Exhibit XIX ADJC Census Report.doc
DOC document 105 KB Posted
- Attached to
- Master Agreement AZ|CTR071422
- Contract number
- CTR071422
- Issued by
- Arizona
About this file
This document is an Arizona Department of Juvenile Corrections (ADJC) Census Report template for Out-of-Home residential contractors, designed to track bed space availability for Arizona residential programs. The document is specific to the state of Arizona and involves juvenile corrections contractors who provide residential care services.
The report requires contractors to email bed space availability bimonthly (on the 1st and 15th of each month) to the ADJC Community Program Service Office by 10:00 AM. The census report template includes fields for contractor name, contact information, level of care (such as BHIF, BHRF, Group Home), specialty, gender, age range, number of open beds, location, and upcoming discharge status. Contractors can contact the CPSO at 602-527-5267 for training or assistance with completing the report.
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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 .