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 and facilities providing congregate care services to request a bed hold for a child who is temporarily absent due to specific circumstances such as being AWOL, hospitalization, detention, or an extended visit.

The form allows for bed holds up to 7 days with approval from the Statewide Placement Program Manager, and up to 14 days with additional authorization from the Statewide Placement Program Administrator. The document provides a structured method for maintaining a child's placement while they are temporarily away, ensuring the bed remains available. Contractors must complete the form with details including the child's name, personal identification number (PID), facility name, reason for the bed hold, and proposed start and end dates. The completed form can be submitted electronically to BedHold@azdcs.gov.