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Foster Care Forms
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Caseworker Visit Tools
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Court Reports
- DHS-0665 CFC Permanent Ward Court Report
Rev 04/12 - DHS-1280 CFC Initial Court Report
Rev 05/12 - DHS-1281 CFC Updated Court Report
Rev 07/12 - MDHHS-5964 Court Cover Letter
Rev 07/21
- DHS-0665 CFC Permanent Ward Court Report
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Credit & Identity Theft
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Determination of Care
- DHS-470-A, Assessment for Determination of Care for Children in Foster Care Ages 13+
Rev 07/24 - DHS-470 Assessment for Determination of Care for Children in Foster Care Ages 0-12
Rev 09/24 - DHS-1254, SED Waiver Foster Home Payment Request and Approval
Rev 03/24 - DHS-1945 Assessment for Determination of Care (DOC) for Medically Fragile Children in Foster Care
Rev 08/24
- DHS-470-A, Assessment for Determination of Care for Children in Foster Care Ages 13+
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MiTEAM Practice Model & Family Team Meetings
- DHS-1104, Family Team Meeting
Rev 05/15 - Family Team Meeting Protocol
Rev 04/13 - DHS-1104, Family Team Meeting Protocol - Spanish
Rev 05/15 - DHS-1105, Family Team Meeting Report
Rev 09/18 - DHS-1105-SP, Family Team Meeting Activity Report - Spanish
Rev 06/17 - DHS-1107, A Caseworker's Guide to Pre-Meeting Discussions and Family Team Meetings
Rev. 03-16 - DHS-1109, Family Team Meeting Invite
Rev 09/11 - MDHHS-PUB-1160, A Family's Guide to Pre-Meeting Discussions and Family Team Meetings
Rev 11/15
- DHS-1104, Family Team Meeting
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Foster Care Additional Forms
- Waiver of Foster Care Payments in Lieu of Government Benefits
Rev 04/22 - DHS-30 Foster Parent/Caregiver Notice of Move
Rev 07/24 - DHS-31 Foster Care Placement Decision Notice
Rev 07/21 - DHS-57 Foster Care Transitional Medicaid
Rev 9/15 - DHS-67A Treatment Foster Care Parent-Agency Treatment Plan and Service Agreement
Rev. 10/17 - DHS-197 - Home Study Outline
Rev 05/15v - DHS-348, Michigan Works! Workforce Innovation and Opportunity Act Agency Referral
Rev 04/18 - DHS-396 Residential Placement Exception Request
Rev 7/12 - DHS-589 Recoupment Notice
Rev 06/14 - DHS-594 Parental Placement of MCI Ward Request
Rev. 04-19 - 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 06/15 - MDHHS-710 Clearance to Publish Information on AWOLP Youth
Rev 09/23 - DHS-715 Hearing Notice
Rev 06/21 - DHS-715 Hearing Notice (Spanish)
Rev 06/21 - DHS-715 Hearing Notice (Arabic)
Rev 06/21 - DHS-719-CWFS, Child Welfare Funding Specialist Tool
Rev 07/24 - DHS-786 Independent Living Plus Extension Request
Rev 1/14 - DHS-790, Foster Parent Orientation Video Questions
Rev 07/11 - DHS-867 - Notification to Court of Jurisdiction and Child's Lawyer Guardian Ad Litem
Rev 05/15 - DHS-901-A, Semi-Annual Transition Plan Report, Youth Age 14-15
Rev 09/23 - DHS-901-B, Semi-Annual Transition Plan Report, Youth Age 16 and Older
Rev 09/23 - DHS-902, 90-Day Discharge Plan Report
Rev 02/19 - DHS-942, School Notification and Education Records Release
Rev 10/24 - DHS-945, Financial Aid Verification of Court/State Ward Status
- DHS-956, Youth Housing Referral
Rev 10/18 - DHS-1445, Child Support Confidential Locate Request
Rev 11/19 - DHS-1476 Early Discharge of MCI Ward
Rev 05/17 - DHS-1555-CS, Authorization to Release Confidential Information
Rev 05/17 - DHS-2351-X, Bridges Provider Enrollment/Change Request
Rev 07/18 - DHS-3198, Unauthorized Leave Notification
Rev 05/15 - DHS 3198-A Unauthorized Leave Report to Court/Law Enforcement
Rev 10/23 - DHS-3307 Placement Outline and Information Record
Rev 05/21 - DHS-3377 Clothing Inventory Checklist
Rev 7/24 - DHS-4527, Independent Living Agreement
Rev 9/17 - DHS-5307 Rights And Responsibilities For Children and Youth In Foster Care
Rev 05/19 - DHS-5307-SP Rights And Responsibilities For Children and Youth In Foster Care
Rev 5/19 - DHS-5307-AR Rights And Responsibilities For Children and Youth In Foster Care
Rev 5/19 - DHS-5331 Guidelines for Reasonable and Prudent Parent Standard
Rev 02/17 - DHS-5333 Conversation Guide on Return from AWOLP
Rev 9/15 - MDHHS-5406 - Bed Hold Payment Request
Rev 09/19 - MDHHS-5406-IL, Bed Hold Payment Request for Independent Living Placements
Rev 01/21 - MDHHS-5523, Human Trafficking Screening Tool - Ongoing Cases
Rev 06/17 - MDHHS-5524, Human Trafficking Screening Tool - Closed Cases
Rev 06/17 - MDHHS-5594, Trauma Assessment Referral
Rev 10/24 - MDHHS-5599, Ancillary Service Approval
Rev 12/23 - MDHHS-5748, Verification of Placement in Foster Care
Rev 07/18 - MDHHS-5822, Pre-Approval Request for Foster Parent Mileage Reimbursement for Visitation Travel Over 150 Miles Round Trip
Rev 02/22 - MDHHS-5829, Family Incentive Grant (FIG) and Unlicensed Relative Caregiver Funding
Rev 08/20 - MDHHS-5841, Waiver of Foster Care Payments in Lieu of Government Benefits
Rev 11/23 - MDHHS-5841-A, Waiver of Foster Care Payments in Lieu of Government Benefits
Rev 03/23 - MDHHS-5853, GROW Training Referral
Rev 10/23 - MDHHS-5855, Orthodontic Payment Agreement
Rev 07/22 - MDHHS-5902 Caregiver Support and Resource Plan
Rev 10/23 - Residential Referral Checklist - MDHHS-5928
Rev 04/22 - MDHHS-5967, Overpayment Notification
Rev 07/21 - MDHHS-6051, Child Welfare Placement Assistance Request
Rev 08/24 - MDHHS-6070, Unlicensed Respite Provider Clearances
Rev 10/23 - MDHHS-6071, Respite Services Exception
Rev 08/24 - MDHHS-6072, Respite Child Information and Case Plan
Rev 08/24 - For Forms Required for Interstate Compact, go to Interstate Compact Forms
- Waiver of Foster Care Payments in Lieu of Government Benefits
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Foster Care Supportive Visitation
- DHS-599, Foster Care Supportive Visitation and In-Home Parent Education Referral
Rev 10/23 - DHS-1469, Foster Care Supportive Visitation and In-Home Parent Education Visit Report
Rev 10/15 - DHS-1470, Foster Care Supportive Visitation Termination Report
Rev 02/19 - DHS-1471, Foster Care Supportive Visitation and In-Home Parent Education Initial Assessment
Rev 02/19 - DHS-1472, Foster Care Supportive Visitation Service Agreement
Rev 010/20 - DHS-1473, Foster Care Supportive Visitation and In-Home Parent Education Weekly Progress Report
Rev 02/18 - DHS-1474 Foster Care Supportive Visitation and In-Home Parent Education Contract Compliance
Rev 10/20 - MDHHS-5465, Family Satisfaction Survey Foster Care Supportive Visitation
Rev 10/16 - MDHHS-5466, Referring Worker Satisfaction Survey, Foster Care Supportive Visitation
Rev 10/20 - MDHHS-5716 - Foster Care Supportive Visitation and In-Home Parent Education Follow-Up Summary/Attempt
Rev 10/20
- DHS-599, Foster Care Supportive Visitation and In-Home Parent Education Referral
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Permanency Goal Approval
- DHS-347 - Permanency Goal Approval
Rev. 09/15 - DHS-569 Permanency Goal Support Agreement
Rev. 08/15 - DHS-643 - Permanency Goal Review
Rev. 08/15
- DHS-347 - Permanency Goal Approval
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Relative Search
- DHS-541 Relative Licensing Referral Agreement
Rev 04/19 - DHS-987, Relative Documentation
Rev. 05/15 - DHS-987-SP Relative Documentation
Rev 05/15 - DHS-990 Relative Notification Letter
Rev 03/21 - DHS-990-SP, Relative Notification Letter (Spanish)
Rev 03/21 - DHS-990-AR Relative Notification Letter (Arabic)
Rev 03/21 - MDHHS-991 Diligent Search Checklist
Rev 05/16v - Relative Caregiving: What You Need to Know DHS-Pub-114
Rev 01/16 - MDHHS-5770, Relative Placement Safety Screen
Rev 09/21
- DHS-541 Relative Licensing Referral Agreement
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Residential Care
- DHS-145 Family Assessment of Needs & Strengths
Rev. 10/15 - DHS-365-A Children's Foster Care Residential Initial Service Plan (10-13 yrs)
Rev. 01/16 - DHS-365 Children's Foster Care Residential ISP (4-9 yrs)
Rev. 12/15 - DHS-365-B Children's Foster Care Residential Initial Service Plan (14 yrs and older)
Rev. 01/16 - DHS-366-A Children's Foster Care Residential Updated Service Plan (10-13 yrs)
Rev. 12/15 - DHS-366-B Children's Foster Care Residential Updated Service Plan (14 yrs and older)
Rev. 02/16 - DHS-366 Children's Foster Care Residential Updated Service Plan (4-9 yrs)
Rev. 12/15 - DHS-5335 Juvenile Justice Service Plan Addendum
Rev. 02/16 - MDHHS-5931, Residential Aftercare Report
Rev. 08/24 - MDHHS-5985, Incident Report
Rev. 12/21 - MDHHS-5999, Residential Foster Care Abuse Neglect (RFCAN) and Residential Foster Care Juvenile Justice (RFCJJ) Contract - Qualified Residential Treatment Program (QRTP) Re-Certification
Rev. 04/23
- DHS-145 Family Assessment of Needs & Strengths
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Residential Care-Juvenile Justice
- DHS-232 Initial Treatment Plan
Rev. 05/24 - DHS-233 Updated Treatment Plan
Rev. 05/24 - DHS-234 Release Report
Rev. 05/24 - DHS-449 Juvenile Justice Reentry Care Coordination Referral
Rev. 01/20 - MDHHS-Pub-1243-AR, Preventing Sexual Assault - Youth Orientation Packet (Arabic)
Rev. 04/19 - MDHHS-Pub-1243, Preventing Sexual Assault - Youth Orientation Packet
Rev. 04/19 - MDHHS-Pub-1243-SP, Preventing Sexual Assault - Youth Orientation Packet (Spanish)
Rev. 04/19 - MDHHS-5520 Residential AWOLP and Escape Checklist
Rev. 03/18 - MDHHS-5605, Juvenile Justice Residential Youth Orientation Checklist
Rev. 11/17 - MDHHS-5606, Prison Rape Elimination Act (PREA) Screening Tool
Rev. 05/24 - MDHHS-5606-AR, Prison Rape Elimination Act (PREA) Screening Tool (Arabic)
Rev. 05/24 - MDHHS-5606-SP, Prison Rape Elimination Act (PREA) Screening Tool (Spanish)
Rev. 05/24 - MDHHS-5799-PREA, PREA Retaliation Monitoring Log
Rev. 05/19 - MDHHS-5809-PREA, Prison Rape Elimination Act (PREA) Investigation Tool
Rev. 08/19 - MDHHS-5810-PREA, Prison Rape Elimination Act (PREA) Investigation Report
Rev. 03/21 - MDHHS-5817-PREA, Annual Prison Rape Elimination Act (PREA) Staffing Plan Review
Rev. 08/19 - MDHHS-5818-PREA, 30-Day Sexual Abuse Incident Review
Rev. 08/19 - MDHHS-5830-PREA, Prison Rape Elimination Act (PREA) Unannounced Rounds Log
Rev. 11/19 - MDHHS-5833-PREA, Prison Rape Elimination Act (PREA) Staffing Plan
Rev. 10/20 - MDHHS-5931, Residential Aftercare Report
Rev. 08/24 - MDHHS-5999, Residential Foster Care Abuse Neglect (RFCAN) and Residential Foster Care Juvenile Justice (RFCJJ) Contract - Qualified Residential Treatment Program (QRTP) Re-Certification
Rev. 05/22
- DHS-232 Initial Treatment Plan
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Juvenile Justice Diversion and Reintegration Alternative Services
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SCAO Court Forms
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SDM Templates
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Supervisor Tools
- DHS-1154 Foster Care Supervisory Guide
Rev 04/13 - DHS-1155 Foster Care Supervisory Tool
Rev 07/13
- DHS-1154 Foster Care Supervisory Guide
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Treatment Foster Care
- DHS-65A Treatment Foster Care Initial Service Plan
Rev. 10/17 - DHS-66A Treatment Foster Care Updated Service Plan
Rev. 10/17 - DHS-67A Treatment Foster Care Parent-Agency Treatment Plan and Service Agreement
Rev. 10/17 - DHS-68A Treatment Foster Care Permanent Ward Service Plan
Rev. 10/17 - 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. 04/14 - DHS-977 Treatment Foster Care Referral Acceptance
Rev. 12/08 - DHS-978 Treatment Foster Care Placement Request
Rev. 05/18 - DHS-979 Treatment Foster Care Discharge Report
Rev. 03/09
- DHS-65A Treatment Foster Care Initial Service Plan
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Well Child Exams & Other Health Forms
- DHS-193, Foster Care Transitional Medicaid (FCTMA)
Rev. 01/15 - DHS-Pub-268, Guidelines for Foster Parents and Relative Caregivers for Health Care and Behavioral/Mental Health Service
Rev. 06/23 - DHS-Pub-268-AR, Guidelines for Foster Parents and Relative Caregivers for Health Care and Behavioral/Mental Health Service (Arabic)
Rev. 06/23 - DHS-Pub-268-SP, Guidelines for Foster Parents and Relative Caregivers for Health Care and Behavioral/Mental Health Service (Spanish)
Rev. 06/23 - DHS-0439, Notice of Health Care Coverage for Former Foster Youth Extended to Age 26
Rev. 11/15 - DHS-579, Well Child Exam Infancy: 4 Weeks
Rev. 04/16 - DHS-580, Well Child Exam Infancy: 1 Week Visit
Rev. 06/15 - DHS-581, Well Child Exam Infancy: 4 Months
Rev. 06/15 - DHS-0583, Well Child Exam Infancy: 2 Months
Rev. 08/11 - DHS-1147 - Foster Care Youth Health Services Refusal
Rev. 05/19 - DHS-1556, Behavioral/Mental Health Exception
Rev. 08/17 - DHS-1631, Well Child Exam Early Childhood: 18 Months
Rev. 06/15 - DHS-1632 Well Child Exam Early Childhood 2 Years
Rev. 06/15 - DHS-1633, Well Child Exam Early Childhood: 30 Months
Rev. 07/15 - DHS-1634 Well Child Exam Early Childhood 3 Years
Rev. 04/16 - DHS-1635 Well Child Exam Early Childhood 5 Years
Rev. 06/15 - DHS-0381 Well Child Exam Middle Childhood 6-10 Years
Rev. 06/15 - DHS-1636, Well Child Exam Early Adolescence: 11-14 Years
Rev. 07/11 - DHS-1637 Well Child Exam Early Adolescence: 15 - 18 Years
Rev. 08/15 - 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. 06/15 - DHS-1641, Well Child Exam Infancy: 6 Months
Rev. 06/15 - DHS-1642, Well Child Exam Early Childhood: 4 Years
Rev. 08/11 - DHS-1643, Psychotropic Medication Informed Consent
Rev. 03/21 - DHS-1664, Youth Dental Exam
Rev 10/21 - MDHHS-5338, Foster Care Well Child Exam/EPSDT Appointment Verification
Rev. 12-15
- DHS-193, Foster Care Transitional Medicaid (FCTMA)
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Young Adult Voluntary Foster Care
- DHS-38, Verification of Employment
Rev. 12/07 - DHS-54A, Medical Needs
Rev. 10/08 - DHS-333, YAVFC Poster
Rev. 7/13 - DHS-650-YA, Young Adult Extension Unit Checklist
Rev. 09/19 - DHS-1295, Young Adult Monthly Visit Report
Rev. 12/18 - DHS-1297, Young Adult Voluntary Foster Care Agreement
Rev. 10/22 - DHS-1297-SP, Young Adult Voluntary Foster Care Agreement (Spanish)
Rev. 10/22 - DHS-1301-YA, Young Adult Voluntary Foster Care Case Denial/Closure Notice
Rev. 08/23 - DHS-1302, Young Adult Voluntary Foster Care Case Closure Request
Rev. 05/17 - DHS-3380, Verification of Student Information
Rev. 10/12 - MDHHS-5778, Young Adult Voluntary Foster Care Verification of Eligibility
Rev. 02/20
- DHS-38, Verification of Employment