Exhibit XII Bed Hold.pdf

This document is a Congregate Care Bed Hold Authorization form issued by the Arizona Department of Child Safety (DCS). The form is designed for contractors providing congregate care services to request a bed hold for a child who is temporarily absent from their placement due to specific circumstances such as being AWOL, hospitalization, detention, or an extended visit.

The form allows contractors to request bed holds for up to 7 days with approval from the Statewide Placement Program Manager, or up to 14 days with the Statewide Placement Program Administrator's signature. The document provides a structured method for maintaining a child's placement while they are temporarily away, ensuring the bed remains available. Contractors must specify the reason for the bed hold, including the actual start and end dates, and can submit the completed form electronically to BedHold@azdcs.gov. The form requires signatures from the contractor and the Statewide Placement Program Manager/Administrator to be considered valid.