Exhibit XVII Quarterly Report.xlsm
XLSM spreadsheet 18 KB Posted
- Attached to
- Master Agreement AZ|CTR071415
- Contract number
- CTR071415
- Issued by
- Arizona
About this file
The document appears to be an Exhibit XVII Quarterly Outcome Report, which is a tracking spreadsheet for monitoring placement, transitions, and outcomes for youth in a care management or foster care program. The template is designed to capture detailed individual-level data including placement dates, reasons for leaving, destination, school enrollment, medical visits, child contact frequency, and extracurricular activities.
The report template provides a comprehensive tracking mechanism for monitoring youth transitions across various care settings, including group homes, foster/kinship placements, and reunification scenarios. It captures multiple data points such as medical interactions (urgent care, primary care, dental visits), educational engagement, contact frequency with children, and reasons for placement changes. The spreadsheet allows for multi-select options in categories like extracurricular activities, medical visits, and reasons for leaving, suggesting a flexible and detailed approach to tracking youth placement and transition outcomes.
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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 .