Exhibit XIX ADJC Census Report.doc
DOC document 105 KB Posted
- Attached to
- Master Agreement AZ|CTR071440
- Contract number
- CTR071440
- Issued by
- Arizona
About this file
This document is an ADJC (Arizona Department of Juvenile Corrections) Census Report template for out-of-home residential contractors providing youth residential services. The document is specific to Arizona and requires contractors to report bed space availability to the Community Program Service Office (CPSO) via email on the 1st and 15th of each month by 10:00 AM.
The reporting template requires contractors to provide detailed information including their organization name, contact details, level of care (such as BHIF, BHRF, Group Home), specialty, gender served, age range, number of open beds, location by city, and indication of upcoming discharges. Contractors can obtain training or assistance by contacting the CPSO at 602-527-5267. The document was revised on 6/20/22 and appears to be a standardized reporting mechanism for tracking residential placement capacity for juvenile justice programs in Arizona.
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Text version
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 .