Welfare

N/A

Finance

N/A

Inventory Review - Retain as is, however this is a report of court ordered payments that is generated to an excel file. Therefore it was reviewed in Reporting Session and we are to Retire.

D00044

CPR-0740

Unified Child, Youth and Family Case Plan

Case plan describe specifics of a child’s care while in placement.

CPR-0740

Unified Child, Youth and Family Case Plan

F0133

The solution must support the completion of the Court Approved Unified Child and Families Case Plan according to West Virginia business rules.

Existing

Retain as is

Child Welfare

Client / Court

Case Management

N/A

Worker Generated

On Demand

Yes

Static

PDF

SM0398, SM0399, SM0510

N/A

D00453

CPR-0750

Unified Child, Youth and Family Case Plan Progress Report

Progress report is submitted o the court when the court orders a review of the progress or completion of improvement periods or when the court conducts permanency reviews.

CPR-0750

Unified Child, Youth and Family Case Plan Progress Report

N/A

Retain as is

Child Welfare

Client / Court

Case management

N/A

Worker Generated

On Demand

Yes

Static

PDF

SM0514

WAI_5814

N/A

D00454

N/A

CPS-0014

Family Case Plan Evaluation of Progress

F0230

Family Case Plan Evaluation of Progress

Existing

Retire

Child Welfare

N/A

Case Management

N/A

Per Inventory Review (Adult Service Documents)- Will not need for WV PATH

D00088

N/A

CPS-0017

Child Protective Services, WV State Police Automatic Referral File Notification

FACTS web

N/A

Retire

Child Welfare

N/A

Investigation

N/A

WAI_5885

N/A

D00467

N/A

CPS-0019

Disposition of Referral

FACTS web

N/A

Retire

Child Welfare

N/A

Investigation

N/A

WAI_5901

WAI_5887

WAI_6255

N/A

D00068

N/A

CPS-0024

Case Evaluation Report

F0169

Case Evaluation Report

Existing

Retire

Child Welfare

N/A

Case Management

N/A

Per Inventory Review (Adult Service Documents)- Will not need for WV PATH

D00429

N/A

CPS-0038

Patient Care Evaluation

F0236

Patient Care Evaluation

Existing

Retire

Child Welfare

N/A

Investigation

N/A

WAI_5888

WAI_5889

WAI_5890

N/A

D00303

CPS-0048

Post Termination Placement Plan

Summary of current childs placement as well as medical, education, scheduled appointments and siblings. Also includes permanency information, barries and adoption subsidy.

CPS-0048

Post Termination Placement Plan

F0187

Post Termination Placement Plan

Existing

Retain as is

Child Welfare

Client / Court

Case Management

N/A

Worker Generated

On Demand

Yes

Editable

Word

GT0142

N/A

D00326

N/A

CPS-0049

Permanent Placement Review Report

F0182

Permanent Placement Review Report

Existing

Retire

Child Welfare

N/A

Case Management

N/A

WAI_5815

N/A

D00307

CPS-0051

Child's Case Plan Cover Letter

Cover letter that is sent with the Child's Case Plan.

CPS-0051

Child's Case Plan Cover Letter

F0231

Child's Case Plan Cover Letter

Existing

Retain as is

Child Welfare

Court / Client

Case Management

N/A

Worker Generated

On Demand

Editable

PDF

GT0142

N/A

D00005

CPS-0054

Permanent Placement Review Report Cover Letter

Cover Letter for the Post-Termination Placement Plan / Review that is sent to the judge.

CPS-0054

Permanent Placement Review Report Cover Letter

F0235

Permanent Placement Review Report Cover Letter

Existing

Retain as is

Child Welfare

Court

Case Management

N/A

Worker Generated

On Demand

Editable

PDF

GT0142

N/A

D00308

N/A

CPS-0055

DHHR Improvement Period Terms

F0196

DHHR Improvement Period Terms

Existing

Retire

Child Welfare

N/A

Case Management

N/A

WAI_5816

N/A

D00060

CPS-0056

Notification of MDT Meeting

Notification of a scheduled MDT hearing to the person(s) it is related to.

CPS-0056

Notification of MDT Meeting

F0195

Notification of MDT Meeting

Existing

Retain as is

Child Welfare

Client

Case Management

N/A

Worker Generated

On Demand

Editable

PDF

SM0404

N/A

None

D00241

N/A

CPS-0057

Confirmation of Hearing

N/A

Existing

Retire

Child Welfare

Client / Attorney

N/A

Case management

N/A

Worker Generated

On Demand

Editable

PDF

SM0537

N/A

D00032

CPS-0058

Notification of Scheduled Hearing

This Correspondence serves as a method of correspondence notifying clients, collaterals and workers of upcoming court hearings.

CPS-0058

Notification of Scheduled Hearing

F0160

Notification of Scheduled Hearing

Existing

Retain as is

Child Welfare

Client

Case Management

N/A

Worker Generated

On Demand

Static

PDF

GT0142

N/A

None

D00247

CPS-0059

Hearing/Status Conference Continuance

Client notification of Hearing / Status conference.

CPS-0059

Hearing/Status Conference Continuance

F0208

Hearing/Status Conference Continuance

Existing

Retain as is

Child Welfare

Client

Case Management

N/A

Worker Generated

On Demand

Editable

Word

SM0522

N/A

D00120

N/A

CPS-0062

Community Service Plan

F0319

Community Service Plan

Existing

Retire

Child Welfare

N/A

Case Management

N/A

Per State on Inventory Review (Adult Service Documents)- Not needed for WV Path assessment

D00030

CPS-0077

Law Enforcement Officers Emergency Placement Contract

Law Enforcement Offices complete the document if Emergency placement is needed.

CPS-0077

Law Enforcement Officers Emergency Placement Contract

F0328

Law Enforcement Officers Emergency Placement Contract

Existing

Retain as is

Child Welfare

Law Enforcement

Case Management

N/A

Worker Generated

On Demand

Static

Word

SM0495 SM0534

N/A

Inventory Review - Retain as is

Document is completed by Law Enforcement. Information is not stored in the system. Placing on Common Landing Portal.

None

D00181

CPS-0083

Referral for Child Protective Services

Summary referral when children are being referred to Child Protective Services.

CPS-0083

Referral for Child Protective Services

F0315

Referral for Child Protective Services

Existing

Retain - Modify

Child Welfare

Client court dhhr

Intake

N/A

Worker Generated

On Demand

Yes

Static

PDF

SM0540, SM0572

WAI_5870

WAI_5945

WAI_5946

N/A

D00347

N/A

CPS-0148

Initial Assessment and Safety Evaluation

F0330

Initial Assessment and Safety Evaluation

Existing

Retire

Child Welfare

N/A

Case Management

N/A

Per Inventory Review (Adult Service Documents)- Will not be needed for WV PATH

D00163

CPS-0149

Safety Plan

Documents in detail how identified Safety Threats are occurring within the family including how often, when, under what conditions, other environmental influences, and caregiver(s) access to children.

CPS-0149

Safety Plan

F0237

Safety Plan

Existing

Retain - Modify

Child Welfare

Client

Investigation

N/A

Worker Generated

On Demand

Yes

Editable

Word

SM0489 SM0271 SM0277

WAI_5891

WAI_5892

N/A

D00385

N/A

CPS-0151

Continuing Safety Form

F0227

Continuing Safety Form

Existing

Retire

Child Welfare

N/A

Case Management

N/A

WAI_5817

N/A

D00040

N/A

CPS-0153

Family Assessment

F0221

Family Assessment

Existing

Retire

Child Welfare

N/A

Case Management

N/A

WAI_5818

N/A

D00087

N/A

CPS-0154

Treatment Plan

F0261

Treatment Plan

Existing

Retire

Child Welfare

N/A

Case Management

N/A

WAI_5819

N/A

D00450

N/A

CPS-0188

CPS Referral for Law Enforcement

F0320

CPS Referral for Law Enforcement

Existing

Retire

Child Welfare

Law Enforcement

N/A

Intake

N/A

Worker Generated

On Demand

Yes

Static

PDF

SM0495 SM0534

WAI_5872

WAI_5873

WAI_5886

WAI_5946

WAI_5947

WAI_5948

WAI_5949

N/A

D00047

CPS-0198

On-Call Staff List

Documents who is on call for DHHR for the time frame on the document.

CPS-0198

On-Call Staff List

N/A

Retain as is

Child Welfare

DHHR

administration

N/A

Worker Generated

On Demand

N/A

Word

GT0142

N/A

Inventory Review - Retain as is

Retired - Do not need

D00255

N/A

CPS-0229

Referral Plan Cover Letter

F0316

Referral Plan Cover Letter

Existing

Retire

Child Welfare

N/A

Case Management

N/A

Per Inventory Review (Adult Service Documents)- This is not needed in WV PATH

D00351

CPS-0601

Child, Youth, and Family Case Plan

Documents the Initial Case Plan and Case Plan Evaluations for the child(ren) that have been placed in Foster Care.

CPS-0601

Child, Youth, and Family Case Plan

F0157

Child, Youth, and Family Case Plan

Existing

Retain as is

Child Welfare

Court / Client

Case Management

N/A

Worker Generated

On Demand

Yes

Editable

Word

SM0398, SM0399, SM0510

WAI_5820

WAI_5892

N/A

WAI_5820 state informed us replaced/updated and we were to retire. Per meeting on 9/9/20 we are NOT to retire the document.

WAI_5892 state sent us the updated Case Plan along with the Safety Plan (CPS-0149) - this is not correct

D00002

N/A

CPS-0747

Temporary Protection Plan

F0229

Temporary Protection Plan

Existing

Retire

Child Welfare

N/A

Investigation

N/A

Duplicate of F1109

Per Inventory Review (Adult Service Documents)- Delete - Safety Plan will take the place of the Temporary Protection Plan

D00436

N/A

CPS-0747

Temporary Protection Plan

F1109

The solution must support the steps involved in developing the Temporary Protection Plan according to West Virginia business rules.

Existing

Retire

Child Welfare

N/A

Investigation

N/A

Duplicate of F0229

Per Inventory Review (Adult Service Documents)- Delete - Safety Plan will take the place of the Temporary Protection Plan

D00437

CPS-0751

Administrative Subpoena Duces Tecum - CPS

Subpoena to an individual to produce information related to an alleged perpetrator related to an APS allegation.

CPS-0751

Administrative Subpoena Duces Tecum

F0338

Administrative Subpoena Duces Tecum

Existing

Retain - Modify

Child Welfare

Client

Case Management

N/A

Worker Generated

On Demand

Editable

Word

GT0142

WAI_5821

N/A

CPS-0751 was used for CPS and APS. Per WAI_5821, CPS-0751 was divided into 2 documents.

D00317

CPS-0752

Notification of Completion to Mandated Reporter

Mandated Reporter notification of findings related to the investigation.

CPS-0752

Disposition of Assessment Report

F0339

Disposition of Assessment Report

Existing

Retain - Modify

Child Welfare

Mandated Reporter

Investigation

N/A

System Generated, Worker Generated

As Defined, On Demand

Static

PDF

SM0633 SM0453

WAI_5901

WAI_5902

WAI_5880

WAI_6255

N/A

D00065

N/A

CPS-0753

Assessment Interviews Report

F0340

Assessment Interviews Report

Existing

Retire

Child Welfare

N/A

Investigation

N/A

WAI_5881

N/A

D00387

CPS-0754

Initial Assessment

Intimal assessment report when maltreatment is reported.

CPS-0754

Family Functioning Assessment

F0341

Family Functioning Assessment

Existing

Retain - Modify

Child Welfare

DHHR / Court / Client

Investigation

N/A

Worker Generated

On Demand

Yes

Static

PDF

SM0557 SM0640

WAI_5882

WAI_5883

WAI_5950

WAI_5951

WAI_5953

WAI_5954

WAI_5955

WAI_5956

N/A

D00090

N/A

CPS-0755

Disposition of Family Functioning Assessment for Family and Circuit Court (overlap)

F1114

The solution must be able to create notifications regarding investigation outcomes according to West Virginia business rules.

Existing

Retire

Child Welfare

N/A

Investigation

N/A

WAI_5884

WAI_5901

WAI_6255 N/A Replaced by the CPS-0752 Session Notes:

ACTION ITEM: State (Amanda Spencer) to review and determine if Disposition of Family Functioning Assessment for Family and Circuit Court, Disposition to Court Letter, and Disposition Letter Family and Circuit Court Documents are the same or if they are different.

D00066

N/A

CPS-0756

WV SAMS In-Home Safety Plan

F0335

In-Home Safety Plan

Existing

Retire

Child Welfare

N/A

Case Management

N/A

WAI_5822

N/A

Per Inventory Review (Adult Service Documents)- WV PATH only has Safety Plan

D00481

N/A

CPS-0757

WV SAMS Out-of-Home Safety Plan

F0336

Out-of-Home Safety Plan

Existing

Retire

Child Welfare

N/A

Case Management

N/A

WAI_5823

N/A

Per Inventory Review (Adult Service Documents)- WV PATH only has Safety Plan

D00482

N/A

CPS-0758

WV SAMS Continuing Safety Evaluation

F0337

Continuing Safety Evaluation

Existing

Retire

Child Welfare

DHHR

N/A

Case Management

N/A

Worker Generated

On Demand

Static

PDF

SM0519

WAI_5824

WAI_5825

N/A

WAI_5825 - ACTION ITEM: State to update WV SAMS Continuing Safety Evaluation (CPS-0758) to support new PATH system.

D00479

N/A

CPS-5150

WV SAMS Protective Capacities Family Assessment Case Plan Report

F0343

Protective Capacities Family Assessment Case Plan Report

Existing

Retire

Child Welfare

N/A

Case Management

N/A

Per Inventory Review (Adult Service Documents)- Do not need for WV PATH

D00483

N/A

CPS-5160

WV SAMS Family Case Plan Evaluation Report

F0344

Family Case Plan Evaluation Report

Existing

Retire

Child Welfare

N/A

Case Management

N/A

Per Inventory Review (Adult Service Documents)- Do not need for WV PATH

D00480

BA-67

Authorization for Payment

Document provides request for payment for services provided on behalf of DHHR. The document is used for Child Support, Child Welfare and Integrated Eligibility.

DF-67

Authorization for Payemnt

N/A

Retain as is

Child Welfare

Family Assistance (IE)

DHHR

Finance

N/A

Worker Generated

On Demand

Yes

Static

PDF

FM0020, FM0021

N/A

None

D00413

EMC-0100

Extended Medicaid Coverage Notification Letter

This Correspondence serves as a method to tell the client that he/she is eligible to receive Medicaid benefits for an extended time period after they have exited care. The Correspondence gives an Eligibility End Date and also informs the client about conditions that may cause their eligibility to end sooner than the stated end date.

EMC-0100

Extended Medicaid Coverage Notification Letter

F0258

Extended Medicaid Coverage Notification Letter

Existing

Retain - Modify

Child Welfare

Client

Case Management

N/A

System Generated, Worker Generated

As Defined, On Demand

Yes

Static

PDF

SM0440

WAI_5826

N/A

Per session notes, document is to be System Generated AND Worker Generated.

D00085

EMC-0200

Notification of Change or Extension to Medicaid Coverage

This Correspondence serves as a method to tell the client that he/she has had a change to their extended Medicaid Coverage since their inital communication. The Correspondence gives an Eligibility End Date and also informs the client about conditions that may cause their eligibility to end sooner than the stated end date.

EMC-0200

Notification of Change or Extention to Medicaid Coverage

F0258

Extended Medicaid Coverage Notification Letter

Existing

Retain as is

Child Welfare

Client

Case Management

N/A

System Generated, Worker Generated

As Defined, On Demand

Yes

Static

PDF

SM0753

N/A

D01602

EMC-0300

Notification of Termination of Medicaid Coverage

Notifies client / guardian that Medicaid coverage has been terminated.

EMC-0300

Notification of Termination of Medicaid Coverage

F0258

Extended Medicaid Coverage Notification Letter

Existing

Retain as is

Child Welfare

Client

Case Management

N/A

System Generated, Worker Generated

As Defined, On Demand

Yes

Static

PDF

SM0753

N/A

D01603

ESC-0606

Adult Emergency Shelter Care Home Payment Agreement

This Correspondence serves as a payment agreement that adivises the adult client has been approved for Emergency Shelter Care.

ESC-0606

Adult Emergency Shelter Care Home Payment Agreement

F0166

Adult Emergency Shelter Care Home Payment Agreement

Existing

Retain as is

Child Welfare

Client / Provider

Case Management

N/A

Worker Generated

On Demand

Editable

Word

GT0142

N/A

Inventory Review - Retain as is

D00009

FC-12-A

Birth and Medical History of Child

Document shows a summary of the Child's Birth and Medical history.

FC-12-A

Birth and Medical History of Child fc12-a

Existing

Retain - Modify

Child Welfare

Client / Provider

Permanency

N/A

Worker Generated

On Demand

Yes

Editable

PDF

GT0142

WAI_5863

N/A

D00418

N/A

FCS-0011

Case Plan Review

F0168

Case Plan Review

Existing

Retire

Child Welfare

N/A

Case Management

N/A

WAI_5827

N/A

Retire FSC-011 in inventory line#307, per email Patty Vincent

D00430

This is the start of the file's text. The full file is on GovTribe.

File details come from the government source that posted it. Updated Jun 25, 2026.