Exhibit XIX ADJC Census Report.doc

105 KB Posted

Attached to
Master Agreement AZ|CTR071429
Contract number
CTR071429
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 youth residential services. The document is specifically intended for contractors to report bed space availability for Arizona residential programs, with instructions to email the completed report to the Community Program Service Office (CPSO) bimonthly on the 1st and 15th of each month.

The report requires contractors to provide detailed information including their name, contact details, level of care (such as BHIF, BHRF, Group Home), specialty, gender, age range, number of open beds, location by city, and indication of upcoming discharges. Contractors can contact the CPSO at 602-527-5267 for training or assistance with completing the report. The document was last revised on 6/20/22 and serves as a standardized tracking mechanism for residential youth service providers working with the Arizona Department of Juvenile Corrections.

View the file

Other files

File Type Posted
2-Attachment_3-D_-_Boycott_of_Israel_Disclosure__Redacted.pdf PDF
Congregate_Care_Services_SOW_Amendment_1.pdf PDF
Contract_Amendment_Special_Terms.pdf PDF
Contract_Extension.pdf PDF
Exhibit CS0-1015A.pdf PDF
Exhibit IV - Medication Error Report.pdf PDF
Exhibit VII Clothing Allowance Ledger.pdf PDF
Exhibit VIII Personal Allowance Ledger.pdf PDF
Exhibit XVII Quarterly Report.xlsm XLSM spreadsheet
Exhibit XVIII ADJC Monthly Attendance Report.doc DOC document
Exhibit XXII ADJC Residential Services Invoice.docx DOCX document
Happy_Home_Living_COI_25_Redacted.pdf PDF
Offer_and_Acceptance_Redacted.pdf PDF
2-Attachment_3-E_Forced_Labor_of_Ethnic_Uyghurs_Ban_Redacted.pdf PDF
3_ADCS_Business_Associate_Agreement_with_HITECH.pdf PDF
Congregate_Care_Services_Amendment.pdf PDF
Congregate_Care_Services_Amendment_4.pdf PDF
Congregate_Care_Services_SOW_2024.pdf PDF
Congregate_Care_Services_SOW_Amendment_2.pdf PDF
Congregate_Care_Services_SOW_Amendment_3.pdf PDF
Directions_to_Procurement_File.docx DOCX document
Exhibit VI Fees Log.pdf PDF
Exhibit I - DCS 06-01 Limited English Proficiency.pdf PDF
Exhibit II - Personalized Service Plan.pdf PDF
Exhibit IX Clothing and Property Inventory.pdf PDF
Exhibit V - Blood Sugar Log.pdf PDF
Exhibit X Returned Allowances Form.xlsx XLSX spreadsheet
Exhibit XIV Provider Census Report.xlsm XLSM spreadsheet
Exhibit XV Discharge Summary.pdf PDF
Exhibit III - Medication Log.pdf PDF
Exhibit XI One on One Supervision.pdf PDF
Exhibit XII Bed Hold.pdf PDF
Exhibit XVI Facility Modification Request.pdf PDF
Exhibit XX ADJC-5002 ADJC Service Providers Protocol ADJC.doc DOC document
Show all 34

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 .