Exhibit XIX ADJC Census Report.doc
DOC document 105 KB Posted
- Attached to
- Master Agreement AZ|CTR071438
- Contract number
- CTR071438
- Issued by
- Arizona
About this file
The document is an Arizona Department of Juvenile Corrections (ADJC) Census Report template for out-of-home residential contractors. It is designed for tracking bed space availability in Arizona residential programs, specifically for youth services. The report is to be submitted bimonthly (on the 1st and 15th of each month) to the ADJC Community Program Service Office via email.
The census report requires contractors to provide detailed information including their organization name, contact details, level of care, specialty, gender and age range served, number of open beds, location by city, and indication of upcoming discharges. The purpose appears to be managing and monitoring residential placement capacity for juvenile justice programs across Arizona, with a standardized reporting mechanism to facilitate placement coordination and resource allocation.
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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 .