ࡱ> WZTUVM @ bjbj BQ+thhh\]$20إ(ۦzUHe$RB'Qxۦۦxx'xx(exe[[ ihpKd0S  [zd i)0Y"{)))''dFDZ$CDZ Michigan Department of Human ServicesFC Case Name: FORMTEXT      FC Case Number: FORMTEXT      FOSTER CARE STRUCTURED DECISION MAKING SAFETY ASSESSMENT AND PLANPS Case Name: FORMTEXT      PS Case Number: FORMTEXT      PS Referral Date: FORMTEXT      County Name: FORMTEXT      DHS FC Worker Name: FORMTEXT      DHS FC Worker Load Number: FORMTEXT      Completed for: (Check one) Updated Service Plan FORMCHECKBOX Initial Service Plan FORMCHECKBOX Assessment Date: FORMTEXT      Household Assessed: Last Name FORMTEXT      First Name FORMTEXT      Is this the household the child(ren) were removed from? FORMCHECKBOX Yes FORMCHECKBOX NoSECTION 1: SAFETY ASSESSMENTSafety Factor Identification Safety Factor Identification Directions: The following list of factors are behaviors or conditions that may be associated with a child being in danger of serious harm. Identify the presence or absence of each factor by checking either yes or no. If the factor applies to any child in the household, check any condition(s) that apply to the family. Note: Consider the vulnerability of each child individually throughout the assessment. Children ages 0-6, developmentally disabled or those repeatedly victimized may be considered especially vulnerable. However, any child subject to harm or risk of harm from an adult cannot be expected to protect him or herself. Caretaker(s) refers to the person or persons responsible for care of the child; generally a parent or legal guardian, in the home from which the child(ren) was removed or another person with legal right to reunification planning. For each factor or condition, check yes or no to indicate if it is present in the family assessed. Explain each factor that is marked yes. A comment section follows each factor.1.Caretaker(s) caused serious physical harm to a child and/or made a plausible threat to cause serious physical harm, indicated by: FORMCHECKBOX Serious injury or abuse to child other than accidental FORMCHECKBOX Threat to cause harm or retaliate against child FORMCHECKBOX Excessive discipline or physical force FORMCHECKBOX Potential harm to child as a result of domestic violence FORMCHECKBOX One or more caretaker(s) fear they will maltreat child FORMCHECKBOX Drug exposed infant FORMCHECKBOX Yes FORMCHECKBOX NoCaretaker(s) caused serious physical harm to the child and/or made a plausible threat to cause serious physical harm and current circumstances suggest that child safety may be an immediate concern. If yes, explain. If no and there was serious or threatened harm, explain why it is not currently a factor.  MACROBUTTON [1] "Click Here and Type"   2.Caretaker(s) has previously maltreated a child in their care. Check all that apply: FORMCHECKBOX Prior death of a child FORMCHECKBOX Prior removal of any child FORMCHECKBOX Prior serious harm to any child FORMCHECKBOX Prior CPS substantiation FORMCHECKBOX Prior Termination of parental rights FORMCHECKBOX Prior threat of serious harm to child  MACROBUTTON [1] "Click Here and Type"    FORMCHECKBOX Yes FORMCHECKBOX NoCaretaker(s) has previously maltreated a child in their care and the severity of the maltreatment or the caretaker(s) response to the previous incident and current circumstances suggest that child safety may be an immediate concern if placement continues with the caretaker(s) or if placement is made with the caretaker(s). If yes, explain. If no and there is prior maltreatment, explain why it is not currently a safety factor.  MACROBUTTON [1] "Click Here and Type"   3. FORMCHECKBOX Yes FORMCHECKBOX NoCaretaker(s) failed to protect children from serious physical harm or threatened harm and perpetrator continues to have access, will likely have access or there are individual(s) living in, or visiting the home on a regular basis, who pose a threat to safety of the child. If yes, explain:  MACROBUTTON [1] "Click Here and Type"   4. FORMCHECKBOX Yes FORMCHECKBOX NoExplanation of the injury is unconvincing. If yes, explain:( Medical evaluation indicates injury is result of abuse, caretaker(s) denies or attributes injury to accidental causes. ( Caretaker(s) explanation for the observed injury is inconsistent with the type of injury. ( Caretaker(s) description of the causes of the injury minimizes the extent of harm to the child.  MACROBUTTON [1] "Click Here and Type"   5. FORMCHECKBOX Yes FORMCHECKBOX NoThe caretaker(s) refuses access to a child, or there is a reason to believe the caretaker(s) is about to flee, or a childs whereabouts cannot be ascertained. If yes, explain:( Family currently refuses access to the child and cannot or will not provide childs location. ( Family has removed child from a hospital against medical advice. ( Family has previously fled in response to a CPS investigation. ( Family has history of keeping child at home, away from peers, school, other outsiders for extended periods.  MACROBUTTON [1] "Click Here and Type"   6. FORMCHECKBOX Yes FORMCHECKBOX NoChild is fearful of caretaker(s), other family members, or other people living in or having access to the home. If yes, explain:( Child cries, cowers, cringes, trembles, or otherwise exhibits fear in the presence of certain individuals or verbalizes such fear. ( Child exhibits severe anxiety (i.e., nightmares, insomnia) related to situation(s) associated with a person(s) in the home. ( Child has reasonable fears of retribution or retaliation from caretakers, other household members or others having access to the child.  MACROBUTTON [1] "Click Here and Type"   7. FORMCHECKBOX Yes FORMCHECKBOX NoCaretaker(s) is unwilling or unable to provide supervision necessary to protect child from potentially serious harm. If yes, explain:( Caretaker(s) does not attend to child to the extent that need for care goes unnoticed or unmet (e.g., caretaker is present but child can wander outdoors alone, play with dangerous objects, play on unprotected window ledge, or be exposed to other serious hazards). ( Caretaker(s) leaves child alone (time period varies with age and developmental stage). ( Caretaker(s) makes inadequate and/or inappropriate baby-sitting or child care arrangements or demonstrates very poor planning for childs care. ( Caretaker(s) whereabouts are unknown.  MACROBUTTON [1] "Click Here and Type"   8. FORMCHECKBOX Yes FORMCHECKBOX NoCaretaker(s) is unwilling or unable to meet the childs immediate need for food, clothing, shelter and/or medical or mental health care. If yes, explain:( No housing or emergency shelter; child must or is forced to sleep in the street, car, etc.; housing is unsafe, without heat, etc. ( No food provided or available to child, or child starved or deprived of food or drink for prolonged periods. ( Child without minimally warm clothing in cold months. ( Caretaker does not seek treatment for childs immediate and dangerous medical condition(s) or does not follow prescribed treatment for such condition(s). ( Child appears malnourished. ( Child has exceptional needs which caretaker(s) cannot/will not meet. ( Child is suicidal and caretaker(s) will not take protective action. ( Child shows effects of maltreatment, such as serious emotional symptoms and lack of behavior control or serious physical symptoms.  MACROBUTTON [1] "Click Here and Type"   9. FORMCHECKBOX Yes FORMCHECKBOX NoCaretaker(s) physical living conditions are hazardous and immediately threatening to a child based on the childs age and developmental status. If yes, explain:( Leaking gas from stove or heating unit. ( Dangerous substances or objects stored in unlocked lower shelves or cabinets, under sink or in open. ( Lack of water or utilities (heat, plumbing, electricity) and no alternate provisions made, or alternate provisions are inappropriate (e.g., stove, unsafe space heaters for heat). ( Open windows/broken/missing windows. ( Exposed electrical wires. ( Excessive garbage or rotted or spoiled food which threatens health. ( Serious illness or significant injury has occurred due to living conditions and these conditions still exist (e.g., lead poisoning, rat bites). ( Evidence of human or animal waste throughout living quarters. ( Guns and other weapons are not locked.  MACROBUTTON [1] "Click Here and Type"   10. FORMCHECKBOX Yes FORMCHECKBOX NoCaretaker(s) substance use seriously affects his/her ability to currently supervise, protect or care for the child. If yes, explain:Caretaker(s) has misused drug(s) or alcoholic beverages to the extent that control of his or her actions is lost or significantly impaired. As a result, the caretaker is unable, or will likely be unable, to care for the child, or has harmed the child, or is likely to harm the child.  MACROBUTTON [1] "Click Here and Type"  MACROBUTTON [1] "Click Here and Type"   11. FORMCHECKBOX Yes FORMCHECKBOX NoCaretaker(s) behavior is violent or out-of-control. If yes, explain:( Extreme physical, verbal, angry, or hostile outbursts at child. ( Use of brutal or bizarre punishment (e.g., scalding with hot water, burning with cigarettes, forced feeding, etc.). ( Domestic violence likely to have negative impact on the child. ( Use of guns, knives, or other instruments in a violent way. ( Violently shakes or chokes baby or young child to stop a particular behavior. ( Behavior that seems out of touch with reality, fanatical, or bizarre. ( Behavior that seems to indicate a serious lack of self-control (e.g., reckless, unstable, raving, explosive).  MACROBUTTON [1] "Click Here and Type"   12. FORMCHECKBOX Yes FORMCHECKBOX NoCaretaker(s) describes or acts toward child in predominantly negative terms or has extremely unrealistic expectations. If yes, explain:( Caretaker(s) describes child in a demeaning or degrading manner (e.g., as evil, possessed, stupid, ugly, etc.). ( Caretaker(s) curses and/or repeatedly puts child down. ( Caretaker(s) scapegoats a particular child in the family. ( Caretaker(s) expects a child to perform or act in a way that is impossible or improbably for the childs age or developmental stage (e.g., babies and young children expected not to cry, expected to be still for extended periods, be toilet trained or eat neatly, expected to care for younger siblings, expected to stay alone). ( Caretaker(s) view child as responsible for the caretakers problems. ( Actions by the caretaker may be periodic but form an overall negative view of the child  MACROBUTTON [1] "Click Here and Type"   13. FORMCHECKBOX Yes FORMCHECKBOX NoChild sexual abuse is suspected or confirmed and circumstances suggest that child safety may be an immediate concern. If yes, explain:( Confirmed means that there is a preponderance of evidence that sexual abuse occurred. ( Caretaker(s) or others have committed rape, sodomy, or has had other sexual contact with child. ( Caretaker(s) or others have forced or encouraged child to engage in sexual performances or activities (including forcing a child to observe sexual performances or activities). ( Access by possible or confirmed sexual abuse perpetrator to child continues to exist.  MACROBUTTON [1] "Click Here and Type"   14. FORMCHECKBOX Yes FORMCHECKBOX NoCaretaker(s) emotional stability seriously affects current ability to supervise, protect or care for child. If yes, explain:( Caretaker(s) refusal to follow prescribed medicines may skew ability to parent the child. ( Caretaker(s) inability to control emotions such as anger results in violent or out of control behavior that threatens a child. ( Caretaker(s) exhibit distorted perception of reality that impacts ability to parent child appropriately (e.g., keeping child from school or play due to extreme fear of germs or violence). ( Depressed behavior that manifests feeling of hopelessness, helplessness, or leading caretaker to being immobilized (e.g., failure to attend to child, feed or properly clothe child, and provide suitable environment).   MACROBUTTON [1] "Click Here and Type"  MACROBUTTON [1] "Click Here and Type"   15. FORMCHECKBOX Yes FORMCHECKBOX NoOther. If yes, explain:  MACROBUTTON [1] "Click Here and Type"   IF NO SAFETY FACTORS ARE PRESENT, GO TO SECTION 3: SAFETY DECISION AND CHECK SAFESECTION 2: SAFETY RESPONSE - PROTECTING INTERVENTIONSFor each safety factor identified in Section 1, consider the resources available in the family and the community that might help keep the child safe. Check each protecting intervention taken to protect the child and explain below. Describe all protecting safety interventions taken or immediately planned by you or anyone else, and explain how each intervention protects (or protected) each child.  FORMCHECKBOX 1.Monitoring or direct services by DHS worker.Includes all activities by the worker in areas such as counseling, crisis intervention, preventative service referrals, repeated home visits, requirements to clean house, contact with collaterals, etc.  FORMCHECKBOX 2.Use of family resources, neighbors or other individuals in the community as safety resources.Includes any activity arranged or approved by the worker that is a non-traditional service.  FORMCHECKBOX 3.Use of community agencies or services as safety resources. (check one) FORMCHECKBOX Intensive Home Based FORMCHECKBOX Other communityUse of community agencies or services as safety resources (intensive home based or other community): Check the specific service type arranged or approved by the worker from an agency or private counselor in the community such as Families First, Wrap Around, Parenting, Substance Abuse, Parent Aide, Homemaker, Home Health, etc. May include monitoring by a service provider.  FORMCHECKBOX 4.Have the alleged perpetrator leave the home, either voluntarily or in response to legal action.Includes any activity where the perpetrator leaves the household such as Personal Protection Orders, arrest of the perpetrator or other similar actions or where the non-offending caretaker prevents access to the child by the perpetrator.  FORMCHECKBOX 5.Have the non-maltreating caretaker move to a safe environment with the child.Includes any move arranged or approved by the worker where the caretaker leaves the household with the victim or potential victims such as a domestic violence shelter, with friends or relatives.  FORMCHECKBOX 6.Have the caretaker(s) place the child outside the home. (Write / type)  MACROBUTTON [1] "Click Here and Type"  MACROBUTTON [1] "Click Here and Type"    FORMCHECKBOX 7.OtherOther only includes services not covered by any of the prior protecting intervention services. Use of Other should be limited to activities not covered in the preceding definitions.   MACROBUTTON [1] "Click Here and Type"    FORMCHECKBOX 8.Legal action must be continued or taken to place child(ren) outside the home.Includes action initiated or continued by the worker to place the children out of the home or to continue out of home placement if the case is open for foster care. For each intervention checked, describe all protecting interventions taken or immediately planned by you or anyone else, and explain how each intervention protects (or protected) each child.  MACROBUTTON [1] "Click Here and Type"   SECTION 3: SAFETY DECISIONIdentify your safety decision by checking the appropriate box below. Check one box only. This decision should be based on the assessment of all safety factors and any other information known about this case. If C is checked, Section 2 does not have to be completed.A. Safe FORMCHECKBOX There are no children likely to be in immediate danger of serious harm if placement is made, or maintained, with the caretaker(s).B. Safe with Services FORMCHECKBOX If in-home protecting interventions are in place that will allow the child(ren) to be placed or maintained with the caretaker(s).C. Unsafe FORMCHECKBOX LNfhjl  4 6 8 B D d f z | ~ jheUjheUjhuUj<huUjhuUjheUjh I:UmHnHujh2Uh2jh2Uh6dhM heh$`y6Njp,!V |}V |.$If_kd$$If94FH+, $    4 9aN .$Ifgd6d $Ifgd6d '$Ifgded PSV | .$Ifgd6d $Ifgd6d *$Ifgde_kdO$$If94FH+, $    4 9aN V | .$Ifgd6d $Ifgd6d.$If`kd$$If944FH+`, $    4 9aN  F V | .$Ifgd6d $Ifgd6d.$If`kd$$If944FH+ , $    4 9aNF H J d V | .$Ifgd6d $Ifgd6d.$If`kd$$If944FH+ , $    4 9aN V | .$Ifgd6d $Ifgd6d.$If`kdS $$If944FH+ , $    4 9aN     0 2 4 > @ D H f |    > @ T V X b d f þþëöàöÕދöÀ޶öjh$`yUjh$`y5Ujh$`yUjh I:Uj#h I:Ujh$`yU h$`y5h$`yh&tKj huUh6dhejh I:UmHnHujheUjH huU/  B V | .$Ifgd6d $Ifgd6d.$If`kd $$If944FH+ , $    4 9aNB D F H  _U |UJ|L|P $$Ifa$  ] $If;kd $$If94+)$4 9aN.$If_kd $$If94FH+, $    4 9aN > f h |E; | 5 |$If  ] $Ifkd$$If94֞ d%+ h$4 9aN.$If $$Ifa$  ~ )cd;<JKLMڼڞڞxڞhڞjh I:h I:CJUjh I:h I:CJUjuh I:h I:CJU h$`yCJjh$`yCJU h$`yCJhUah$`y5<B* phh$`yB*phjh I:Ujh I:Uh$`yjh I:UmHnHujh$`yUjh$`yU'  ~  |l| |$Ifrkdb$$If94\+   $4 9aN.$If zt2)9|3)!9$If:kdz$$If94+)4 9aNf4$Ifkd$$If94rJ+hhR $4 9aN  )dehi!)juoP|o|oK#|$If7kd8$$If9+)$4 9aN9pd$If^`p 9d$If7kd$$If9+)$4 9aN 89*)]|Wm|QK!|Wx|$If-$If$If:kd$$If94+)4 9aNf4$If`kd$$If94F+#    4 9aNf49:;M}~m|y!|x|$If-$If$Ifskd$$If94\S *+_t!4 9aNf4~m|y!|x|$If-$If$Ifskd$$If94\S *+_t!4 9aNf4m|y!|x|$If-$If$Ifskd$$If94\S *+_t!4 9aNf4  TUVWefgh!$   QR߶ߦߖƏۇۇuh$`y<B* phh$`yB*phjh$`yU h$`y5>*jg&h I:h I:CJUj%h I:h I:CJUj"h I:h I:CJU h$`y5j h I:h I:CJUh$`y h$`yCJjh$`yCJUjh I:h I:CJU.  STm|y!|x|$If-$If$Ifskd $$If94\S *+_t!4 9aNf4TUVh|}m|y!|x|$If-$If$Ifskd#"$$If94\S *+_t!4 9aNf4}~2)J|DP!>8P|$If-$If9$If:kd$$$If94+)4 9aNf4$Ifskd$$$If94\S *+_t!4 9aNf4  |3!!VeRH )H )H ) .$If^kd'$$If9ֈ=i +_j!$4 9aN9$If$If-$If hij|ĎP!bm\Vl|$If-$If[kd($$If94F+#    4 9aNf4$If9$If2kd($$If9+|)4 9aU Rjkyz{|!"0123XYghijwh$`yB*phjh$`yUj0h I:h I:CJUj.h I:h I:CJUj8-h I:h I:CJUj*,h I:h I:CJUjq*h I:h I:CJU h$`y5jg)h I:h I:CJU h$`yCJjh$`yCJUh$`y.!qkml!!$Ifkdu+$$If94rS 1+_y4 9aNf49$If-$If !3Xj}wmqkl!qk!9$If-$If$Ifkd8.$$If94rS 1+_y4 9aNf4}w*)A|?5)5) .$If^5kd1$$If94+)4 9aNf4$Ifkd1$$If94rS 1+_y4 9aNf4)TP!}P!}!3!!-$If9$If7kd2$$If94+)4 9aUf45kd12$$If94+)4 9aNf4$If 46#&'8MNOXYgh־ֶ־֫־ֶ־{j:h I:h I:CJUj7h I:h I:CJUj6h I:h I:CJUh$`y<CJOJQJh$`yB*phjh$`yUj3h I:h I:CJUh$`yj2h I:h I:CJU h$`yCJjh$`yCJU h$`y50k g] )] )S $If^ .$If^kd4$$If9ֈ=h +_i!4 9aU#P!}P!}!4!!-$If9$If7kd$6$$If94+)4 9aUf4$If5kd5$$If94+|)4 9aUf4 #$%&PQkei_ )_ )_ ) .$If^kdc9$$If9ֈ=h +_i!4 9aUQRSTUXjnĎP!P!!2!!-$If9$If7kd:$$If94+)4 9aUf4$If2kd-:$$If9+|)4 9aU hijmno}~:;< "#$-.<=>?BCDRSTU    jóóótój?h I:h I:CJUjm>h I:h I:CJUh$`yB*phjh$`yUhUah$`y<B* CJphhUah$`y5<B* CJph% jlhUah$`y5<B* CJ phj;h I:h I:CJUh$`y h$`y5 h$`yCJjh$`yCJU-:k]]]; >$If^ `>kd<$$If9ֈ=h +_i! 4 9aU%&'() ) ) )Ď$If2kd=$$If9+|)4 9aU .$If^.5kdY=$$If9+) 4 9aU)*-?CUX P!P!!3!!-$If9$If7kd >$$If94+)4 9aUf4  j\khC]]]]; >$If^ `>kd;A$$If9ֈ=h +_i! 4 9aUjkl\]^_`q> ? @ A B!C!D!!!!!wq h$`yCJjgDh I:h I:CJUjCh I:h I:CJU h$`yCJjh$`yCJUh$`yB*phjh$`yUh$`y h$`y5hUah$`y5B* phhUah$`y<B* CJphhUah$`y5<B* CJph% jlhUah$`y5<B* CJ ph,\]^_ ) ) )Ď$If2kdaB$$If9+|)4 9aU .$If^.^5kdB$$If9+) 4 9aU> P!P!!3!!-$If9$If7kdB$$If94+)4 9aUf4> ? B!!khC]]]; >$If^ `>kdE$$If9ֈ=h +_i! 4 9aU!!!!!!!!! ) ) )Ď$If2kdF$$If9+|)4 9aU .$If^.^5kd}F$$If9+) 4 9aU!!!!!!"""""""""&"'"(")"""""###$$$$$$$$$$$$$$$%%%۶󣓄whUah$`y5B* phhUah$`y<B* CJphhUah$`y5<B* CJph% jlhUah$`y5<B* CJ phjHh I:h I:CJU h$`y5jGh I:h I:CJU h$`yCJjh$`yCJUh$`yB*phh$`yjh$`yU+!!""")",""P!P!!3!!-$If9$If7kd0G$$If94+)4 9aUf4""#$$$khC]]]]; >$If^ `>kd/J$$If9ֈ=h +_i! 4 9aU$$$$$$%%% ) ) )$If2kdUK$$If9+|)4 9aU .$If^.^5kdJ$$If9+) 4 9aU%%%%%.%1%%P!P!!3!!-$If9$If7kdK$$If94+)4 9aUf4%%%%%%%+%,%-%.%%%%%Q&R&S&&&&&&&'''''''''?(@(A((((((((((((ֳwh$`yB*phjh$`yUhUah$`y5B* phhUah$`y<B* CJphhUah$`y5<B* CJph% jlhUah$`y5<B* CJ phjMh I:h I:CJUh$`y h$`y5 h$`yCJjh$`yCJUj Lh I:h I:CJU.%%Q&&&'''?((khC]]]]]]]]; >$If^ `>kdN$$If9ֈ=h +_i! 4 9aU ((((((((( ) ) )Ď$If2kdP$$If9+|)4 9aU .$If^.^5kdO$$If9+) 4 9aU((( ))!)$))P!P!!3!!-$If9$If7kdpP$$If94+)4 9aUf4() ) ) )))))) )!))))))))X*Y*Z* +++4+5+6+P+Q+R++++(,),*,h,i,j,,,,,,,,,,״ׂzׂh$`yB*phjh$`yUhUah$`yB* phhUah$`y<B* CJphhUah$`y5<B* CJph% jlhUah$`y5<B* CJ phj;Rh I:h I:CJUh$`y h$`y5jh$`yCJUjPh I:h I:CJU h$`yCJ0)))X* +4+P++(,h,,khC]]]]]]]]]; >$If^ `>kdS$$If9ֈ=h +_i! 4 9aU ,,,,,,,,, ) ) )Ď$If2kdT$$If9+|)4 9aU .$If^.^5kdmT$$If9+) 4 9aU,,,,,,,x-P!P!!3!!-$If9$If7kd U$$If94+)4 9aUf4,,,,,,,,,,,,,,x-y-...............//// / / /////f/g/qjZh I:h I:CJUjYh I:h I:CJUh$`yB*phh$`y<B*phjh$`yUhUah$`y5B* phhUah$`y<B* CJphjVh I:h I:CJU h$`y5jUh I:h I:CJU h$`yCJjh$`yCJUh$`y+x-y-...khCa,&.^5kdX$$If9+) 4 9aU ;$If^kdW$$If9ֈ=h +_i! 4 9aU........./ // /f/ ) ) )Ď|P!v|P!v|!|3!!-$If9$If7kdpY$$If94+)4 9aUf4$If2kdY$$If9+|)4 9aU .$If^ f/g//0`000611k]]]]]]]; >$If^ `>kd[$$If9ֈ=h +_i! 4 9aUg/h/i////0 0!0`0a0b000000061718111111111111111111222222223wj^h I:h I:CJU h$`y5jy]h I:h I:CJU h$`yCJjh$`yCJUh$`yB*phjh$`yUh$`yhUah$`y5B* phhUah$`y<B* CJphhUah$`y5<B* CJph% jlhUah$`y5<B* CJ ph.111111111 ) ) )Ď$If2kd\$$If9+|)4 9aU .$If^.^5kde\$$If9+) 4 9aU11111222P!P!!3!!-$If9$If7kd]$$If94+)4 9aUf4223<3x345a5khC]]]]]]; >$If^ `>kdO`$$If9ֈ=h +_i! 4 9aU333<3=3>3x3y3z344455 5a5b5d5e5v55555555555555555J6K6L6M66667777wjch I:h I:CJU h$`y5j-bh I:h I:CJU h$`yCJjh$`yCJUh$`yB*phjh$`yUh$`yhUah$`y5B* phhUah$`y<B* CJphhUah$`y5<B* CJph% jlhUah$`y5<B* CJ ph.a5b5c5d555555 ) ) )Ď$If2kdua$$If9+|)4 9aU .$If^.^5kda$$If9+) 4 9aU5555555J6P!P!!3!!-$If9$If7kda$$If94+)4 9aUf4J6K66778khC]]]]; >$If^ `>kdd$$If9ֈ=h +_i! 4 9aU7778888$898:8;8E8F8T8U8V8W8Z8[8\8j8k8l8m88888K9L9M9999:::e;f;h;i;z;;wmh$`y<B*phj#hh I:h I:CJU h$`y5jfh I:h I:CJU h$`yCJjh$`yCJUh$`yB*phjh$`yUh$`yhUah$`y5B* phhUah$`y<B* CJphhUah$`y5<B* CJph% jlhUah$`y5<B* CJ ph*8888<8=8>8?8@8 ) ) )Ď$If2kdf$$If9+|)4 9aU .$If^.^5kde$$If9+) 4 9aU@8A8E8W8[8m8p88P!P!!3!!-$If9$If7kdlf$$If94+)4 9aUf488K99:d;e;khC]]]]]; >$If^ `>kdwi$$If9ֈ=h +_i! 4 9aUe;f;g;h;;;;;; ) ) )$If2kdj$$If9+|)4 9aU .$If^.^5kdAj$$If9+) 4 9aU;;;;;;;;;;;;;;;;;;;;< < <<1<2<3<9<<<<<<<X>Z>\>]>k>l>m>n>>>>>>l?ܷLJxhUah$`y<B* CJph hU!5jBqh I:UhUah$`yB* phhUah$`y5<B* ph h$`y5CJjmlh I:h I:CJU h$`y5jUkh I:h I:CJU h$`yCJjh$`yCJUh$`yB*phjh$`yUh$`y/;;;;;;;<P!P!!3!!-$If9$If7kdj$$If94+)4 9aUf4<< < <4<5<ki_ )_ )_ ) .$If^kdm$$If9ֈ=h +_i!4 9aU5<6<7<8<9<<<<Ď1)| )!N!7kdo$$If9+)$4 9aN0$If8kdn$$If94+)4 9aNf4$If2kdSn$$If9+|)4 9aU<<<<<<X> )!!J99!d$If^!`:kdp$$If94+)4 9aNf4$If7kdo$$If9+)$4 9aN0$If7kdco$$If9+)$4 9aNX>Y>Z>[>\>n>q>> )PS~xPr!r%!9$If.$If<kdp$$If94+)$4 9aNf4$If7kdp$$If9+)$4 9aN;$If>>>k?l?m???JPD!9$IfJkdr$$If90=+!^&$4 9aN;$If.$If]kdVr$$If9F=+_^&$    4 9aNl?m?n?|?}?~??????@@A@B@P@Q@R@S@@@@@@@@@@@@@@@@@@fBgBhBvBwBxByBBB˼襞襞zojzh I:U"j\xh I:h I:5CJU"jwh I:h I:5CJU h$`y5CJjh$`y5CJUjuh I:UhUah$`y<B* CJphhUah$`y5B* ph h$`y5jPsh I:Uh$`yjh$`yUhUah$`yB* ph+??????@@@%!P!;$If.$If]kdt$$If9F=+_^&$    4 9aN9$If@@A@S@V@@@@P!n!n! v:$If9$If.$If]kdBu$$If9F=+_^&$    4 9aN@@@@@@@@hCy!y !s$If9$If-$If.$Ifskdv$$If94\=+_~$4 9aNf4@@@eBfBe_YY;$If.$Ifkd@y$$If94ֈ=3Yo+!_8_& P4 9aNf4fBgByB|BBBBCP!%!GA;$If]kd{$$If9F=+_^&$    4 9aN9$If.$IfMkdz$$If940=+!^&$4 9aNf4BBCCCCCCC1D2D3DDDDEE E EVEWEXEYEZEkEEEEEEEEEEEEEEEEEEEFFFFFFFFFFFFٱ٧ٟٟٔj5h I:Uh$`yB*phh$`y<B*phj>h I:UhUah$`y5B* ph h$`y5j|h I:Uh$`yjh$`yUhUah$`y<B* CJphhUah$`yB* ph6CCCCC1D2D3DP!%!A]kd>~$$If9F=+_^&$    4 9aN9$If.$IfMkdz|$$If940=+!^&$4 9aNf4;$If3DDDD E EUEVEP!]! -$If9$If.$IfMkd~$$If940=+!^&$4 9aNf4;$IfVEWEXEYEEEEE ) )| )FĎ5kd؀$$If94+|)4 9aUf4-$If .K$If^K-pkd:$$If9\= !+_ $4 9aNEEEEEFFFFP!%! )v:TN.^5kd$$If94+|)4 9aUf4$If ;$If^Xkd$$If9F=+_[&    4 9aU9$If.$IfFFFFFFFGG ) )v:aP!%!RXkdP$$If9F=+_[&    4 9aU9$If.$If-5kd߂$$If94+|)4 9aUf4$If .K$If^KFFFFGGGG}H~HHHHHHHHHHHIIIIIIIwJxJyJJJJJJJ(K)K*K5K6KDKEKFKGKjۋh$`yUUjh I:Ujh I:U h$`y>*jOh I:U h$`y5CJh$`yB*phhUah$`yB* phhUah$`y<B* CJph h$`y5h$`yjh$`yUj<h I:U3GGGG~HHHHHH )!hCy )y )y ) .$If^.2kd*$$If9+|)4 9aU 9$If^2kdӄ$$If9+|)4 9aU ;$If^ HHHHHIIIĎ )!! )!TeNA)$If5kd4$$If9+)44 9aU9$If5kd؅$$If9+)44 9aU0$If2kd$$If9+|)4 9aUIIIIIIwJ| )v:u:!4v4!! 9$$Ifa$.$If9$If8kd$$If94+)44 9aUf4$If5kd$$If94+)4 9aUf4wJxJyJzJJJJ(KhC )v:fu:`!`!Z4Q4!! 9$$Ifa$.$If9$If8kd$$If94+)44 9aUf4$If[kd$$If9FO +3!4    4 9aU(K)K*K+K5KGKhC )v:fu:`!Z4Q4!! 9$$Ifa$.$If9$If8kd=$$If94+)44 9aUf4$If[kd$$If9FO +3!4    4 9aUWithout continued legal intervention and placement, one or more children are likely to be in immediate danger of serious harm. Caretaker(s) have not resolved safety issues leading to placement.  FORMTEXT       Department of Human Services (DHS) will not discriminate against any individual or group because of race, sex, religion, age, national origin, color, height, weight, marital status, political beliefs or disability. If you need help with reading, writing, hearing, etc., under the Americans with Disabilities Act, you are invited to make your needs known to a DHS office in your area.AUTHORITY: P.A. 280 of 1939. RESPONSE: Voluntary. PENALTY: None PAGE 6 DHS-149 (Rev.11-05) Previous edition obsolete. MSWord  PAGE 1 hC(((9Ď_kd$$Ifl4+)044 laUf4.$If-$If[kdS$$If9FO +3!4    4 9aUYZ44 4"4$4&4B4D4F4H4̽Ҳ̽栖siXs!jh]{CJOJQJUh]{CJOJQJjh]{CJOJQJUh]{!jh]{CJOJQJUh]{CJOJQJjh]{CJOJQJUh?had0J8mHnHuh.wh.w0J8mHnHu h.w0J8jh.w0J8U hU!h h$`y5h$`yjh$`yUjh I:UmHnHu"Zw555q~ op,fdb$$&`#$okdG$$Ifl0+r 044 laU $If^ $If^ $$Ifa$ $4H4l44445$5H5p5555 646\6666p,!  $ !+^/0 P xP x&P/ =!"#$%2 00P xP x&P/ =!"#$%/ 0P xP x&P/ =!"#$%2 00P xP x&P/ =!"#$%/ 0P xP x&P/ =!"#$%2 00P xP x&P/ =!"#$%/ 0P xP x&P/ =!"#$%2 00P xP x&P/ =!"#$%/ 0P xP x&P/ =!"#$%2 00P xP x&P/ =!"#$%/ 0P xP x&P/ =!"#$%2 00P xP x&P/ =!"#$%/ 0P xP x&P/ =!"#$%2 00P xP x&P/ =!"#$%/ 0P xP x&P/ =!"#$%2 00P xP x&P/ =!"#$%/ 0P xP x&P/ =!"#$%2 00P xP x&P/ =!"#$%/ 0P xP x&P/ =!"#$%2 00P xP x&P/ =!"#$%/ 0P xP x&P/ =!"#$%2 00P xP x&P/ =!"#$%/ 0P xP x&P/ =!"#$%2 00P xP x&P/ =!"#$%/ 0P xP x&P/ =!"#$%2 00P xP x&P/ =!"#$%/ 0P xP x&P/ =!"#$%2 00P xP x&P/ =!"#$%/ 0P xP x&P/ =!"#$%2 00P xP x&P/ =!"#$%/ 0P xP x&P/ =!"#$%2 00P xP x&P/ =!"#$%/ 0P xP x&P/ =!"#$%2 00P xP x&P/ =!"#$%/ 0P xP x&P/ =!"#$%2 00P xP x&P/ =!"#$%/ 0P xP x&P/ =!"#$%2 00P xP x&P/ =!"#$%/ 0P xP x&P/ =!"#$%D FCCaseNameEnter FC case name. CaseInfo.MAIN$$IfU!vh5,5 5#v,#v #v:V 94$5,5 5/ / / / / / /  44 9aND FCCaseNoEnter FC case number.$$IfU!vh5,5 5#v,#v #v:V 94$5,5 5/ / / / / / /  44 9aND PSCaseName'Enter PS case name (primary caretaker).$$IfU!vh5,5 5#v,#v #v:V 944$+5,5 5/ / / / / / /  44 9aND PSCaseNoEnter PS case number.$$IfU!vh5,5 5#v,#v #v:V 944$+5,5 5/ / / / / / /  44 9aND ReferralDateM/d/yyyyEEnter date Protective Services received referral on child's family. $$IfU!vh5,5 5#v,#v #v:V 944$+5,5 5/ / / / / / /  44 9aND CountyNameEnter the county name $$IfU!vh5,5 5#v,#v #v:V 944$+5,5 5/ / / / / / /  44 9aND FCWorkerName Enter in assigned worker's name.$$IfU!vh5,5 5#v,#v #v:V 944$+5,5 5/ / / / / / /  44 9aND FCWorkerLoadNo'Enter in assigned worker's load number.$$IfU!vh5,5 5#v,#v #v:V 94$5,5 5/ / / / / / /  44 9aNa$$IfU!vh5)#v):V 94$5)44 9aNDeCheck42Click to check box if this is a review assessment.DeKClick to check box if this is the first safety assessment for this referralD DCompleted$Enter date assessment was completed.$$IfU!vh5 55h5555#v #v#vh#v#v#v#v:V 94$5 55h5555/ 44 9aNDHouseholdAssessedLst#Enter Household assessed last name.DHouseholdAssessedFst$Enter Household assessed first name.$$IfU!vh5 5 55 #v #v #v#v :V 94$5 5 55 44 9aNDe;Check if this is the household child(ren) were removed fromDeCheck67Check if no child(ren) were removed from this household$$IfU!vh55h55h5R #v#vh#v#vh#vR :V 94$55h55h5R 44 9aN`$$IfU!vh5)#v):V 945)44 9aNf4Z$$IfU!vh5)#v):V 9$5)44 9aNU$$IfN!vh5)#v):V 9$5)44 9aN$$IfN!vh555##v#v#v#:V 94555#44 9aNf4[$$IfN!vh5)#v):V 945)44 9aNf4rDeCheck7Check if caretaker caused serious harm to child or made plausible threat as indicated by serious injury or abuse not accidental$$IfN!vh55_5t!5#v#v_#vt!#v:V 9455_5t!544 9aNf4lDeCheck if caretaker caused serious harm to child or made plausible threat as indicated by threat to harm or retaliate against child$$IfN!vh55_5t!5#v#v_#vt!#v:V 9455_5t!544 9aNf4fDeCheck if caretaker caused serious harm to child or made plausible threat as indicated by excessive discipline or physical force$$IfN!vh55_5t!5#v#v_#vt!#v:V 9455_5t!544 9aNf4vDeCheck if caretaker caused serious harm to child or made plausible threat as indicated by potential harm to child from domestic violence$$IfN!vh55_5t!5#v#v_#vt!#v:V 9455_5t!544 9aNf4xDeCheck if caretaker caused serious harm to child or made plausible threat as indicated by one or more caretakers fear they will maltreat $$IfN!vh55_5t!5#v#v_#vt!#v:V 9455_5t!544 9aNf4@DelCheck if caretaker caused serious harm to child or made plausible threat as indicated by drug exposed infant$$IfN!vh55_5t!5#v#v_#vt!#v:V 9455_5t!544 9aNf4`$$IfU!vh5)#v):V 945)44 9aNf4dDeCheck1xCheck if yes, caretaker caused serious harm and/or made threat and circumstances suggest safety may be immediate concernVDewCheck if no, caretaker caused serious harm and/or made threat and circumstances suggest safety may be immediate concern$$IfU!vh55_55j55!#v#v_#v#vj#v#v!:V 9$55_55j55!44 9aNU$$IfU!vh5|)#v|):V 95|)44 9aU$$IfN!vh555##v#v#v#:V 94555#44 9aNf4 DeQCheck if caretaker(s) previously maltreated a child prior to the death of a childDeNCheck if caretaker(s) previously maltreated a child prior removal of any child$$IfN!vh55_55y5#v#v_#v#vy#v:V 9455_55y544 9aNf4DeSCheck if caretaker(s) previously maltreated a child prior serious harm to any childDeLCheck if caretaker(s) previously maltreated a child prior CPS substantiation$$IfN!vh55_55y5#v#v_#v#vy#v:V 9455_55y544 9aNf4DeXCheck if caretaker(s) previously maltreated a child prior termination of parental rightsDeYCheck if caretaker(s) previously maltreated a child prior threat of serious harm to child$$IfN!vh55_55y5#v#v_#v#vy#v:V 9455_55y544 9aNf4[$$IfN!vh5)#v):V 945)44 9aNf4[$$IfN!vh5)#v):V 945)44 9aNf4_$$IfU!vh5)#v):V 945)44 9aUf4DePCheck if yes, the child(s) safety is of immediate concern if placement continuesDeOCheck if No, the child(s) safety is of immediate concern if placement continues$$IfU!vh55_55i55!#v#v_#v#vi#v#v!:V 955_55i55!44 9aU[$$IfU!vh5|)#v|):V 945|)44 9aUf4_$$IfU!vh5)#v):V 945)44 9aUf4pDeCheck if Yes, caretaker(s) failed to protect child and perpetrator continues to have access who pose a threat to safety of the childnDeCheck if No, caretaker(s) failed to protect child and perpetrator continues to have access who pose a threat to safety of the child$$IfU!vh55_55i55!#v#v_#v#vi#v#v!:V 955_55i55!44 9aUU$$IfU!vh5|)#v|):V 95|)44 9aU_$$IfU!vh5)#v):V 945)44 9aUf4De7Check if Yes, Explanation of the injury is unconvincingDe6Check if No, Explanation of the injury is unconvincing$$IfU!vh55_55i55!#v#v_#v#vi#v#v!:V 9 55_55i55!44 9aUZ$$IfU!vh5)#v):V 9 5)44 9aUU$$IfU!vh5|)#v|):V 95|)44 9aU_$$IfU!vh5)#v):V 945)44 9aUf4hDeCheck if Yes, caretaker refuses access to a child, reason to believe about to flee, or child's whereabouts cannot be ascertainedfDeCheck if No, caretaker refuses access to a child, reason to believe about to flee, or child's whereabouts cannot be ascertained$$IfU!vh55_55i55!#v#v_#v#vi#v#v!:V 9 55_55i55!44 9aUZ$$IfU!vh5)#v):V 9 5)44 9aUU$$IfU!vh5|)#v|):V 95|)44 9aU_$$IfU!vh5)#v):V 945)44 9aUf4NDesCheck if Yes, child is fearful of caretaker, family members, or other people living in or having access to the homeLDerCheck if No, child is fearful of caretaker, family members, or other people living in or having access to the home$$IfU!vh55_55i55!#v#v_#v#vi#v#v!:V 9 55_55i55!44 9aUZ$$IfU!vh5)#v):V 9 5)44 9aUU$$IfU!vh5|)#v|):V 95|)44 9aU_$$IfU!vh5)#v):V 945)44 9aUf4PDetCheck if Yes, caretaker is unwilling or unable to provide supervision to protect child from potentially serious harmNDesCheck if No, caretaker is unwilling or unable to provide supervision to protect child from potentially serious harm$$IfU!vh55_55i55!#v#v_#v#vi#v#v!:V 9 55_55i55!44 9aUZ$$IfU!vh5)#v):V 9 5)44 9aUU$$IfU!vh5|)#v|):V 95|)44 9aU_$$IfU!vh5)#v):V 945)44 9aUf4tDeCheck if Yes, caretaker is unable to meet the child's immediate need for food, clothing, shelter and/or medical or mental health needsrDeCheck if No, caretaker is unable to meet the child's immediate need for food, clothing, shelter and/or medical or mental health needs$$IfU!vh55_55i55!#v#v_#v#vi#v#v!:V 9 55_55i55!44 9aUZ$$IfU!vh5)#v):V 9 5)44 9aUU$$IfU!vh5|)#v|):V 95|)44 9aU_$$IfU!vh5)#v):V 945)44 9aUf4jDeCheck if Yes, caretaker's physical living conditions are hazardous and threatening to child based on age and developmental statushDeCheck if No, caretaker's physical living conditions are hazardous and threatening to child based on age and developmental status$$IfU!vh55_55i55!#v#v_#v#vi#v#v!:V 9 55_55i55!44 9aUZ$$IfU!vh5)#v):V 9 5)44 9aUU$$IfU!vh5|)#v|):V 95|)44 9aU_$$IfU!vh5)#v):V 945)44 9aUf4:DeiCheck if Yes, Caretaker's substance use seriously affects ability to supervise, protect or care for child8DehCheck if No, Caretaker's substance use seriously affects ability to supervise, protect or care for child$$IfU!vh55_55i55!#v#v_#v#vi#v#v!:V 9 55_55i55!44 9aUZ$$IfU!vh5)#v):V 9 5)44 9aUU$$IfU!vh5|)#v|):V 95|)44 9aU_$$IfU!vh5)#v):V 945)44 9aUf4De?Check if Yes, Caretaker's behavior is violent or out of controlDe>Check if No, Caretaker's behavior is violent or out of control$$IfU!vh55_55i55!#v#v_#v#vi#v#v!:V 9 55_55i55!44 9aUZ$$IfU!vh5)#v):V 9 5)44 9aUU$$IfU!vh5|)#v|):V 95|)44 9aU_$$IfU!vh5)#v):V 945)44 9aUf4lDeCheck if Yes, caretaker(s) describes or acts toward child in predominatly negative terms or has extremely unrealistic expectationsjDeCheck if No, caretaker(s) describes or acts toward child in predominatly negative terms or has extremely unrealistic expectations$$IfU!vh55_55i55!#v#v_#v#vi#v#v!:V 9 55_55i55!44 9aUZ$$IfU!vh5)#v):V 9 5)44 9aUU$$IfU!vh5|)#v|):V 95|)44 9aU_$$IfU!vh5)#v):V 945)44 9aUf4bDe}Check if Yes, child sexual abuse is suspected or confirmed and circumstances suggest child safety may be of immediate concern`De|Check if No, child sexual abuse is suspected or confirmed and circumstances suggest child safety may be of immediate concern$$IfU!vh55_55i55!#v#v_#v#vi#v#v!:V 9 55_55i55!44 9aUZ$$IfU!vh5)#v):V 9 5)44 9aUU$$IfU!vh5|)#v|):V 95|)44 9aU_$$IfU!vh5)#v):V 945)44 9aUf4VDewCheck if Yes, caretaker's emotional stability seriously affects current ability to supervise, protect or care for childTDevCheck if No, caretaker's emotional stability seriously affects current ability to supervise, protect or care for child$$IfU!vh55_55i55!#v#v_#v#vi#v#v!:V 9 55_55i55!44 9aUZ$$IfU!vh5)#v):V 9 5)44 9aUU$$IfU!vh5|)#v|):V 95|)44 9aU_$$IfU!vh5)#v):V 945)44 9aUf4DeXCheck Yes if there is other behavior or condition associated with child being in danger.DeZCheck No if there is no other behavior or condition associated with child being in danger.$$IfU!vh55_55i55!#v#v_#v#vi#v#v!:V 955_55i55!44 9aUU$$IfU!vh5|)#v|):V 95|)44 9aU[$$IfU!vh5)#v):V 945)44 9aNf4Z$$IfU!vh5)#v):V 9$5)44 9aN^$$IfN!vh5)#v):V 9$5)44 9aNZ$$IfU!vh5)#v):V 9$5)44 9aN_$$IfU!vh5)#v):V 945)44 9aNf4Z$$IfU!vh5)#v):V 9$5)44 9aNd$$IfU!vh5)#v):V 94$5)44 9aNf4DeCheck5PCheck if monitoring or direct services by FIA worker was taken to protect child.$$IfU!vh55_5^&#v#v_#v^&:V 9$55_5^&44 9aNp$$IfU!vh5!5^&#v!#v^&:V 9$5!5^&44 9aNjDeCheck if use of family resources, heighbors or other individuals in the community as safety resources were used to protect child.$$IfU!vh55_5^&#v#v_#v^&:V 9$55_5^&44 9aN$$IfU!vh55_5^&#v#v_#v^&:V 9$55_5^&44 9aN$De^Check if Use of community agencies or services as safety resources were used to protect child.$$IfU!vh55_55~#v#v_#v#v~:V 94$55_55~44 9aNf4De1Check if Intensive Home Based resources were usedDe>Check if other community resources were used to protect child.$$IfU!vh5!5_585_5& 5#v!#v_#v8#v_#v& #v:V 94P5!5_585_5& 544 9aNf4v$$IfU!vh5!5^&#v!#v^&:V 94$5!5^&44 9aNf4jDeCheck if having alleged perpetrator leave the home, either voluntarily or in response to legal action was taken to protect child.$$IfU!vh55_5^&#v#v_#v^&:V 9$55_5^&44 9aNv$$IfU!vh5!5^&#v!#v^&:V 94$5!5^&44 9aNf4LDerCheck if having the non-maltreating caretaker move to a safe environment with the child was done to protect child.$$IfU!vh55_5^&#v#v_#v^&:V 9$55_5^&44 9aNv$$IfU!vh5!5^&#v!#v^&:V 94$5!5^&44 9aNf4DeJCheck if the caretaker placed the child outside the home to protect child.$$IfU!vh55_55 #v#v_#v#v :V 9$55_55 44 9aN[$$IfU!vh5|)#v|):V 945|)44 9aUf4De1Check if other action was taken to protect child.$$IfU!vh55_5[&#v#v_#v[&:V 955_5[&44 9aU[$$IfU!vh5|)#v|):V 945|)44 9aUf4[$$IfU!vh5|)#v|):V 945|)44 9aUf4DeVCheck if legal action must be continued or taken to place child(ren) outside the home.$$IfU!vh55_5[&#v#v_#v[&:V 955_5[&44 9aUU$$IfU!vh5|)#v|):V 95|)44 9aUU$$IfU!vh5|)#v|):V 95|)44 9aUU$$IfU!vh5|)#v|):V 95|)44 9aUZ$$IfU!vh5)#v):V 945)44 9aUZ$$IfU!vh5)#v):V 945)44 9aU[$$IfU!vh5)#v):V 945)44 9aUf4`$$IfU!vh5)#v):V 9445)44 9aUf4De$Check if the Safety Decision is Safe$$IfU!vh5355!#v3#v#v!:V 945355!44 9aU`$$IfU!vh5)#v):V 9445)44 9aUf4De2Check if the Safety Decision is Safe with Services$$IfU!vh5355!#v3#v#v!:V 945355!44 9aU`$$IfU!vh5)#v):V 9445)44 9aUf4De&Check if the Safety Decision is Unsafe$$IfU!vh5355!#v3#v#v!:V 945355!44 9aUDText1(Enter Worker Name, Typist Initials, etc.$$If!vh5)#v):V l4045)/  / 4aUf4$$If!vh5r5 #vr#v :V l045r5 / 4aUD>8@8 Normal_HmH sH tH DA@D Default Paragraph FontVi@V  Table Normal :V 44 la (k(No List POP BLANKLINEdx5CJOJQJkHTOT Captions 6ptd(CJ OJQJkHDOD Captions 6pt bold5`O"` Captions 6pt boxd<5CJ OJQJkHDO2D Captions 6pt Nbox<DOBD Captions 7pt dtCJDOARD Captions 7pt Bold5BOqbB Captions 7pt box5^Or^ Captions 7pt NBoxdt<CJOJQJkHPOP Captions 8pt d`CJOJQJkH^O^ Captions 8pt Bold d`5CJOJQJkHFOF Captions 8pt box <DOD Captions 8pt NboxPPOP Captions 9pt dLCJOJQJkHJOJ Captions 9pt BolddLCJFOF Captions 9pt Box dDOD Captions 9pt Nbox5POP Captions 10pt d`( OJQJkH^O^ Captions 10pt Bold!d`(5OJQJkHXO"X Captions 10pt box"d`P OJQJkHHO2H Captions 10pt Nbox#P5J @BJ Footer$dt !CJOJQJkHRORR Form Title 10pt%$d8a$ OJQJkH^Ob^ Form Title 10pt Bld&$d8a$5OJQJkHVOrV Form Title 11pt'$d$a$CJOJQJkHLOaL Form Title 11pt Bld(d$CJVOV Form Title 12pt)$da$CJOJQJkHbOb Form Title 12pt Bld*$da$5CJOJQJkH4@4 Header + !HOH Small Blank Line ,CJTOT User Input 10pt-d8( OJQJkHLOL User Input 11pt.d CJOJQJ\O\ User input 12pt/d((5CJOJQJkHTOT Letter Text 10pt0$d$a$ OJQJkHFOF Letter Text 11pt1dCJXO"X Letter Text 12pt2$da$CJOJQJkHLO2L Captions 10pt 2 line 3<BOBB Date 08pt4CJOJQJkH6OAR6 Date 09pt5CJ6OAb6 Date 10pt6CJ2Oar2 Date 11pt7CJ.)@. Page NumberBOB Letter Text 9pt95CJ>'> Comment ReferenceCJ2O2 Hidden;dB* O l<44  Comment Text=  %S(^!!##&&c**-?-g00 171X::;;==5C$1$e$$$$/%`%%%%*&^&&&&('Y''''#(W((((!)R))))*P****+K++#zzzzzz  %S(^!!##%&&&&c**-?-g00000 171X::;;<<<==5C,*+U'5IJK[op#$%2FGH\pqr34Sgr  )dehi89:;M}~   S T U V h | } ~      h i j |   ! 3 X j #$%&PQRSTUXjn:%&'()*-?CUX  j\]^_>?B),.1Q? !$X 4 P (!h!!!!!!!!!!!!!!!!x"y"###########$ $$ $f$g$$%`%%%6&&&&&&&&&&&&&&''''(<(x()*a*b*c*d************J+K++,,----<-=->-?-@-A-E-W-[-m-p---K../d0e0f0g0h00000000000011 1 141516171819111111111X3Y3Z3[3\3n3q3333k4l4m4444444?5@5A5S5V5555555555555e7f7g7y7|777788888192939999 : :U:V:W:X:Y:::::::::;;;;;;;;;;<<<<<~==========>>>>>>>>w?x?y?z????(@)@*@+@5@G@ A A AA A!ABBBBBBBBB2C3C6C0'0 0 .0 0 .0 0 -0 0 *0 0 .0 0 .0 0 .0 0 .0 0 .0 0 .0 0 .0 0 .0 0 .0 0 .0 0 .0 0 .0 0 0 0 .0 0 .0 0 .0 0 0 .0 0 .0 0 0 .0 0 .0 0 0 0 0 90 0 90909090 0 0 0 0 0 0 0 0 -0 0 0 0 0 -0 0 0 0 0 -0 0 0 0 0 -0 0 0 0 0 -0 0 0 0 0 -0 0 0 0 0 0 90 -0 0 -0 0 90 0 0.0.0.0 0 090 0 90 0 0 -0 0 -0 90 0 0 -0 90 -0 90 0 0 -0 90 -0 90 0 0 0 0.0.00 0 00 0 90 -0 90 -0 90 90 0 0.0.00!0 00 0 90 -0 90 -0 90 90 0 0.0.0.0 0 00 0 90 -0 90 -0 90 90 0 ;0;0;0!0 .0.0.0.0 0 000 0 90 -0 90 -0 90 90 0 ;0;0@;0;0!0 .0.0.0.0 0 00 0 90 -0 90 -0 90 90 0 ;0;0;0!0 .0.0.0.0 0 00 0 90 -0 90 -0 90 90 0 ;0;0;0;0!0 .0.0.0.0 0 00 0 90 -0 90 -0 90 90 0 ;0;0;0;0;0;0;0;0!0 .0.0.0.0 0 00 0 90 -0 90 -0 90 90 0 ;0;0;0;0;0;0;0;0;0!0 .0.0.0.0 0 00 0 90 -0 90 -0 90 90 0 ;0!0 .0.0.0.0 0 00 0 90 -0 90 -0 90 90 0 ;0;0;0;0;0;0;0!0 .0.0.0.0 0 00 0 90 -0 90 -0 90 90 0 ;0;0;0;0;0;0!0 .0.0.0.0 0 00 0 90 -0 90 -0 90 90 0 ;0;0;0;0!0 .0.0.0.0 0 00 0 90 -0 90 -0 90 90 0 ;0;0;0;0;0!0 .0.0.0.0 0 00 0 90 -0 90 -0 90 90 0 0.0.0.0 0 00 0 00 0 00 0 00 0 0 0 90;0 0 0 0 .0 90 90 0 .0 ;0;0!0 .0 90 90 0 .0 90 ;0;0!0 .0 90 9090 0 0 .0 -0 90 -0 90 0 0 .0 ;0;0!0 .0 90 90 0 .0 ;0;0!0 .0 90 90 0 .0 ;0;0!0 .0 90 90 -0 0 -0.0.0-0 0 -0.0 90 90 0 ;00 0 .0.00 0 -0.0 90 90 0 ;0;0!0 90 0 .0.0.0.0 0 000 0 90 0 0 0 0 0 90 .0 90 0 0 0 9090 .0 90 0 0 0 90 .0 90 0 -0.0-0 0 0 000 0 0@$0@$0@0$0@00IJop#Fp34Sgr  )dehi89:;M}~   S T U V h | } ~      h i j |   ! 3 X j #$%&PQRSTUXjn:%&'()*-?CUX  j\]^_>?B),.1Q? !$X 4 P (!h!!!!!!!!!!!!!!!!x"y"###########$ $$ $f$g$$%`%%%6&&&&&&&&&&&&&&''''(<(x()*a*b*c*d************J+K++,,----<-=->-?-@-A-E-W-[-m-p---K../d0e0f0g0h00000000000011 1 141516171819111111111X3Y3Z3[3\3n3q3333k4l4m4444444?5@5A5S5V5555555555555e7f7g7y7|777788888192939999 : :U:V:W:X:Y:::::::::;;;;;;;;;;<<<<<~==========>>>>>>>>w?x?y?z????(@)@*@+@5@G@ A A AA A!ABBBBBBB2C6C00D @0?0!| @00#0%0'P0)0+?0-@0@0@0@.0@0@.0@0@.0@0@0@.0@0@.0@0@0@.0@0@.0@0@0@0@0@90@0@90@90@90@90@0@0@0@0@0@0@0@0@-0@0@0@0@0@-0@0@0@0@0@-0@0@0@0@0@-0@0@0@0@0@-0@0@0@0@0@-0@0@0@0@0@0@90@-0@0@-0@0@90@00@.0@.0@.0@009009000-00-09000-090-09000-090-0900000.0.00000090-090-0909000.0.00000090-090-0909000.0.0.0(000090-090-090900 ;0;0;00 .0.0.0.0000090-090-090900 ;0;0@;0;00 .0.0.0.00<00090-090-090900 ;0;0;00 .0.0.0.0000090-090-090900 ;0;0;0;00 .0.0.0.0000090-090-090900;0;0;0;0;0;0;0;00.0.0.0 .0 000090 -0 90 -0 90 90 0;0 ;0 ;0 ;0 ;0 ;0 ;0 ;0 ;0 0.0.0.0 .0 000090 -0 90 -0 90 90 0;0 0.0.0.0 .0 000090(-0(90(-0(90(90(0;0(;0(;0(;0(;0(;0(;0(0.0.0.0(.0(000090(-0(90(-0(90(90(0;0(;0(;0(;0(;0(;0(0.0.0.0(.0(000090(-0(90(-0(90(90(0;0(;0(;0(;0(0.0.0.0(.0(0000900-00900-009009000;00;00;00;00;000.0.0.00.000000900-00900-0090090000.0.00.000000000000000000000900;000000.009009000.00;00;000.009009000.08908;08;080.08908908908080.08-08908-08908080.08;08;080.089089080.08;08;080.089089080.08;08;080.08908908-080-0.0.08-080-0.090900 ;08080.0.000-0.090900 ;08;08090@0.0.0.0@.0@00000 90@00@00@090@.0@90@00@090@90@.0@90@00@090@.0@90@0-0@.0@-0@0@0@0@0@0@00{0$ TZo@ved from0 PPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPS5AG[gm!2>D\hn +1S_er~;K  V f j z  ! 1 X h &NXhn~#-=CS_', !!!!!!#####$ $$&&&&&'d******-:-E-U-[-k-h00000000 121\3l3m4}4A5Q55555g7w7889:Y::::::;;;;==>>??5@E@ AAA5CFFFFFFFFG$G$FFFG$G$G G G G G G G G 3G G G G G G 3G G 3G G 3G G 3G G 3G G 3G G 3G G 3G G 3G G 33G G 3G G 3G G 3G G 33G G 3G G G G G G G G 33G 3G 3G G G F4 CJLS!!8@0(  B S  ? FCCaseNameFCCaseNo PSCaseNamePSCaseNo ReferralDate CountyName FCWorkerNameFCWorkerLoadNoCheck4 DCompletedHouseholdAssessedLstHouseholdAssessedFstCheck6Check7Check1Check5Text16\3] Ts ]3 A6C Hn"Eo2f m3A6CWYWbW%%,6C+006C9*urn:schemas-microsoft-com:office:smarttagsplace=*urn:schemas-microsoft-com:office:smarttags PlaceName=*urn:schemas-microsoft-com:office:smarttags PlaceType BB&C0C3C6C`sTZ6;BB&C0C3C6C::::::5H[n"2E\o  2Sfr;L  V g   j {  ! 2 X i &&OOXin$$->CT__(-  !!!!!!!!#####$ $$&&&&&&&'d*d*******--;-;-E-V-[-l-00000000 1 13131\3m3m4~4A5R55555g7x7889 :::::::;;;;;;====>>??5@F@ AABBBBBCC&C0C3C6CB6C*yy`\@h E ^E `OJQJo( @ IUa eM U!e'K+ I:0<&tKwOVTLb6dad~!eSe=g.w$`y2^8<uaC~?9e'5IJK[op#$%2FGH\pqr34Sgr  dehi89:;M}~   S T U V h | } ~      h i j |   ! 3 X j #$%QRSTUXjn&'()*-?CUX  \]^>?),.1 !$!!!!!!!!!!!!!x"y"#########$ $$ $f$g$&&&&&&&&&&&''''a*b*c***********J+K+---=->-?-@-A-E-W-[-m-p---e0f0g0000000000011 1516171819111111111Y3Z3[3\3n3q3333l4m4444444@5A5S5V555555555555f7g7y7|7777888819293999 : :U:V:W:X::::::::;;;;;;;;<<<<~========>>>>>>>>w?x?y?z???(@)@*@+@5@G@ A A A!ABBB6CV++V++V++V++V++ FCSA and P TOOLSFCSA and P TOOLSMMeMMcMMcMMcMM 0 Change CaseInfo Case Info CaseInfo.Main Clear Case InfoClear Case InfoClearCaseInfo.Main(TemplateProject.ToolHelp.Main Tool Help ToolHelp.Main1(Remove Table Row Remove RowRemoveRow.MAIN( Check SpellingNewMacros.CheckSpelling(p(pTemplateProject.CaseInfo.MAIN"TemplateProject.ClearCaseInfo.MAIN'TemplateProject.NewMacros.CheckSpellingTemplateProject.ToolHelp.MAINTemplateProject.RemoveRow.MAINTEMPLATEPROJECT.CASEINFO.MAINTEMPLATEPROJECT.TOOLHELP.MAINTEMPLATEPROJECT.REMOVEROW.MAIN"TEMPLATEPROJECT.CLEARCASEINFO.MAIN'TEMPLATEPROJECT.NEWMACROS.CHECKSPELLING@ BGkBBLG@GA5CPP P P@PP4@UnknownGz Times New Roman5Symbol3& z Arial;Wingdings?5 z Courier New"h*|&7Fq 8"y 8"yr cq#4dBB 3H?$`yIDHS-0149, Foster Care Structured Decision Making Safety Assessment & Plancomp Administrator yL@LNormal#CJ OJQJ_HmHnHsH tH uDAD Default Paragraph FontVi@V Oh+'0$ <H d p | LDHS-0149, Foster Care Structured Decision Making Safety Assessment & Plancomp0149Administrator31Microsoft Word 10.0@1@2bۍ@ F@(i 8՜.+,0@ hp  "State Of Michigany"B JDHS-0149, Foster Care Structured Decision Making Safety Assessment & Plan Title  !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~      !"#$%&'()*+,-./0123456789:;<=>?@ABCNEFGHIJKMNOPQRSXY\]^_abcdewghijklmnpqrstuv`xyz{|}~Root Entry Fi[&Data `1Table7WordDocumentSummaryInformation(DDocumentSummaryInformation8LMacros`ˮiiVBA `ˮipViThisDocument ClearCaseInfoGToolHelpf[CaseInfo o+  !"#$%')*+,-./0123456789:;<>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijkmnopqrstuvxz{|}~':4#xME (SLSS<N0{00020906-0000-0000-C000-000000000046}@(%H@0W8 xAttribute VB_Name = "ThisDocument" Bas0{00020P906-0C$0046} |GlobalSpacFalse dCreatablPredeclaIdTru BExposeTemplateDerivBustomizD2dk:6xMEP 0@W8  "  c:\" caseinfo.ini$&(*,.0d2468:<>@BD B@1c:\caseinfo.ini B@F}oPH>Attribute VB_Name = "ClearCaseInfo" Public Sub MAIN() WordBasic.File@Find Slch:=" ",! Path c:V\$:ci.ini(ubDir:=0, Title.Autho" Keywqsject Option=MatchKex#ternDateSavedFrom3# ToByCre  View0Sort4, LisPSel\;Kill " Eub rU $`n9   Enter File Name in SaveAs Dialog Box ' ~OPEN FCUSP TOOLSNPR B@Lt OFCSA and P ToolsTV B@LtBordersT B@LDatabaseT B@L@DrawingT B@LFormsT B@L B@save the documentiDEFINE DIALOG BOXI^CaseInfo B@X  YourFCCNo B@8 YourFCCN B@P  YourFCWLNo B@h YourFCWN B@  YourPSCNo B@ YourPSCN B@ YourCTNO B@^YourPOSA B@^YourPOSW B@fYourDC B@bk  0Enter the following information about this case. B@d# FC Case No.: B@dPre; FC Case Name: B@drS DHS FC Load No.: B@dak DHS FC Worker Name: B@des PS Case No.: B@dtom PS Case Name: B@def Court ID No.: B@dabT POS Agency Name: B@dT POS Worker Name: B@dc Date Completed: B@dl^X B@ZearX B@asth B@\or]HF !`!b.^6GET USER INFO FROM INI FILE AND PUT IT INTO DIALOG BOXtUserInfoFCCaseNoC:\caseinfo.ini % ^(aUserInfo FCCaseNameC:\caseinfo.ini % ^(UserInfoFCLoadNoC:\caseinfo.ini % ^(tUserInfo FCWorkerNameC:\caseinfo.ini % ^(kPUserInfoPSCaseNoC:\caseinfo.ini % ^(tUserInfo PSCaseNameC:\caseinfo.ini % ^(UserInfoCOURTNOC:\caseinfo.ini % ^(UserInfoPOSAC:\caseinfo.ini % ^(UserInfoPOSwC:\caseinfo.ini % ^(UserInfo DCompletedC:\caseinfo.ini % ^(,DISPLAY DIALOG BOX AND RESPOND TO USER INPUT ^ !d%b'J J OK BUTTONWRITE NEW USER INFO IN INI FILEUserInfoFCCaseNo ^!C:\caseinfo.ini B@UserInfo FCCaseName ^!C:\caseinfo.ini B@UserInfoFCLoadNo ^!C:\caseinfo.ini B@UserInfo FCWorkerName ^!C:\caseinfo.ini B@UserInfoPSCaseNo ^!C:\caseinfo.ini B@UserInfoPSCaseNo ^!C:\caseinfo.ini B@UserInfo PSCaseName ^!C:\caseinfo.ini B@UserInfoCOURTNO ^!C:\caseinfo.ini B@UserInfoPOSA ^!C:\caseinfo.ini B@UserInfoPOSw ^!C:\caseinfo.ini B@UserInfo DCompleted ^!C:\caseinfo.ini B@ :0xMEx ++@J h\`^ rLpW8 , ""&8 `&xJTTH>JL0ZPL0H6VHXT  8 X x   < 2(`x " 4  ]@NPR B@Lile FCUSP ToolsTV B@LSDEFINE DIALOG BOXF,FCUSP Tool Help B@X  ,**To CHANGE Case Info WITHOUT closing form** B@d:; 61. Click Clear Case Info Button on FCSA and P Toolbar B@d;" 62. Click Change CaseInfo Button on FCSA and P Toolbar B@dR.  to bring up new pop-up screen. B@d;: ,3. Enter new case information and click OK. B@d@@`;H -The new information will fill in on the form. B@d`` \ <**To Select Appropriate ADD Buttons from the FCUSP Toolbar** B@d;h 11. Use Mouse to position Cursor over any button B@d;t -2. Read the Help message line at the Bottom B@d`PR *of the Screen to see an exact description B@dR of the Button function. B@d`; 83. When you have located the correct button, Click it. B@d  )** To Remove Entire Row from any table** B@d; 5 Click Remove Table Row Button on FCSA and P Toolbar B@d   B@d;  B@d  B@d;  B@d   B@dN B@Z B@\MS]XF !`!b.^6GET USER INFO FROM INI FILE AND PUT IT INTO DIALOG BOX,DISPLAY DIALOG BOX AND RESPOND TO USER INPUT ^ !d%b'J J OK BUTTONGet user info from INI file. Update other Form Fields on Form & Exit MacrokoJAttribute VB_Name = "ToolHelp" Public Sub MAIN() Dim iRet WordBasic .Viewnbars ColorButtons:=1, Larg"e 0, TTip:EN:="FCUSP3s",` ShowU'DEFINE DIALOG BOX MBeginDialog 58`2, 30zM  eText 9, 1513, "**To CHANGE Case Info WITHOUT closing form**)5)2B)P1. Cke ar+ on FCSA and  .34, .2.hange/Z.AO46E@t" to brcHOK7UTheB will finUtkj9Select AppropriaADD Ss from ǫk10Jl UMou@Xp@ACursor ovJany ט11FkA Read'A@ messa@l@ine atBo@vm A@1274ofSB>BseA` n exa$dre`AipAB 4lD DTfunc.95 5JWhen you have loc 5CcorrA8',o,it @1K**`)m`1!Wire0 Row?A3table7`18>ReB T" d g22)'2n3 '4 2+,2>6 3! , OKY45"7@O3F0GEnd QdlggrA s Obj`=: Set I= 'kValues.! 'GET USER INFO FROM I FILE AND PIT` TO@DISPLAY"RESC@CH>CBC>C@CP>C:C:C @CP 2 1  & >:( @:h >: B: >:0 >:p @: >: ::0 ::p @: " :? <?X :? >? :?<?X:?6?6?<?H "6U:UBU(>Up6U:U6U(.U`.UBU 4@H PX `&$h&.8m6H P `]@]X]p]]]]]]]]0| Define prompt((You MUST SAVE this document to continue! $ $ Select Save In Folder and $ $Get user info from INI fileUserInfoFCCaseNoC:\caseinfo.ini %' hUserInfo FCCaseNameC:\caseinfo.ini %' jUserInfoFCLoadNoC:\caseinfo.ini %' lUserInfo FCWorkerNameC:\caseinfo.ini %' nUserInfoPSCaseNoC:\caseinfo.ini %' pUserInfo PSCaseNameC:\caseinfo.ini %' rUserInfoCOURTNOC:\caseinfo.ini %' tUserInfoPOSAC:\caseinfo.ini %' vUserInfoPOSwC:\caseinfo.ini %' xUserInfo DCompletedC:\caseinfo.ini %' z Update Form with user infoFCCASENO %GFCCASENO h B@j FCCASENAME %G FCCASENAME j B@joFCWORKERLOADNO %GFCWORKERLOADNO l B@j FCWORKERNAME %G FCWORKERNAME n B@jöPSCASENO %GPSCASENO p B@j PSCASENAME %G PSCASENAME r B@jCOURTNO %GCOURTNO t B@jPOSA %GPOSA v B@jPOSW %GPOSW x B@j DATECOMPLETED %G DATECOMPLETED z B@j`. Update other Form Fields on Form & Exit Macrodk|| fsave file cancelled ~ A@ #return to point of error in routined( ! Error ! In Case InfoA@+Reprotect Document and exit sub after errorkoϵAttribute VB_Name = "CaseInfo" Public Sub MAIN() Dim iRet$UserFCCNo$  WL >WN>PS >CTNO -OSA WDC On Error GoTo Handle'Define prompcP$}You MUST SAVE this document to continue!" + Chr(10)"Select Save In Folder ? "Ent File inAs Dial@og Box'OPEN FCUSP TOOLS WordBasic.ViewToolbars ColorButtons:=1, Large0, Tip":="FCSA.s", Show B(er Hide Datab@( @rawing Form& ActiveD{.p'sqtheEFINE DIALOG BOXACBeginp585, 35^ Ն GpTextz 1 32, 26 18, "g 56 8/$ t7 104O WN[ 12`wk ~5N!7N!7@-20 ;4.P@:22 !W5! 4 !L10& DCR 107,, 4913AQfolloa^ inf Yation aXbouAc`h.m 9!R` 39 FC ! No.:uw51o@Ƙ8# DHS Load `!`fk@x13PS!317"Court( ID W)2034/M AgPency:92B+"125"emplet$ed FOKSccK26 8+21Cancel=41LxRest NPOT lEndSScdlgq 0qObj`u@: Set = CurVal0ues. 'GET USER INFO FROMI FILE AND PUT I NTO;J].XP'[GetPrivate@f|Strh$](" it!6NoC:\9;`.ini"CNgr`+*FCQ_CaseNo", dlgUserInfo.YourPSCNo, "PC:\ci\ini" WordBasic.SetPrivateProfileString ""ameAdCOURTNOaCBOSAW` D/w/WA/DCompleted2DC 'Get u@  from INI z zFC@$ = [Q$](ʆ)K:WLNo5Loa6dBќN5VkerN1su1!  ိ= av_ Q 91Pv R  h= W a DC_ Q  } Upd@ Form 0withGCqIfAH|ExistBookmark(""yASE) pThenhā R@esult , _ G AME"ݟ CA $ WORKERLOAD } N' f N?A4 p_4!Q ._  y רg c_"u>_ et)@&rE_ "B/&|,B E۟WW`F1 @W??("DATECOMPLETED/,S E @other@Fields $on& t Macro ElsePnd IfHere:#Sub HandleErxrorE 4198C'save cancelledMsgBox mpt$, vbCri`ticalaFme 'return to point of e1 rouK@ A .Description!Exclamait"or" Prr.Numb`& "In C A 'Reprotect Docu me  exit sub aft EdC __SRP_2$__SRP_3&gRemoveRow(NewMacros = +:pxME(< <<<@ `|@0x%P "  (80X H cladd87 B@ B@7 !B@ho cladd87rU~| \ A a9   a Q  A q 1 i Ay!Y II) IyQI)q Iy1Y I Qy9aY PKl:$ 4 4  :  :`1646($%(%(l%$ @  .:$ %(%$ @ .:$%(%$ @ .:$%(%$ @ .:$%(%$ @ .:$%(%$ @ $ 4 .($I%(^%:l%$ @:($%( %(l %(L%:,%$ @:($%(8%(l %(L%:,%$ @:($%(P%(l %(L%:,%$ @:($%(h%(l %(L%:,%$ @:($%(%(l %(L%:,%$ @:($%(%(l %(L%:,%$ @:($%(%(l %(L%:,%$ @:($%(%(l^%(L%:,%$ @:($%(%(l^%(L%:,%$ @:($%(%(lf%(L%:, %$ @:($k%( %(l%(L %:,!%$ @":($%(#%(l%(L %:,#%$ @":($%(;%(l%(L %:,$%$ @":($%(S%(l%(L %:,Z%$ @":($%(k%(l%(L %:,[%$ @":($%(%(l%(L %:,'%$ @":($%(%(l%(L %:,(%$ @":($%(%(l%(L %:,)%$ @":($%(%(lT%(L %:,*%$ @":($%(%(lT%(L %:,+%$ @":($%(%(l%(L %:,,%$ @"4($^%(%(lX%(L%$ @-4($%(%(lX%(L%$ @.K$ @/.$ @W40A1464C:L2%:$3%:4%:l5%$ @4%654C:L2%:$3%:7%:l5%$ @4%854C:L2%:$3%:9%:l5%$ @4%:54C:L2%:$3%:;%:l5%$ @4%<54C:L2%:$3%:=%:l5%$ @4%>54C:L2%:$3%:?%:l5%$ @4%@54C:L2%:$3%:A%:l5%$ @4%B54C:L2%:$3%:C%:l5%$ @4%D54C:L2%:$3%:E%:l5%$ @4%F54C:L2%:$3%:G%:l5%$ @4%H541 @$ @W4IB1l54l($]3{::$3%:4%W46%:\5%$ @J54::$3%:7%W48%:\5%$ @J54::$3%:9%W4:%:\5%$ @J54::$3%:;%W4<%:\5%$ @J54::$3%:=%W4>%:\5%$ @J54::$3%:=%W4>%:\5%$ @J54::$3%:?%W4@%:\5%$ @J54::$3%:A%W4B%:\5%$ @J54::$3%:C%W4D%:\5%$ @J54::$3%:E%W4F%:\5%$ @J54::$3%:G%W4H%:\5%$ @J54?:L2%:$3%:4%:l5%$ @4`1h54?:L2%:$3%:7%:l5%$ @4`1d54?:L2%:$3%:9%:l5%$ @4`1`54?:L2%:$3%:;%:l5%$ @4`1\54?:L2%:$3%:=%:l5%$ @4`1X54?:L2%:$3%:?%:l5%$ @4`1T54?:L2%:$3%:A%:l5%$ @4`1P54?:L2%:$3%:C%:l5%$ @4`1L54?:L2%:$3%:E%:l5%$ @4`1H54?:L2%:$3%:G%:l5%$ @4`1D54,:$K%$ @4L54{):$K%h@$ @M,:$N%$ @4L54):$N%d@$ @M,:$O%$ @4L54%):$O%`@$ @M,:$P%$ @4L54z):$P%\@$ @M,:$Q%$ @4L54):$Q%X@$ @M,:$R%$ @4L54$):$R%T@$ @M,:$A%$ @4L54y):$A%P@$ @M,:$C%$ @4L54):$C%L@$ @M,:$S%$ @4L54#):$S%H@$ @M,:$T%$ @4L54x):$T%D@$ @M}$ U Vlf&'''4M$@ W64 Jm U ,V U V''Xl#*#Y*F">F4 W2)64 P\DDLhTXH\d`lP@ 4k l B@ްAttribute VB_Name = "RemoveRow" Public Sub MAIN() ActiveDocument.Unprotect Password:="clad(d87 Sel>ion. s.DY'te ePc, NoReset:=True, Type:= _HwdAllowOnlyFormFields` Endry(c :xME(6 LLLL<,<0<4<8<<< `k0x%@pX(.@x @h @X @H @8 @4 @2 @ @0 @H @` 6@x @ @ 0@ @@ P@ `@ @ p @8` @PP X@h@ @0 @ @ p@ @ PP@W8 $*\Rffff*0f4b0be25f*\R1*#17b*\R1*#c1*\R1*#c6*\R1*#1e*\R1*#129*\R1*#a4*\R1*#5b*\R1*#166*\R1*#91"   ,0 `)0h5 0'  Z058 p CheckSpelling Macro& Macro recorded 10/09/99 by Sandy Cain5  B@l   B@  (  B@r .!d B@d B@kocladd87 B@  cladd87 l B@0Attribute VB_Name = "NewMacros" Sub CheckSpelling() ' T `, recorded 10/09/99 by Sandy CainP  ActiveDocument.Unprotect PasswB:="cladd871Selion.HomeKey Unit:=wdStoryV$End#, Extend4Langu ageIDwdEnglishUSAIf OptSs.GrammarWith-True Then ?Else0`nd If .P, NoReseV), Typ`e:= _wdAllowOnlyFormFi@elds \  rU~| 1"a9  a"" ):hNXXx$ 4x x5X04'8Xx$ <x x6X8548Xx$ <__SRP_6l__SRP_7wg_VBA_PROJECT|diryx x6X8 x$ <x x04'8Xx$ <x x6X8'2x$ x k2x%x$ 4x xZ'''0'P'p''''''8'Xx$ 4x x6X8pP05:hNXXc8x$ 4x x6X8$ @ xX8pP0krU $`n0* pHdTemplateProjectQH@  = | W8 J< 9stdole>stdoleP h%^*\G{00020430-C 0046}#2.0#0#C:\WINDOWS\System32\e2.tlb#OLE Automation0MSForms>SFFrms3ED452EE1-E08F-101A-8-02608C4D0BB 4EsEFM20.DLL#Microsoft :" ^ Ob Library/;D1uA00}#0#Gk0 A6F27A418-FDEC-41FB-9F3E-16990<E5C6DOCUME~1\putmaourFCWLNoYourFCWN0 YourPSCNo9YourPSCNP<YourCTNO~9YourPOSA/)YourPOSWD)YourDCSetPrivateProfileString=ExistingBookmark SetFormResultExitHereP$ErroMsgBoxR vbCritical+} Description  vbExclamaitonфNumber- RemoveRow0^ToolsUnprotectDocument(TableSelectRowTableDeleteRowAToolsProtectDocument-0NoResetg NewMacrosj CheckSpellingW Unprotect? SelectionZHomeKeyUnitwdStory&EndKey5Extend?wdExtendd LanguageID wdEnglishUSCheckGrammarWithSpelling CheckGrammarProtectfPasswordwdAllowOnlyFormFields!Documentj _B_var_Chr\; _B_str_Promptl_B_var_vbExclamaitonoX_B_var_Passwordy_B_var_NoResetj SelectRowRowsUDeletexI g lt Office 8.0 Object Library  W8 :ThisDocument1<40ff843bThisDocument4-ClearCaseInfo1=40ff843bClearCaseInfona\LOCALSA\VBE\DT.exd;!.E .`M ÊOffi"cĊOf@ijcŠ A12DF8D04C-5BFAhB-BHDE5IAA4 2h@gram Files\C`ommonGhS@hared\ 105Op 8..0 q@%B":ThisDocumentG TiDcuen 2 HB1`-B,Q!4""+nClearCaseInfo(G@C"ra rCaeIf@O2\/-6!b%ToolHelpGAH@lpi2ro m0p"a aecmoVs/m2l RemoveRowXGmvRw@2e/10/p+/A NewMa#N wM`Ac`Bo B#/m )-__SRP_0 __SRP_1ZPROJECTwmPROJECTcPOSW DATECOMPLETEDfĤIx8< Error In Case InfoVBE6.DLL `   S DHS FC Load No.:  &DHS FC Worker Name: ,ToolsUnprotectDocumentTableSelectRowTableDeleteRowNoResetType (ToolsProteas  *\G{000204EF-0000-0000-C000-000000000046}#4.0#9#C:\Program Files\Common Files\Microsoft Shared\VBA\VBA6\VBE6.DLL#Visual Basic For Applications*\G{00020905-0000-0000-C000-000000000046}#8.2#0#C:\Program Files\Microsoft Office\Office10\MSWORD.OLB#Microsoft Word 10.0 Object Library*\G{00020430-0000-0000-C000-000000000046}#2.0#0#C:\WINDOWS\System32\stdole2.tlb#OLE Automation*\G{0D452EE1-E08F-101A-852E-02608C4D0BB4}#2.0#0#C:\WINDOWS\system32\FM20.DLL#Microsoft Forms 2.0 Object Library*\G{6F27A418-FDEC-41FB-9F3E-16990EE1E5C4}#2.0#0#C:\DOCUME~1\putmana\LOCALS~1\Temp\VBE\MSForms.exd#Microsoft Forms 2.0 Object Library.E .`M &*\G{2DF8D04C-5BFA-101B-BDE5-00AA0044DE52}#2.2#0#C:\Program Files\Common Files\Microsoft Shared\Office10\MSO.DLL#Microsoft Office 8.0 Object Library  W8 :ThisDocument1<40ff843bThisDocument4-ClearCaseInfo1=40ff843bClearCaseInfo6ToolHelp1>40ff843bHToolHelp00 CaseInfo1B40ff843bfCaseInfo2Hs"RemoveRow2H4b0be8ccRemoveRowp`1NewMacros0f4b0be25fNewMacrosx xH`0 ],@E^%Vz|*E7=эp+ljBa:MG0m2 L2+QJUc7\tA(ahz{7WordkVBAWin16~Win32MacVBA6#TemplateProjectEstdole`MSFormsCOfficeu ThisDocument< _Evaluate ClearCaseInfohMAIN, WordBasicFileFind SearchName֡ SearchPath.SubDir+Title~AuthorKeywordsTSubjectRPOptions MatchCase PatternMatch DateSavedFromu= DateSavedTojdSavedByDateCreatedFrom DateCreatedToViewISortByoListBy+ SelectedFile\KillToolHelpTiRet,p ViewToolbars| ColorButtons} LargeButtonsSWToolTips5+Toolbar2Show BeginDialogFOKButton| EndDialogmP dlgUserInfo2" CurValuesȤ UserDialogDialogfCaseInfo UserFCCNoBUserFCCN7 UserFCWLNoyUserFCWN UserPSCNoOUserPSCNqUserCTNOUserPOSAPUserPOSWeUserDC HandleError;PromptmChrK~Hide9zActiveDocument\SaveTextBoxQ CancelButton YourFCCNo+GetPrivateProfileString$xYourFCCN. YctDocument CheckSpelling cladd87u F FPassword$ ThisDocument ClearCaseInfoToolHelpCaseInfo RemoveRow NewMacrosF /C:\PROGRA~1\COMMON~1\MICROS~1\VBA\VBA6\VBE6.DLLVBA  Q0 F5C:\Program Files\Microsoft Office\Office10\MSWORD.OLBWord YrU  tle  QThisDocumentThisDocumentClearCaseInfoClearCaseInfoToolHelpToolHelpCaseInfoCaseInfoRemoveRowRemoveRowNewMacrosNewMacrosD 1pID="{EDF0EC96-7959-43D3-AAAC-EDBD02CEA06C}" Document=ThisDocument/&H00000000 Module=ClearCaseInfo Module=ToolHelp Module=CaseInfo Module=RemoveRow Module=NewMacros Name="TemplateProject" HelpContextID="0" VersionCompatible32="393222000" CMG="484A0F9513951395139513" DPB="707237B838B838B8" GC="989ADFE0E0E0E01F" [Host Extender Info] &H00000001={3832D640-CF90-11CF-8E43-00A0C911005A};VBE;&H00000000 [Workspace] ThisDocument=0, 0, 0, 0, C ClearCaseInfo=88, 88, 481, 453, ToolHelp=54, 54, 732, 236, C CaseInfo=66, 66, 459, 431, RemoveRow=0, 0, 678, 182, Z NewMacros=176, 176, 569, 541, ewToolbars @ 2bjbj 0h%0h%p U\]$4 """""A'-)e3g3g3g3g3g3g35R7g3i%*""%*%*g3""3%*%*%*%*""e3%*%*e3%*%* e%*" ip%*%*A*$ 304%*7%*7%*K*srU~~~~~~~~~~~~~~W /!KGRKqSk%   Aa yaaa y0 "aqiI TemplateProject ThisDocument ClearCaseInfoToolHelpCaseInfo RemoveRow NewMacrosF /C:\PROGRA~1\COMMON~1\MICROS~1\VBA\VBA6\VBE6.DLLVBA  Q0 F5C:\Program Files\Microsoft Office\Office10\MSWORD.OLBWord Y@0FC:\WINNT\System32\STDOLE2.TLBstdole  QP.E .`M C:\WINDOWS\System32\FM20.DLLMSForms 1`1AQګyC:\TEMP\VBE\MSForms.EXD 1pL-[DR 2C:\Program Files\Microsoft Office\Office\MSO97.DLLOffice YMAIN  BordersHide PYou MUST SAVE this document to continue! 4Select Save In Folder and  HEnter File Name in SaveAs Dialog Box F F  ColorButtonsLargeButtonsToolTipsViewToolbars FCSA and P ToolsToolbarShow Database Drawing Formsk F CaseInfoBeginDialog YourFCCNoTextBox YourFCCN YourFCWLNo YourFCWN YourPSCNo YourPSCN YourCTNO YourPOSA YourPOSW YourDC Date Completed:OKButton `Enter the following information about this case.Text FC Case No.: FC Case Name: FIA FC Load No.: &FIA FC Worker Name: PS Case No.: PS Case Name: Court ID No.: "POS Agency Name: POS Worker Name:CancelButtonEndDialogCurValuesUserDialog UserInfo FCCaseNo C:\caseinfo.ini 0GetPrivateProfileString$YourFCCNo FCCaseNameYourFCCN FCLoadNoYourFCWLNo FCWorkerNameYourFCWN PSCaseNoYourPSCNo PSCaseNameYourPSCN COURTNOYourCTNO POSAYourPOSA POSwYourPOSW DCompleted YourDC Dialog .SetPrivateProfileString FCCASENO  ExistingBookmarkSetFormResult FCCASENAME FCWORKERLOADNO FCWORKERNAME PSCASENO PSCASENAME 7%*%*%*%*%*%*%*%*%*g3g3 p%*p FORMDROPDOWN   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMDROPDOWN   FORMTEXT        FORMDROPDOWN   FORMDROPDOWN   FORMTEXT        FORMDROPDOWN   FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT     FORMTEXT        FORMTEXT        FORMTEXT      FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT     FORMTEXT        FORMTEXT        FORMTEXT     FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT     FORMTEXT        FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMDROPDOWN   FORMDROPDOWN   FORMDROPDOWN   FORMDROPDOWN   FORMDROPDOWN   FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMDROPDOWN   FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT       Section C-1 Household  FORMTEXT   of  FORMTEXT  C.Parent Reassessment 1.Household Name FORMTEXT       Last Name First NameIs this the Household Children Were Removed From? (Y/N)   FORMTEXT       FORMTEXT       FORMDROPDOWN  CPS Investigation/Substantiation Incident This Period? (check one)  FORMCHECKBOX  1. None  FORMCHECKBOX  2. Investigation  FORMCHECKBOX  3. SubstantiationFamily Needs and Strengths Reassessment:   MACROBUTTON [2] "Click Here and Type"   2.Individual Barrier Reduction: Parent/Caretaker Progress Towards Reduction of Primary Barriers to Reunification Identified in Needs and Strengths Assessment and Service Plan. a.List the priority needsPrimary Barriers to Reunification (check one for each service need) Barrier1 Substantial2 Partial3 Poor4 Refused FORMDROPDOWN  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX b.Briefly describe the reasons for the above assessment of the Primary Barriers to Reunification as Substantial, Partial, Poor or Refusing Service.   MACROBUTTON [2] "Click Here and Type"   c.Describe the progress made by each household on other (secondary) goals established in the most recent service plan.   MACROBUTTON [2] "Click Here and Type"   D.Overall Barrier Reduction Assessment Has parent/caretaker made progress in addressing barriers that reduce the risk of subsequent harm if the child is returned home? (check one) 1. FORMCHECKBOX Yes, caretaker(s) have substantially complied with the plan and reduced barriers. 2. FORMCHECKBOX Yes, caretaker(s) have partially complied with the plan and made progress in reducing barriers 3. FORMCHECKBOX No, caretaker(s) progress is poor or they have refused services and barriers have not been reduced. Briefly describe the reasons for the overall barrier reduction evaluation.   MACROBUTTON [2] "Click Here and Type"   E.Parenting Time (Visitation) Assessment  Parent / Caretaker1 Substantial2 Partial3 Poor4 Refused FORMTEXT       FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX 1.Describe compliance with parenting time (visitation) plan as established in the last service plan and the reasons for the assessment.   MACROBUTTON [2] "Click HH4J4f4h4j4l4n4444444444444444444555 5ҠtjYttjH!j-h]{CJOJQJU!jh]{CJOJQJUh]{CJOJQJjh]{CJOJQJU$jh]{5CJOJQJUh]{5CJOJQJjh]{5CJOJQJU!jh]{CJOJQJU!jPh]{CJOJQJUh]{!jh]{CJOJQJUh]{CJOJQJjh]{CJOJQJU 5"5$5&5B5D5F5H5J5^5`5n5p5r555555555555555555 6 66"6$62646ҿ퀋uj_jh]{UjEh]{Ujh]{Uj|h]{Ujh]{U!j̓h]{CJOJQJU!j`h]{CJOJQJUh]{CJOJQJ$jh]{5CJOJQJUh]{5CJOJQJjh]{5CJOJQJUh]{jh]{CJOJQJU%4666J6L6Z6\6^6r6t666666666666666666677"7$7&7:7<7J7L7N7b7d7r7t7v777777öéÜÏÂujh]{5Ujh]{5Uj*h]{5Ujʘh]{5Ujjh]{5Uj h]{5U h]{5jh]{5Ujh]{Ujh]{Uj~h]{Uh]{jh]{U.66$7L7t7777868^88888"9D9l9999:.:V:~:9876543210/.-,+*)('&%$#"7777777777788888*8,8486888L8N8\8^8`8t8v888888888888888888899 9"9$989jh]{Ujh]{Ujh]{Ujh]{Uj3h]{Ujh]{Ujٛh]{UjFh]{Ujh]{Ujh]{UjJh]{Uh]{389:9B9D9F9Z9\9j9l9n999999999999999999:::::,:.:0:D:F:T:V:X:l:n:|:~::::::j0h]{UjǤh]{Uj^h]{Ujӣh]{Ujeh]{Ujh]{Uj5h]{Ujh]{Ujh]{Uh]{jh]{UjVh]{U0~::::;4;X;;;;; <H<l<<<<<$=L=t====>QPONMLKJIHGFEDCBA@?>=<;::::::::::::: ; ;;;;.;0;2;4;6;R;T;V;X;Z;n;p;~;;;ĺĺĺĺvlfYlQjh]{Ujh]{@U h]{@jh]{@U!j:h]{CJOJQJU!j٦h]{CJOJQJU!jxh]{CJOJQJU!jh]{CJOJQJUh]{CJOJQJjh]{CJOJQJUh]{!jh]{CJOJQJUh]{CJOJQJjh]{CJOJQJU;;;;;;;;;;;;;;;;<<< <"<6<8<F<H<J<f<h<j<l<n<<<<<<<<<<<vgjh]{5CJUjh]{5CJUjQh]{5CJUjh]{5CJU h]{5CJjh]{5CJUjqh]{Ujʩh]{CJU h]{CJjh]{CJUjh]{Ujh]{Uj.h]{Uh]{(<<<<<<<<<<<=="=$=&=:=<=J=L=N=b=d=r=t=v================ >ٷ٭٭كxmjzh]{Ujh]{Ujh]{UjQh]{5Ujh]{5U h]{5jh]{5Ujh]{Ujh]{Ujh]{5CJUh]{jh]{5CJUjh]{5CJU h]{5CJ) > >>>>&>(>6>8>:>N>P>^>`>b>v>x>>>>>>>>>>>>>>>>>????&?(?*?>?@?N?P?R?f?觢觢}jHh]{Ujh]{5Ujh]{5U h]{5jh]{5Ujh]{Ujh]{Uj?h]{Ujh]{UjRh]{Uh]{jh]{Ujڰh]{U->8>`>>>>?(?P?x?????? $$Ifa$ $$Ifa$$If\[ZYXWVUTSRf?h?v?x?z???????????????@ @@ @&@.@0@D@F@L@P@R@@@@@@@@ȽȽȽȽȽzpk h]{5jh]{5Uh]{5>*CJOJQJ$j5h]{5CJOJQJU$jֶh]{5CJOJQJUjh]{5CJOJQJUh]{5CJOJQJh]{CJOJQJjh]{Ujh]{Uh]{jh]{Ujh]{U%???????9Vkdi$$Ifl4FD*%    4 lf4 $$Ifa$ $$Ifa$$IfVkd$$Ifl4FD*%    4 lf4??N@P@R@X@@@$IfVkd$$Ifl4FD*%    4 lf4 $$Ifa$ $$Ifa$@@@@@@@w$If $$Ifa$$IfVkd$$Ifl4FD*%    4 lf4@@@@@@@@@@ AAVA~AAAAAAAAAAAAAAAAAAAAAB:BGBHBVBWBXBbBcBqBŸŸڸ奰嚰台ЁpЁ!jh]{CJOJQJUjh]{CJOJQJUjϺh]{Ujoh]{Ujh]{Ujh]{Uh]{5>*CJOJQJh]{>*CJOJQJh]{CJOJQJh]{5CJOJQJh]{jh]{5Ujoh]{5U+@@@@@@@@@A~AA|sjjjjjjjj $$Ifa$ $$Ifa$$If|kdϸ$$Ifl4rDb*n4 lf4 AAAAAAAAzzzzzx$If|kdh$$Ifl4rDb"*jN z4 lf4AABFBGBaBbBBBBrllllll$Ifbn$If^b`n|kdP$$Ifl4rDb"*jN z4 lf4 qBrBsBBBBBBBBBBBBBBBBBBBB C C C C CCCCC0CCCCCCCCCC)D+D]D^D_Dֲֲֲֲֲֲֲֲֲֽ֥֛֥zjh]{CJOJQJUh]{h]{5B*ph h]{5jh]{5Uh]{5>*CJOJQJh]{5CJOJQJh]{OJQJ!jh]{CJOJQJUh]{CJOJQJjh]{CJOJQJU!jXh]{CJOJQJU-BBBBBB $$Ifa$$Iffkd$$Ifl\"*8/4 lBBBBBBB $$Ifa$$Ifikd$$Ifl4\D*"4 lf4BBBBBB C C~w$If $$Ifa$$Ifikd$$Ifl4\D*"4 lf4 CCCCCCCC $$Ifa$$Iffkd$$Ifl\D*"4 lCCCCCCC $$Ifa$ikd$$Ifl4\D*"4 lf4CCCC*DqCq-kd $$Ifl*z(4 l$$If^`a$|kd$$Ifl4rD2 *b 4 lf4*D+D,D4D6DBDDDLDNDSDUD]D $$Ifa$-kdc$$Ifl*z(4 l ]D^DpDDDDDvvvv $$Ifa$$Ifykd$$IflrGZ> i%*+++4 l_DmDnDoDpDqDDDDDDDDDDDDDDDDDDDDDDDD EEWE^Eɿɿɿɿɿɿɿ{ɿshh[hh]{5>*CJOJQJh]{5CJOJQJh]{OJQJ!joh]{CJOJQJU!jh]{CJOJQJU!jh]{CJOJQJU!jLh]{CJOJQJUh]{CJOJQJjh]{CJOJQJUjh]{CJOJQJU!jh]{CJOJQJUh]{CJOJQJ DDDDDDD||||| $$Ifa$ykd$$IflrGZ> i%*+++4 lDDDDDDWEXEyyyyyy $$Ifa$|kd$$Ifl4rD2 *b 4 lf4XEYEZE[E\E]E^EEE}ttttntw$If $$Ifa$$a$|kdP$$Ifl4rD2 *b 4 lf4^E_EpEEEEEEEEF F FFF4F5F6F7F;FeFhFFFFFF G G GGaGeGgGhGiGwGxGyG{GGGGGGGGGGYH]HHHHHHٯٍٞ!j~h]{CJOJQJU!j|h]{CJOJQJU!jzh]{CJOJQJUjh]{CJOJQJUh]{5CJOJQJh]{CJOJQJh]{h]{5B*ph h]{5jh]{5U7EEEEEEEFF}ttttt $$Ifa$$Ifykd$$IflrD2 *vb 4 lFF F F F F F7F8Fzqqqkqw$If $$Ifa$$If|kdn$$Ifl4rD2 *v` 4 lf48F9F:F;F>FdFeFzqqq $$Ifa$$If|kd$$Ifl4rD2 *v` 4 lf4eFfFgFhFFFFFBVkd $$Ifl4FD*%    4 lf4 $$Ifa$$IfVkd$$Ifl4FD*%    4 lf4FFFGGaGbGcGdGeGhG]W$Ifkd$$Ifl4ֈD *11q!4 lf4 $$Ifa$ $$Ifa$ hGzG{GGGGGGGGG]W$Ifkd$$Ifl4ֈD *11q!4 lf4 $$Ifa$ $$Ifa$ GYHZH[H\H]HHHf`$Ifkd$$Ifl4ֈD *11q!4 lf4 $$Ifa$HHHHHHHw$If $$Ifa$$IfVkd$$Ifl4FD*%    4 lf4HHHHHII I IIIHIIIJITIUI JJJ,J.J0J2J4JPJRJTJVJXJtJvJxJzJ|JJ⇘ve!jEh]{CJOJQJU!jh]{CJOJQJU!jh]{CJOJQJUjh]{CJOJQJU!j#h]{CJOJQJUh]{CJOJQJjh]{CJOJQJUh]{OJQJh]{5CJOJQJh]{CJOJQJh]{jh]{5U h]{5"HHHHHIIICVkdT$$Ifl4FD*%    4 lf4 $$Ifa$$IfSkd$$IflFD*%    4 lI I I I II!I-I/I7I9I>I@IHI $$Ifa$Vkd$$Ifl4FD*%    4 lf4 $$Ifa$ HIIIJ2JVJzJJvvvv $$Ifa$$Ifykd.$$Iflr\lI r%*@))4 lJJJJJJKKKKL (±ıƱȱ̱α "&(p֤֗{j!jh]{CJOJQJU!j?h]{CJOJQJUh]{6CJOJQJh]{56CJOJQJh]{OJQJh]{Uh]{5B*ph h]{5jh]{5Uh]{5CJOJQJh]{CJOJQJjh]{CJOJQJU!jh]{CJOJQJU)JJJJJJvv $$Ifa$$Ifykd$$IflrXgI o%*<&&4 lJJJJJKK $$Ifa$$Ifikd$$Ifl4\D*"4 lf4KKKKKK "~w$If $$Ifa$$Ifikdq$$Ifl4\D*"4 lf4      !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~ere and Type"   F.Overall Parenting Time (Visitation)/Barrier Reduction Results *If 1, 2, or 3 is checked, complete the Safety Assessment. If 4 is checked, do not complete the Safety Assessment  FORMCHECKBOX 1.Both are Substantial*  FORMCHECKBOX 3.One is Substantial, One is Partial*  FORMCHECKBOX 2.Both are Partial*  FORMCHECKBOX 4.Either is Poor or Refused Is a Safety Assessment of this household required:  FORMDROPDOWN  G.Safety Assessment Results If a Safety Assessment is required, indicate the results: 1. FORMCHECKBOX Safe2. FORMCHECKBOX Conditionally Safe3. FORMCHECKBOX Unsafe4. FORMCHECKBOX Not CompletedH.Hallmark Recommendation Indicate the recommendation for the case based on the Reunification Assessment Hallmarks. If case recommendations differ from the Hallmarks, describe the reason for not following the recommendations, including overrides?   MACROBUTTON [2] "Click Here and Type"   I. Child Placement/Permanency Plan Recommendation: Based on the Reunification Assessment and Hallmarks: (use codes below) Recommen- dations applicable to: Child Placement (code)Change PP Goal? (Y/N) If Change, New PP Goal (code)Hall- mark Override (Y/N) If Override, Reason (code)All Children in case? (check one) If not applicable to all children, list foster care case number and record recommendation for each child below.  FORMCHECKBOX  Yes  FORMCHECKBOX  No FORMTEXT       FORMDROPDOWN  FORMDROPDOWN  FORMDROPDOWN  FORMDROPDOWN  FORMDROPDOWN   FORMTEXT        FORMTEXT     FORMTEXT      FORMTEXT        FORMTEXT        FORMTEXT        FORMDROPDOWN   FORMDROPDOWN   FORMTEXT        FORMTEXT        FORMDROPDOWN   FORMDROPDOWN   FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT     FORMTEXT        FORMTEXT        FORMTEXT     FORMTEXT      FORMTEXT        FORMTEXT        FORMTEXT       "$&(. $$Ifa$$Iffkd$$Ifl\D*"4 lHSkd$$IflF*%    4 l $$Ifa$$IfSkdU$$IflF*%    4 lȱα"(pr$If prtxzƲʲ̲&*,prtvz|~δ!jh]{CJOJQJUjh]{5U h]{5jh]{5U!j[h]{CJOJQJUh]{5CJOJQJ!jh]{CJOJQJUjh]{CJOJQJUh]{OJQJh]{CJOJQJ1rtvx93333$Ifkd$$Ifl ]c* p Yn$$$$4 lƲȲʲ(*$If*,9/)x$If $If^kd$$Ifl ]c* p Yn$$$$4 lijprtv|YSkd$$IflF*%    4 l $$Ifa$$If@kd($$Ifl04*`4 l Դ$28\xz|~FfDFf$IfδдҴԴ "$0268:VXZ\vxzεе^Ƹֺ֩֡֡֡˗֡ˡyh]{5CJOJQJh]{h]{5B*ph h]{5jh]{5Uh]{OJQJ!jh]{CJOJQJU!jh]{CJOJQJUh]{5CJOJQJh]{CJOJQJjh]{CJOJQJU!j]h]{CJOJQJU.еw$IfSkdf$$IflF*%    4 l$If $$Ifa$ uG> $$Ifa$-kd$$Ifl**4 l-kdP$$Ifl**4 l$IfSkd$$IflF*%    4 lƸʸ24fй<>bdлһ㴦zoc\Mcj>h]{5CJU h]{5CJjh]{5CJUh]{5CJOJQJ!jxh]{CJOJQJU!jh]{CJOJQJUh]{CJOJQJjh]{CJOJQJUh]{5CJOJQJh]{5@CJOJQJh]{5@CJOJQJh]{CJOJQJh]{OJQJh]{5CJOJQJh]{5OJQJ46BXft¹йܹ .< $$Ifa$<>rf82x$If-kd$$Ifl**4 l $ \ $Ifkd$$Iflֈ"D%*2 *F4 l$&(*,HJLNPlnprt¼ļؼڼwljh]{UjLh]{Ujh]{Ujh]{Uh]{h]{OJQJjGh]{5CJUjh]{5CJUjh]{5CJUj_h]{5CJUjh]{5CJUjh]{5CJU h]{5CJ**Nr¼igeca_^]kd$$Iflֈ#"D%*; !H4 l x$$Ifa$   .02FHVXZnp~½ĽƽȽʽ޽68:<>Z\^`bvķjkh]{Uj h]{Ujh]{Ujfh]{Ujh]{UjMh]{;U h]{;jh]{;Ujh]{Ujh]{Ujhh]{Ujh]{Uh]{00XȽ<`ؾ(Pr¿0Xvutsrqponmlkjihgfedcba`vxƾȾ־ؾھ&(*>@NPRfhprt¿Ŀؿڿjh]{Uj%h]{Ujh]{Uj>h]{Ujh]{Ujh]{Uj-h]{Ujh]{Ujyh]{Uh]{jh]{Ujh]{U2  .02FHVXZnp~jh]{Uj)h]{Ujh]{Uh]{jh]{Ujh]{U 0/ =!@"`#`$`%" 00/ =!@"`#`$`% 0/ =!@"`#`$`%" 00/ =!@"`#`$`% 0/ =!@"`#`$`%" 00/ =!@"`#`$`% 0/ =!@"`#`$`%" 00/ =!@"`#`$`% 0/ =!@"`#`$`%" 00/ =!@"`#`$`% 0/ =!@"`#`$`%" 00/ =!@"`#`$`% 0/ =!@"`#`$`%" 00/ =!@"`#`$`%/ =!"#$%CompObjjf Dropdown20 "6GWj  Emotional StabilityParenting SkillsSubstance AbuseDomestic RelationsSocial Support System"Communication/Interpersonal SkillsLiteracyIntellectual Capacity EmploymentPhysical Health Issues Resource Availability/ManagementHousing Sexual AbuseChild CharacteristicsaDeCheck10aDeCheck17aDeCheck18aDeCheck25Df Dropdown5B  "$&(*,.0369<?123456789101112131415lDText28 Child's NameDf Dropdown3   YesNoN/ADf Dropdown5B  "$&(*,.0369<?123456789101112131415lDText28 Child's NameDf Dropdown4C  ; Continued PlacementReturn Home and MonitoringClosureiD Text53 M/dd/yyyy`DText54`DText55DAddress1 UppercasedEnter the Addressee's mail address (street address, PO Box, etc., where the mail will be delivered). ClientCityfD dob M/dd/yyyyDCareOf UppercaseUEnter the Addressee's Supplemental Address (Example: Suite or Apartment Number, C/O)Address1`D"Text44`D Text45`D Text46`D Text46`D Text46`D Text46`D Text46D CaseNumber Uppercase/Enter the Case Number (Example: V1234567A,B,C)`D Text33D ClientCity UppercaseEnter the Addressee's City. ClientStateD ClientState Uppercase1Enter the Addressee's 2 digit State Abbreviation. ClientZipD ClientZip UppercaseFEnter the Addressee's Zip (+4 if known) (Example: 48909 or 48909-7537)D CoAddress UppercaseaEnter the County's mail address (street address, PO Box, etc., where the mail will be delivered).D  CoAreaCode000Enter the County's Area Code CoPhoneNumberDCoCity UppercaseEnter the County's City.D CoExtension_HmH sH tH 0O0 E5?_HmH sH tH `O` EnteredCare@d8(5OJQJ_HkHmH sH tH XOX FirstNameAd8(OJQJ_HkHmH sH tH ZO"Z FirstName2Bd8(OJQJ_HkHmH sH tH O2 GranteeFirstName3C$ p@ P ^a$CJ_HmH sH tH dOBd GranteeLastNameDd8(OJQJ_HkHmH sH tH PORP I-1Ed8(5OJQJ_HkHmH sH tH PObP I-2Fd8(5OJQJ_HkHmH sH tH POrP I-3Gd8(5OJQJ_HkHmH sH tH POP I-4Hd8(5OJQJ_HkHmH sH tH POP I-5Id8(5OJQJ_HkHmH sH tH POP I-6Jd8(5OJQJ_HkHmH sH tH POP II-C.Kd$#5CJOJQJ_HkHmH sH tH ROR II-C.2Ld$#5CJOJQJ_HkHmH sH tH ROR II-C.3Md$#5CJOJQJ_HkHmH sH tH `O` InitialDateNd8(5OJQJ_HkHmH sH tH XOX IV-C1FNOd8(5OJQJ_HkHmH sH tH XOX IV-C1LNPd8(5OJQJ_HkHmH sH tH XOX IV-C1YNQd8(5OJQJ_HkHmH sH tH ZO"Z KidName1Rd8(5OJQJ_HkHmH sH tH VO2V LastNameSd8(OJQJ_HkHmH sH tH XOBX LastName2Td8(OJQJ_HkHmH sH tH \OR\ LegalNameUd8(5OJQJ_HkHmH sH tH bObb legalstatus1Vd8(5OJQJ_HkHmH sH tH bOrb legalstatus2Wd8(5OJQJ_HkHmH sH tH bOb legalstatus3Xd8(5OJQJ_HkHmH sH tH TOT Name1Yd8(5OJQJ_HkHmH sH tH `O` NextCrtDateZd8(5OJQJ_HkHmH sH tH TOT OtherID[d8(OJQJ_HkHmH sH tH ^O^ ParentName\d8(5OJQJ_HkHmH sH tH hOh Parentrelation1]d8(5OJQJ_HkHmH sH tH VOV Section1^d8(OJQJ_HkHmH sH tH bOb SuperAreaCode1_d8(OJQJ_HkHmH sH tH dOd SuperExtension1`d8(OJQJ_HkHmH sH tH hOh SuperPhoneNumber1ad8(OJQJ_HkHmH sH tH dO"d SupervisorName1bd8(OJQJ_HkHmH sH tH XO2X SvcRefF12 cd` CJOJQJ_HkHmH sH tH ZOBZ SvcRefF101 dd` CJOJQJ_HkHmH sH tH ZORZ SvcRefF111 ed` CJOJQJ_HkHmH sH tH XObX SvcRefF21 fd` CJOJQJ_HkHmH sH tH XOrX SvcRefF31 gd` CJOJQJ_HkHmH sH tH XOX SvcRefF41 hd` CJOJQJ_HkHmH sH tH XOX SvcRefF51 id` CJOJQJ_HkHmH sH tH XOX SvcRefF61 jd` CJOJQJ_HkHmH sH tH XOX SvcRefF71 kd` CJOJQJ_HkHmH sH tH XOX SvcRefF81 ld` CJOJQJ_HkHmH sH tH XOX SvcRefF91 md` CJOJQJ_HkHmH sH tH bOb TOPlacement1nd8(5OJQJ_HkHmH sH tH POP Unit1od8(OJQJ_HkHmH sH tH dOd WardshipDate1pd8(5OJQJ_HkHmH sH tH dOd WardshipType1qd8(5OJQJ_HkHmH sH tH TO"T Worker1rd8(OJQJ_HkHmH sH tH dO2d WorkerAreaCode1sd8(OJQJ_HkHmH sH tH fOBf WorkerExtension1td8(OJQJ_HkHmH sH tH \OR\ WorkerName1ud8(OJQJ_HkHmH sH tH ^Ob^ WorkerPhone1vd8(OJQJ_HkHmH sH tH ^Or^ User Input 11ptwd$5CJOJQJkHmH sH ufOf User Input 10ptxd8(5CJOJQJkHmH sH uZ : 9iN!Ef5Yz'(BCkl * + ] ^ X Y   8 9 e f b c Z [   HI78gh%&23 !LMOPtu23?0l`?0l?0l?0l?0l?0l?0l?0l?0l@?0l?0 lP?0l?0 lt/?0l?0l;?0l?0l<;?0l?0l ?0l?0lD?0l?0l|?0l?0lt?0l?0l?0l?0l?0l?0lL?0l?0 l?0l?0"l?0l?0$l?0l?0&l<?0l?0(lt?0l?0*l?0l?0,l?0l?0.lMT?0l?00lLMT?0l?02lMT?0l?04lMT?0l?06lMT?0l?08l?0l?0:l?0l?0<l(?0l?0>l`?0l?0@l?0l?0Bl?0l?0Dl?0l?0Fl#?0l?0Hl#?0l?0Jl$?0l?0LlT$?0l?0Nl$?0l?0Pl$?0l?0Rl$?0l?0Tl4%?0l?0Vll%?0l?0Xl6?0l?0Zl7?0l?0\lT7?0l?0^l7?0l?0`l7?0l?0bl7?0l?0dl48?0l?0li2a12a22a32a42a56A16A26A36B16B2 6B3 Add SocialWrk Contact1 Add SocialWrk Contact2 Add SocialWrk Contact3 Address1 birthdateCareOf caretaker1 caretaker2 Caretaker3 Caretaker4 Caretaker5 Caretaker6 Caretaker7 CaseNumber CaseNumber1 ClientCity ClientState ClientZip CoAddress CoAreaCodeCoCity CoExtension CoPhoneNumber!CoState" CoSuppaddress# CountyName$ CountyNumber%CoZip& CurrentPlace'Date1(Date2) DatePlace*District+e1,E2-E3.E4/E50 EnteredCare1 FirstName2 FirstName23GranteeFirstName4GranteeLastName5I-16I-27I-38I-49I-5:I-6;II-C.<II-C.2=II-C.3> InitialDate?IV-C1FN@IV-C1LNAIV-C1YNBKidName1CLastNameD LastName2E LegalNameF legalstatus1G legalstatus2H legalstatus3IName1J NextCrtDateKOtherIDL ParentNameMParentReassessc1NParentrelationOSectionP SuperAreaCodeQSuperExtensionRSuperPhoneNumberSSupervisorNameTSvcRefF1U SvcRefF10V SvcRefF11WSvcRefF2XSvcRefF3YSvcRefF4ZSvcRefF5[SvcRefF6\SvcRefF7]SvcRefF8^SvcRefF9_ TOPlacement`Unita WardshipDateb WardshipTypecWorkerdWorkerAreaCodeeWorkerExtensionf WorkerNameg WorkerPhonehi2a12a22a32a42a56A16A26A36B16B26B3Add SocialWrk Contact1Add SocialWrk Contact2Add SocialWrk Contact3Address1 birthdateCareOf caretaker1 caretaker2 Caretaker3 Caretaker4 Caretaker5 Caretaker6 Caretaker7 CaseNumber CaseNumber1 ClientCity ClientState ClientZip CoAddress CoAreaCodeCoCity CoExtension CoPhoneNumberCoState CoSuppaddress CountyName CountyNumberCoZip CurrentPlaceDate1Date2 DatePlaceDistricte1E2E3E4E5 EnteredCare FirstName FirstName2GranteeFirstNameGranteeLastNameI-1I-2I-3I-4I-5I-6II-C.II-C.2II-C.3 InitialDateIV-C1FNIV-C1LNIV-C1YNKidName1LastName LastName2 LegalName legalstatus1 legalstatus2 legalstatus3Name1 NextCrtDateOtherID ParentNameNormalParentrelation1Section1SuperAreaCode1SuperExtension1SuperPhoneNumber1SupervisorName1 SvcRefF12 SvcRefF101 SvcRefF111 SvcRefF21 SvcRefF31 SvcRefF41 SvcRefF51 SvcRefF61 SvcRefF71 SvcRefF81 SvcRefF91 TOPlacement1Unit1 WardshipDate1 WardshipType1Worker1WorkerAreaCode1WorkerExtension1 WorkerName1 WorkerPhone1$6HZl.BVj~ /CUi}+?Pdv$6HZl~0DXl(:Nbt#7HZn Rhj!%(,g/37;l?BFH4 546789:;< >f?@qB_D^EHJpδƸv&.2:@EJOTY]aeimry F B  9~T} #Q) \> !!"$%%((),,x-.f/112a55J68@88e;;<5<<X>>?@@@@fBC3DVEEFGHIwJ(K6~:>??@@AABBB CCC*D]DDDXEEF8FeFFhGGHHIHIJJK"r*<')*+,-/013456789;<=>?ABCDFGHIKLMNPQRSUVWXZ[\^_`bcdfghjklnopqstuvwxz{|}~("$46FHXZjlx~&,.:@BNTVbhjv|~ '-/;ACOSUagiu{}#)+7=?KNP\bdtv"$46FHXZjl|~(.0<BDPVXdjlx~#%WciGWbr ^ n p ^ 5 h x IU[]mo<d(8Ue 0!I-3?EGWYik{}&(8:FLNZ`brt  !#/57CFHTXZflnzS$G$G$G$G$S FS$S FS$FFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFG$G$G$G$FFFFFFS$S$S$S$S$FFFFFFS$FFFFFFFFFFFFFFFFS G$G$G$3S$G$G$G$G$33G G G 3FG$G$G$G$3G$G$G$G$S G$G$G$G$3G$G$FS$S$S$S$S$FFFFFFS S$FFS$S$FFFFFFFFFFFFFF= Dropdown5Text28 Dropdown3 Dropdown4Text53Text54Text55Address1dobCareOfText44Text45Text46 CaseNumber ClientCity ClientState ClientZip CoAddress CoAreaCodeCoCity CoExtension CoPhoneNumberCoState CoSuppaddress CountyNameCountyCoZip dateofplacedate1District dateentercare FirstName FirstName2GranteeFirstNameGranteeLastNameText50Text51Text52 childnameLastName LastName2Text47Text48Text49OtherID parentnameSandyText45 parentnameSection SuperAreaCodeSuperExtensionSuperPhoneNumberSupervisorNametopUnitWorkerWorkerAreaCodeWorkerExtension WorkerName WorkerPhone[m/CWk 0DVj~@ 1Ym8I[o  !"#$%&'()*+,-./0123456789:;<k-AUi} .BTh|O/Ck&GYm]{'(),BCDEHWklmnzFa * + 4 B L S ] ^ p X Y Z [ \ ] ^   8 9 : ; > e f g h   b c d e h z { Z [ \ ]    -7>HI]o789:;<ghijm%&'(:=TUgj 23458 !"% !LMNOP >Xtu23GYk}a0@dVVP4P8P<P>P@P@PJPUnknownGz Times New Roman5Symbol3& z Arial;Wingdings?5 z Courier NewWTms RmnTimes New Roman"h0@?]{  FMicrosoft Word Document MSWordDocWord.Document.89q