Exhibit XIX ADJC Census Report.doc
DOC document 105 KB Posted
- Attached to
- Master Agreement AZ|CTR071408
- Contract number
- CTR071408
- Issued by
- Arizona
About this file
This document is an Exhibit XIX ADJC (Arizona Department of Juvenile Corrections) Census Report template designed for out-of-home residential contractors. The document is specific to Arizona state government and provides a standardized reporting mechanism for residential program providers to communicate bed space availability to the Community Program Service Office (CPSO).
The report requires contractors to submit bed availability information bimonthly (on the 1st and 15th of each month) via email, detailing specific program attributes including level of care (such as BHIF, BHRF, Group Home), 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 by 10:00 AM, with technical support available at 602-527-5267 for training or assistance with report completion.
View the file
Other files
Show all 37
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 .