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Court Reports

• DHS-0665 CFC Permanent Ward Court Report
Rev 04/12

• DHS-1280 CFC Initial Court Report
Rev 11/11

• DHS-1281 CFC Updated Court Report
Rev 11/11

Determination of Care

• DHS-470 Assessment for Determination of Care for Children in Foster Care Ages 0-12
Rev 08/11

• DHS-470-A, Assessment for Determination of Care for Children in Foster Care Ages 13+
Rev 08/11

• DHS-668 Administrative Review Request for Determination of Care Denial
Rev 10/09

• DHS-669 Local DHS Response to Administrative Review Request for Determination of Care Denial
Rev 09/09

• DHS-670 Central Office Decision to Administrative Review Request for Determination of Care Denial
Rev 10/09

• DHS-1254, SED Waiver Foster Home Payment Request and Approval PDF icon
Rev 10/09

• DHS-1945 Assessment for Determination of Care for Medically Fragile Children in Foster Care
Rev 08/11

Family Team Meeting

• DHS-1104, Family Team Meeting
Rev 09/11

• DHS-1105, Family Team Meeting Activity Report
Rev 09/11

• DHS-1108, Family Team Meeting Preparation Tool
Rev 09/11

• DHS-1109, Family Team Meeting Invite
Rev 09/11

Foster Care Additional Forms

• DHS-30 Foster Parent Notification of Move
Rev 3/10

• DHS-31 Foster Care Placement Decision Notice
Rev 4/08

• DHS-57 Foster Care Transitional Medicaid
Rev 3/09

• DHS-221, Medical Passport
Rev 2/06

• DHS-594 Parental Placement of MCI Ward Request

• DHS-602 Adoption Referral
Rev 11/11

• DHS-637 Caseworker Visit Report
Rev 8/08

• DHS-649 Foster Care/Juvenile Justice Child Fatality Notification
Rev 9/11

• DHS-715 Hearing Notice
Rev 7/08

• DHS-719 Child Placing Agency Case Report
Rev 03/08

• DHS-790, Foster Parent Oreintation Video Questions
Rev 07/11

• DHS-956, Foster Youth Housing Referral PDF icon
Rev 07/11

• DHS-1555-CS, Authorization to Release Confidential Information
Rev 02/09

• DHS-3198, Unauthorized Leave Notification
Rev 4/06

• DHS 3198-A Unauthorized Leave Report to Court/Law Enforcement
Rev 3/07

• Interstate Compact Forms

Permanency Goal Approval

• DHS-341 Another Planned Permanent Living Arrangement - E Permanancy Goal Approval
Rev. 02/10

• DHS-343 Another Planned Permanent Living Arrangement Permanency Goal Approval
Rev. 02/10

• DHS-344 Placement With a Fit and Willing Relative Permanency Goal Approval
Rev. 02/10

• DHS-642 - Another Planned Permanent Living Arrangement -E Agreement
Rev. 02/10

• DHS-643 - Permanency Goal Review
Rev. 08/09

• DHS-843 Another Planned Permanent Living Arrangement Agreement (Temporary Court Wards)
Rev. 06/09

• DHS-844 Another Planned Permanent Living Arrangement Agreement PCW or MCI Wards
Rev. 03/12

• DHS-845 Permanent Placement with a Fit and Willing Relative Agreement (Permanent Court Wards and MCI Wards) DOC icon
Rev. 03/12

• DHS-846 - Permanent Placement with a Fit and Willing Relative Agreement (TCW)
Rev. 08/09

Permanency Planning Conference

• DHS-963 Permanency Planning Conference (PPC) Administrative Review Activity Report
Rev. 03/10

• DHS-965 Permanency Planning Conference Meeting Satisfaction Survey DOC icon
Rev. 02/10

• DHS-966 Permanency Planning Conference Meeting
Rev. 04/10

• DHS-966-SP Permanency Planning Conference Meeting
Rev. 04/10

• DHS-967 Permanency Planning Conference Meeting Ground Rules
Rev. 04/10

• DHS-967-SP Permanency Planning Conference Meeting Ground Rules
Rev. 04/10

• DHS-968 Permanency Planning Conference Attendance Report
Rev. 04/10

• DHS-969 Permanency Planning Conference (PPC) Facilitator
Rev. 09/10

• DHS-971 Permanency Planning Conference (PPC) Activity Report
Rev. 09/10

Relative Search

• Relative Caregiving: What You Need to Know DHS-114 PDF icon

• DHS-541 Relative Licensing Referral Agreement

• DHS-588 Initial Relative Safety Screen
Rev 09/11

• DHS-875 Waiver of Foster Care Licensure Relative Caregiver
Rev. 4/12

• DHS-987 Relative Documentation
Rev 7/09

• DHS-987-SP Relative Documentation
Rev 7/09

• DHS-988 Relative Search Form for CPS and Foster Care
Rev 1/09

• DHS-988-SP, Relative Search Information (Busqueda de Informacion de Parentesco)
Rev 1/09

• DHS-989 Relative Response Form for CPS and Foster Care
Rev 12/08

• DHS-989-SP Relative Response Form for CPS and Foster Care
Rev 12/08

• DHS-990 Relative Notification Form Letter for CPS and Foster Care
Rev 02/09

• DHS-990-SP Relative Notification Form Letter for CPS and Foster Care
Rev 05/11

• DHS-972 Relative Agreement for Placement and Licensure
Rev 2/11

• DHS-3130-A Children's Foster Care Initial Relative Placement Home Study
Rev 1/12

Residential Care

• DHS-365-B Children's Foster Care Residential Initial Service Plan (14 yrs and older)
Rev. 07/09

• DHS-365 Children's Foster Care Residential Initial Service Plan (4-9 yrs)
Rev. 07/09

• DHS-365-A Children's Foster Care Residential Initial Service Plan (10-13 yrs)
Rev. 07/09

• DHS-366 Children's Foster Care Residential Updated Service Plan (4-9 yrs)
Rev. 07/09

• DHS-366-B Children's Foster Care Residential Updated Service Plan (14 yrs and older)
Rev. 07/09

• DHS-366-A Children's Foster Care Residential Updated Service Plan (10-13 yrs)
Rev. 07/09

SDM Templates

• DHS-65 Foster Care Structured Decision Making Initial Service Plan
Rev. 06/11

• DHS-66 Updated Service Plan
Rev. 09/11

• DHS-67 Parent Agency Treatment Plan and Service Agreement
Rev. 07/11

• DHS-68 Permanent Ward Service Plan
Rev. 07/11

• DHS-69 Foster Care Action Summary
Rev. 07/08

• DHS-145 Family Assessment of Needs & Strengths
Rev. 02/06

• DHS-147 Family Reunification Assessment
Rev. 11/05

• DHS-148 SDM Case Reading Form PDF icon
Rev. 10/08

• DHS-149 Foster Care Safety Assessment
Rev. 11/05

• DHS-432 Foster Care Child Assessment of Needs and Strengths Children Ages 14 years and older
Rev. 03/06

• DHS-433 Foster Care Child Assessment of Needs and Strengths Children Ages 0-3 years
Rev. 04/06

• DHS-434 Foster Care Child Assessment of Needs and Strengths Children Ages 4-9 years
Rev. 03/06

• DHS-435 Foster Care Child Assessment of Needs and Strengths Children Ages 10-13 years
Rev. 09/06

Treatment Foster Care

• DHS-65A Treatment Foster Care Initial Service Plan
Rev. 03/10

• DHS-66A Treatment Foster Care Updated Service Plan
Rev. 02/10

• DHS-68A Treatment Foster Care Permanent Ward Service Plan
Rev. 03/10

• DHS-974 Treatment Foster Care Extension Request
Rev. 09/09

• DHS-975 Treatment Foster Care Exception Request
Rev. 10/09

• DHS-976 Treatment Foster Care Denial of Referral
Rev. 12/08

• DHS-977 Treatment Foster Care Referral Acceptance
Rev. 12/08

• DHS-978 Treatment Foster Care Placement Request
Rev. 02/09

• DHS-979 Treatment Foster Care Discharge Report
Rev. 03/09

Well Child Exam

• DHS-579, Well Child Exam Infancy: 4 Weeks
Rev. 07/11

• DHS-580, Well Child Exam Infancy: 1 Week Visit
Rev. 07/11

• DHS-581, Well Child Exam Infancy: 4 Months
Rev. 07/11

• DHS-0583, Well Child Exam Infancy: 2 Months
Rev. 08/11

• DHS-1631, Well Child Exam Early Childhood: 18 Months.
Rev. 07/11

• DHS-1632 Well Child Exam Early Childhood 2 Years
Rev. 07/11

• DHS-1633, Well Child Exam Early Childhood: 30 Months.
Rev. 07/11

• DHS-1634 Well Child Exam Early Childhood 3 Years
Rev. 07/11

• DHS-1635 Well Child Exam Early Childhood 5 Years
Rev. 07/11

• DHS-0381 Well Child Exam Middle Childhood 6-10 Years
Rev. 07/11

• DHS--1636, Well Child Exam Early Adolescence: 11-14 Years.
Rev. 07/11

• DHS-1637 Well Child Exam Early Adolescence: 15 - 18 Years
Rev. 07/11

• DHS-1638, Well Child Exam Early Childhood: 9 Months
Rev. 07/11

• DHS-1639, Well Child Exam Early Childhood: 12 Months
Rev. 08/11

• DHS-1640, Well Child Exam Early Childhood: 15 Months
Rev. 08/11

• DHS-1641, Well Child Exam Infancy: 6 Months
Rev. 07/11

• DHS-1642, Well Child Exam Early Childhood: 4 Years
Rev. 08/11

• DHS-1643, Psychotropic Medication Informed Consent
Rev. 10/11

Young Adult Voluntary Foster Care

• DHS-38, Verification of Employment PDF icon
Rev. 12/07

• DHS-54A, Medical Needs PDF icon
Rev. 10/08

• DHS-626-YA, Foster Care Payment Authorization. PDF icon
Rev. 04/12

• DHS-0634 - YA, Foster Care Non-Scheduled Payment Authorization PDF icon
Rev. 04/12

• DHS_650, Young Adult Extension Unit PDF icon
Rev. 04/12

• DHS-1295, Young Adult Monthly Visit Report PDF icon
Rev. 04/12

• DHS-1297, Young Adult Voluntary Foster Care Agreement PDF icon
Rev. 03/12

• DHS-1302, Young Adult Voluntary Foster Care Case Closure Request PDF icon
Rev. 04/12

• DHS-3380, Verificaiton of Student Information PDF icon
Rev. 09/06

• DHS-4765, Young Adult Voluntary Foster Care Invoice PDF icon
Rev. 04/12



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