Exhibit XII Bed Hold.pdf

The document is a Congregate Care Bed Hold Authorization form issued by the Arizona Department of Child Safety. It is designed for contractors to request holding a bed for a child in care under specific circumstances such as AWOL, detention, extended visit, hospitalization, or other reasons. The form allows for bed holds of up to 7 days with approval from the Statewide Placement Program Manager, and up to 14 days with the Statewide Placement Program Administrator's signature.

The form requires detailed client information including the child's name, Personal Identification (PID) number, contractor details, facility name, and specific dates for the bed hold. Contractors must specify the reason for the bed hold and can submit the completed form electronically to BedHold@azdcs.gov. The document includes signature lines for the contractor and the Statewide Placement Program Manager/Administrator to authorize the bed hold, ensuring proper documentation and approval for maintaining a child's placement during temporary absences or special circumstances.