Exhibit XII Bed Hold.pdf

This document is a Congregate Care Bed Hold Authorization form issued by the Arizona Department of Child Safety (AZDCS). The form is designed for contractors providing congregate care services to request a bed hold for a child under specific circumstances, such as AWOL, detention, extended visit, hospitalization, or other reasons.

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 requires detailed client information, including the child's name, PID (Personal Identification), facility name, and specific dates for the bed hold. Completed forms can be submitted via email to BedHold@azdcs.gov or through a submit button on the form. The purpose is to maintain a child's placement in a congregate care facility during temporary absences or exceptional circumstances.