Exhibit XIX ADJC Census Report.doc
DOC document 105 KB Posted
- Attached to
- Master Agreement AZ|CTR071423
- Contract number
- CTR071423
- Issued by
- Arizona
About this file
This document is an Exhibit XIX ADJC (Arizona Department of Juvenile Corrections) Census Report template for out-of-home residential contractors. The document is designed for contractors to report bed space availability in Arizona residential programs, with reporting requirements to the Community Program Service Office (CPSO) via email 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 person details, level of care (such as BHIF, BHRF, Group Home), specialty, gender, age range, number of open beds, location (city), and indication of upcoming discharges. Contractors can obtain training or assistance by contacting the CPSO at 602-527-5267. The document was last revised on 6/20/22 and appears to be a standardized reporting mechanism for tracking residential program capacity and availability within the Arizona juvenile corrections system.
View the file
Other files
Show all 40
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
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 .