Exhibit XIX ADJC Census Report.doc
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- Attached to
- Master Agreement AZ|CTR071445
- Contract number
- CTR071445
- 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 residential programs in Arizona. The report is to be completed by contractors and submitted electronically to the ADJC Community Program Service Office (CPSO) via email on the 1st and 15th of each month by 10:00 AM.
The report requires contractors to provide detailed information about their residential program bed space availability, including specific details such as level of care (BHIF, BHRF, Group Home or Other), specialty, gender, age range, number of open beds, location by city, and indication of upcoming discharges. Contractors requiring training or assistance with the report can contact the CPSO at 602-527-5267 for support. The document was last revised on 6/20/22 and serves as a standardized tracking mechanism for juvenile residential program capacity 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 .