Exhibit XIX ADJC Census Report.doc
DOC document 105 KB Posted
- Attached to
- Master Agreement AZ|CTR071415
- Contract number
- CTR071415
- 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 providing youth residential services in Arizona. The document provides a standardized reporting mechanism for contractors to communicate bed space availability to the Community Program Service Office (CPSO) via email on the 1st and 15th of each month.
The census report requires contractors to submit detailed information including their name, contact information, level of care (such as BHIF, BHRF, Group Home), specialty, gender and age range served, number of open beds, location by city, and indication of upcoming discharges. Contractors are instructed to email the completed report by 10:00 AM to communityprogramservice@azdjc.gov, with technical support available by calling 602-527-5267 for training or assistance with report completion.
View the file
Other files
Show all 32
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 .