Exhibit XII Bed Hold.pdf

This document is a Congregate Care Bed Hold Authorization form from the Arizona Department of Child Safety (DCS). The form is designed for contractors who provide congregate care services to request the holding of a child's bed during temporary absences such as being AWOL, hospitalization, detention, or extended visits. The form allows for bed holds to be approved by the Statewide Placement Program Manager (up to 7 days) or the Statewide Placement Program Administrator (up to 14 days).

The form requires specific details including the child's name, personal identification number (PID), contractor information, facility name, actual start and end dates of the bed hold, and the reason for the request. Reasons can include AWOL status (with confirmation of hotline and police department notifications), detention, extended visits (waiting for Child Protective Conference), hospitalization, or other circumstances. Completed forms can be submitted electronically to BedHold@azdcs.gov. The document provides a structured process for maintaining a child's placement while temporarily away from the congregate care facility.