Exhibit XII Bed Hold.pdf

This document is a Congregate Care Bed Hold Authorization form issued by the Arizona Department of Child Safety. The form is designed to request and authorize the holding of a bed for a child in congregate care under specific circumstances, such as AWOL, detention, extended visits, or hospitalization. The form allows for bed holds to be approved by the Statewide Placement Program Manager (up to 7 days) or the Statewide Placement Program Administrator (up to 14 days).

The form provides a structured process for contractors to request bed holds, requiring detailed information about the child, including their name, Personal Identification (PID) number, and the specific reason for the bed hold. Key provisions include the ability to submit the form electronically to BedHold@azdcs.gov, with checkboxes for various reasons for the bed hold. The document emphasizes the need for documentation and proper authorization, with signature lines for both the contractor and the Statewide Placement Program Manager/Administrator to validate the bed hold request.