Exhibit XVII Quarterly Report.xlsm
XLSM spreadsheet 18 KB Posted
- Attached to
- Master Agreement AZ|CTR071425
- Contract number
- CTR071425
- Issued by
- Arizona
About this file
The document appears to be an Exhibit XVII Quarterly Outcome Report, which is a tracking document for a youth services or foster care placement program. The file contains a detailed template for reporting individual placements, transitions, and outcomes for youth in out-of-home care settings. The spreadsheet includes columns for tracking personal identification, placement dates, reasons for leaving, destination, school enrollment, medical visits, child contact frequency, and extracurricular activities.
The report template suggests a comprehensive monitoring system for youth placement services, with multiple potential outcomes and transition scenarios including reunification, placement in foster/kinship homes, higher levels of care, and tracking of medical, educational, and social engagement metrics. The document provides a structured mechanism for reporting on individual youth outcomes, potentially for a state or local government human services agency managing foster care or youth support programs. The detailed tracking allows for granular assessment of placement effectiveness, medical and educational engagement, and transition management for youth in care.
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Text version
GH_monthly Exhibit XVII
| Quarterly Outcome Report | Quarter submitted: | |||||||||||
| Provider Name | ||||||||||||
| Facility Name | ||||||||||||
| Report Date | ||||||||||||
| PID | Last Name | First Name | Date Placed | Date Left | Reason for Leaving | Destination | School Name | Date Enrolled In School | Extracurriculars (select multiple) | Medical Visits During Month (select multiple) | Child Contact: # of visits | Child Contact: # of calls |
options
| Reason for Leaving | Extracurriculars | Medical | Disruption | Destination |
| Planned Transition to other out of home care | Sports Team | Urgent care visit | N/A | Other group home |
| Reunification | Music | Primary Care Physician | with 30 day notice | Licensed foster or kinship home |
| Aged out | Job | Dental exam | without 30 day notice | Home (reunification) |
| Disruption w 30 day notice | Academic club | Dental procedure | Higher level of care (HCTC, RTC) | |
| Disruption w/o 30 day notice | Arts program | Emergency room visit | Hospital | |
| Runaway | Community club (Boys/Girl Scouts etc | Hospital visit (outpatient) | Jail/Prison (arrest) | |
| Military | Overnight hospitalization | Aged Out | ||
| Student Leadership |
File details come from the government source that posted it. Updated .