Exhibit XIX ADJC Census Report.doc

105 KB Posted

Attached to
Master Agreement AZ|CTR071443
Contract number
CTR071443
Issued by
Arizona

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The document is an Arizona Juvenile Detention Census Report template for Out-of-Home residential contractors, specifically designed by the Arizona Department of Juvenile Corrections (ADJC). The report requires contractors to submit bed space availability for Arizona residential programs via email to the Community Program Service Office (CPSO) on the 1st and 15th of each month by 10:00 AM.

The census report template requires contractors to provide detailed information including contractor name, contact details, level of care (such as BHIF, BHRF, Group Home), specialty, gender, age range, number of open beds, location by city, and upcoming discharge status. The document includes contact information for training and assistance at 602-527-5267, with reports to be emailed to communityprogramservice@azdjc.gov. The template was last revised on 6/20/22 and appears to be a standardized tracking mechanism for residential juvenile detention and rehabilitation program bed availability across Arizona.

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EXHIBIT XIX

ADJC Census Report

Out-of-Home residential Contractors, please provide your bed space availability for AZ residential programs. Email the completed report on 1st and 15th of the month by 10:00 AM to the ADJC Community Program Service Office (CPSO) at communityprogramservice@azdjc.gov For training or assistance regarding this report, please contact the CPSO at 602-527-5267.

Contractor name:
Census for the week of

Contact person phone and email:

Level of Care

(BHIF, BHRF, Group Home or Other)

Specialty
Gender
Age

Range # of open beds Location (City) Upcoming

Discharges

(Y or No)

REV 6/20/22

File details come from the government source that posted it. Updated .