ࡱ> ikh @ NDbjbj *P؝؝lllllll%%%8 &,L&D3, '(((()?++,x2222222$p4R62Ql,)),,2ll((2{.{.{.,l(l(2{.,2{.{.ll{.(' `F%,"{..30D3{.N7,N7{.llllN7l{.H,,{.,,,,,22de.CASEWORKER VISIT REPORTDepartment of Human ServicesUse this format to report monthly caseworker visits with the child(ren). Report only face-to-face contacts that occur between the assigned caseworker and the child. The time of the contact needs to be listed only if more than one face-to-face contact is made on the same day. Report those contacts where there is meaningful interaction used to gather needed information to update a service plan, not contacts where a child is seen in the office (perhaps for parenting time), but no exchange of information between the caseworker and child is made.Case Name: FORMTEXT      Case Number:Agency: FORMTEXT       FORMTEXT      DHS Monitor Name:Date of Contact:Time: FORMTEXT       FORMTEXT       FORMTEXT       FORMCHECKBOX A.M. FORMCHECKBOX P.M.Contact Type FORMCHECKBOX Case Contact FORMCHECKBOX Parent Time FORMCHECKBOX AWOLContact Description: List name of assigned caseworker and name of child contacted.Case Worker: FORMTEXT      Child Contacted: FORMTEXT      Contact Summary: Short description of content of contact. FORMTEXT      Contact Location: FORMCHECKBOX Court FORMCHECKBOX Jail FORMCHECKBOX Department of Human Services FORMCHECKBOX Parental Home FORMCHECKBOX Detention FORMCHECKBOX Relatives Home FORMCHECKBOX Doctors Office FORMCHECKBOX Residential Placement FORMCHECKBOX Foster Home FORMCHECKBOX School FORMCHECKBOX Hospital FORMCHECKBOX Therapists office FORMCHECKBOX Independent Living FORMCHECKBOX Other FORMTEXT   2 4 H J L V X Z \ p r t ~     $ & ( * > @ B L N P R n p r jkhV'Ujh%YUjh-Ujh-Uh%Yjh-UhjdCJOJQJj`h-Ujh-UjhV'UmHnHujh-Uh-jh-Uhjd28sj $Ifgdjd<kdX$$Ifl4y,y,4 lalf4 $Ifgdjd<kd$$Ifl4y,y,4 lalf4 $Ifgd(,DLD89:; |s6<kd`$$Ifl4y,y,4 lalf4 $Ifgdjd<kd$$Ifl4y,y,4 lalf4 $Ifgd(,<kd$$Ifl4y,y,4 lalf4   |s6<kd$$Ifl4 y,y,4 lalf4 $Ifgdjd<kd$$Ifl4y,y,4 lalf4 $Ifgdjd<kd$$Ifl4y,y,4 lalf4 0 2 Z MOkd$$Ifl4 0<y,<=4 lalf4 $IfgdjdOkdj$$Ifl40<y,<=4 lalf4 $Ifgdjd ( P t ~ z $Ifgdjd $IfgdjdskdV$$Ifl4F<Z!y,<      4 lalf4p~ \SSSJA $Ifgdjd $Ifgdjd $Ifgd(,kd$$Ifl4r<Z!P()y,< a4 lalf4p2   2 4 6 P R n p r BDXZ\fh.24HJLVX\~}ujhUj=h-UhjKhV'UhV'jhV'UjhV'UmHnHuj9h-Uh-jh-Ujc hV'Uj hV'Uj{ hV'Ujh%YUj hV'Uh%Y. \S $Ifgd(,kdw $$Ifl4r<Z!P()y, <   a4 lalf4p2  8 P t ~ |sjsjsj $Ifgd%Y $Ifgd%Y<kd $$Ifl4y,y,4 lalf4 $Ifgd%Y<kd $$Ifl4y,y,4 lalf4 ~ &(cZ<kd $$Ifl4y,y,4 lalf4 $Ifgdkd $$Ifl4hֈhDy,hk qb bq 4 lalf4(Bjl5Okd$$Ifl40xy,x&4 lalf4 $IfgdV' $$Ifa$gdV'Okd$$Ifl40y,&4 lalf4 $Ifgd%Y $$Ifa$gd%Y,.02Z\|s6<kd$$Ifl4y,y,4 lalf4 $Ifgd<kd$$Ifl4y,y,4 lalf4<kde$$Ifl4y,y,4 lalf4 $Ifgd\|sjsj $Ifgd $Ifgd<kd$$Ifl4y,y,4 lalf4<kd$$Ifl4y,y,4 lalf4 $Ifgd"#123CDRST_`nopjhV'Uj3hV'UjhV'UjbhV'UjhV'UjhV'Uj4hV'UjhV'UjchV'UhjhUjhV'U2"4Btkbkb $Ifgd $Ifgdkd$$Ifl4\<y,4 lalf4p(BCU_qtkbkb $Ifgd $Ifgdkd$$Ifl4\<y,4 lalf4p(tkbkb $Ifgd $Ifgdkd{$$Ifl4\<y,4 lalf4p(tkbkb $Ifgd $IfgdkdL$$Ifl4\<y,4 lalf4p( 2Etkbkb $Ifgd $Ifgdkd$$Ifl4\<y,4 lalf4p( !/01FGUVWklz{|@ @ @6@8@T@V@X@Z@l@n@p@@@@@@@@DDD迻thh^JaJ hB:hj!"hV'Uh%Yj!hV'UjhV'UmHnHuUjh-Uh-jh-UjOhV'UjhV'Uj|hV'UhjhUjhV'U,EFXk}@@tkbkUkb $If]gd $Ifgd $Ifgdkd$$Ifl4\<y,4 lalf4p(     Appointment: FORMCHECKBOX Scheduled FORMCHECKBOX UnscheduledDepartment of Human Services (DHS) will not discriminate against any individual or group because of race, religion, age, national origin, color, height, weight, marital status, sex, sexual orientation, gender identity or expression, 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. 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