Exhibit XIX ADJC Census Report.doc

105 KB Posted

Attached to
Master Agreement AZ|CTR071437
Contract number
CTR071437
Issued by
Arizona

About this file

Written by GovTribe AI ·

This document is an Exhibit XIX ADJC (Arizona Department of Juvenile Corrections) Census Report template designed for out-of-home residential contractors providing residential programs in Arizona. The document is intended to be used by contractors to report bed space availability to the ADJC Community Program Service Office (CPSO), with reporting required on the 1st and 15th of each month by 10:00 AM via email.

The census report requires contractors to provide detailed information including contractor name, contact details, level of care (such as BHIF, BHRF, Group Home, or Other), specialty, gender, age range, number of open beds, location by city, and indication of upcoming discharges. Contractors can receive training or assistance by contacting the CPSO at 602-527-5267. The document was last revised on 6/20/22 and serves as a standardized tracking mechanism for residential program capacity and availability within the Arizona juvenile corrections system.

View the file

Other files

File Type Posted
2-Forced_Labor_of_Ethnic_Uyghurs_Ban_Redacted.pdf PDF
COI_-_State_of_AZ_-_Homes_By_Lighthouse__LLC_-_2024_10_14__1__Redacted.pdf PDF
Congregate_Care_Services_SOW_2024_with_Terms_and_Conditions.pdf PDF
Exhibit III - Medication Log.pdf PDF
Attachment__ADCS_Business_Associate_Agreement_with_HITECH_pdf.pdf PDF
Congregate_Care_Services_Amendment_4.pdf PDF
Congregate_Care_Services_SOW_Amendment_2.pdf PDF
Contract_Amendment_1.pdf PDF
Exhibit II - Personalized Service Plan.pdf PDF
Exhibit IX Clothing and Property Inventory.pdf PDF
Exhibit VI Fees Log.pdf PDF
Exhibit VII Clothing Allowance Ledger.pdf PDF
Exhibit VIII Personal Allowance Ledger.pdf PDF
Exhibit XII Bed Hold.pdf PDF
Exhibit XV Discharge Summary.pdf PDF
Exhibit XVIII ADJC Monthly Attendance Report.doc DOC document
Exhibit XX ADJC-5002 ADJC Service Providers Protocol ADJC.doc DOC document
Exhibit XXII ADJC Residential Services Invoice.docx DOCX document
Congregate_Care_Services_SOW_Amendment_1.pdf PDF
Directions_to_Procurement_File.docx DOCX document
Exhibit CS0-1015A.pdf PDF
Exhibit V - Blood Sugar Log.pdf PDF
Exhibit X Returned Allowances Form.xlsx XLSX spreadsheet
Exhibit XI One on One Supervision.pdf PDF
Exhibit XVI Facility Modification Request.pdf PDF
Exhibit XVII Quarterly Report.xlsm XLSM spreadsheet
Exhibit I - DCS 06-01 Limited English Proficiency.pdf PDF
2-Boycott_of_Israel_Disclosure_Redacted.pdf PDF
Congregate_Care_Services_Amendment.pdf PDF
Congregate_Care_Services_SOW_Amendment_3.pdf PDF
Exhibit IV - Medication Error Report.pdf PDF
Exhibit XIV Provider Census Report.xlsm XLSM spreadsheet
Offer_and_Acceptance_Redacted.pdf PDF
Show all 33

On GovTribe

Work with this file

  • Download the original file
  • Contacts named in this file
  • Similar government files
  • Ask GovTribe AI about this file
Try for free Login

Text version

The file's text, extracted by GovTribe without its formatting.

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 .