Exhibit XII Bed Hold.pdf

This document is a Congregate Care Bed Hold Authorization form issued by the Arizona Department of Child Safety (DCS). It is designed for contractors providing congregate care services to request a temporary hold on a child's bed placement under specific circumstances such as AWOL (absent without leave), detention, extended visits, or hospitalization.

The form allows contractors to request bed holds for up to 14 days, with the Statewide Placement Program Manager able to approve up to 7 days and the Statewide Placement Program Administrator authorized to approve up to 14 days. The document provides a structured mechanism for maintaining a child's placement while they are temporarily unable to occupy their assigned bed, ensuring continuity of care and administrative flexibility within the child welfare system. Completed forms can be submitted electronically to BedHold@azdcs.gov, with signature requirements from the contractor and placement program management.