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 and placement facilities to request a temporary hold on a child's bed during specific circumstances such as AWOL (absent without leave), detention, extended visits, hospitalization, or other reasons. The form allows for bed holds to be approved by either the Statewide Placement Program Manager (up to 7 days) or the Statewide Placement Program Administrator (up to 14 days).

The form requires detailed information about the child, including their name, Personal Identification (PID) number, and the specific dates and duration of the requested bed hold. Contractors must provide a reason for the request and can submit the completed form via email to BedHold@azdcs.gov or through an electronic submit button. The document includes signature lines for the contractor and the Statewide Placement Program Manager/Administrator to validate and approve the bed hold request, ensuring proper documentation and tracking of child placement status.