Exhibit XIX ADJC Census Report.doc
DOC document 105 KB Posted
- Attached to
- Master Agreement AZ|CTR071411
- Contract number
- CTR071411
- 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 specifically designed for contractors providing residential programs in Arizona, requiring them to report bed space availability to the ADJC Community Program Service Office (CPSO).
The report template requires contractors to submit detailed information bimonthly (on the 1st and 15th of each month by 10:00 AM), including contractor name, contact information, level of care, specialty, gender, age range, number of open beds, location, and upcoming discharge status. Contractors are instructed to email the completed report to communityprogramservice@azdjc.gov, with technical support available by calling 602-527-5267. The document appears to be a standardized tracking mechanism for monitoring residential program capacity and availability across juvenile correction facilities 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 .