Exhibit XVII Quarterly Report.xlsm
XLSM spreadsheet 18 KB Posted
- Attached to
- Master Agreement AZ|CTR071408
- Contract number
- CTR071408
- Issued by
- Arizona
About this file
The document appears to be an Exhibit XVII Quarterly Report template for tracking youth placement and transition outcomes, likely related to a state or local government social services contract. The spreadsheet is designed to capture detailed information about individual placements, including personal identifiers, placement dates, reasons for leaving, destination, school enrollment, extracurricular activities, and medical visits.
The report template provides a comprehensive tracking mechanism for monitoring youth transitions across different care settings, including group homes, foster/kinship care, reunification, and other placement types. It includes columns for tracking critical metrics such as child contact frequency, reasons for placement changes, medical interactions, school enrollment, and extracurricular participation. The document suggests a structured approach to monitoring youth services, with specific categorizations for destinations, medical visits, and transition reasons that enable detailed performance and outcomes reporting.
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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 .