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CASE NAME FORMTEXT ?????CASE NUMBER FORMTEXT ?????COMPLETED BY FORMTEXT ?????DISTRICT FORMTEXT ?????STAGE # FORMTEXT ?????DATE FORMTEXT ??/ FORMTEXT ??/ FORMTEXT ??CPS Investigation Stage Progress Notes(Make additional copies of this form as needed for completing the CPS – Progress Notes) Event Date: FORMTEXT ??/ FORMTEXT ??/ FORMTEXT ??Time: FORMTEXT ????? FORMDROPDOWN Duration: FORMTEXT ??? Hours FORMTEXT ??? MinutesType: FORMTEXT ?????Identify one or more “Type” Values FORMCHECKBOX Approval FORMCHECKBOX Attempted Caseworker Contact FORMCHECKBOX Attempted Collateral Contact FORMCHECKBOX Attempted Family/Primary Discharge Resource Visitation FORMCHECKBOX Attempted Sibling Visitation FORMCHECKBOX Case Conference FORMCHECKBOX Casework Contact FORMCHECKBOX Collateral Contact FORMCHECKBOX Court FORMCHECKBOX Criminal Clearance FORMCHECKBOX Family/Primary Discharge Resource Visitation FORMCHECKBOX Notice FORMCHECKBOX Notice/Approval FORMCHECKBOX Other Casework Activity FORMCHECKBOX Other Visitation FORMCHECKBOX Sibling Visitation FORMCHECKBOX Summary FORMCHECKBOX Supervisor/Managerial ReviewMethod of Contact: FORMDROPDOWN Location of Contact: FORMDROPDOWN FORMCHECKBOX Unannounced VisitPurpose: FORMTEXT ????? Identify one or more “Purpose” Values from the list belowPersonFPFocusOther Participant Identify one or more “Other Participant” Values from the list below FORMTEXT ????? FORMCHECKBOX FORMCHECKBOX FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX FORMCHECKBOX FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX FORMCHECKBOX FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX FORMCHECKBOX FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX FORMCHECKBOX FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Progress Note Narrative: FORMTEXT ?????Progress Notes: Data Values PurposeAdoption ActivitiesPre-Adoption ActivitiesAftercare ServicesAssessmentCounselingChild PreparationCrisis InterventionEducational PlanningEmployment/TrainingFamily PlanningHousingIndependent Living ServicesCoordinate/MonitorCase PlanningParent TrainingPlacementInvestigationMedicalPermanency ConsultationNotifications and LettersReview NotesReview Case24 Hour48 HourInitial5 Day10 Day25 Day30 Day50 DayCase Transfer Review55 DayChild’s AccountParent’s AccountOther Household Member’s AccountAlleged Subject’s Account72-Hour Child Safety Conference: Elevated Risk changed to 72-Hour Elevated Risk Child Safety Conference72-Hour Child Safety Conference: Post Removal changed to 72-Hour Post Placement Safety Conference30 Day Family Permanency Conference: Elevated Risk changed to 30 Day Elevated Risk Permanency Conference30 Day Family Permanency Conference: Post Removal changed to 30 Day Post Placement Permanency Conference40 Day45 Day FSU ConferenceReplacementCritical Case PlanningCourt Extension ReviewPost Court Extension ReviewTrial DischargeFinal Discharge90 Day Service Plan Review6 Month Service Plan Review45 Day FSU Review40 Day FSU/CPM Review10 Day FSU Review30 Day FSUFSU Case Transfer Conference10 Day FSU conference40 Day FSU/CPM ConferenceCross ReferenceProtective Placement Decision MakingVoluntary Placement Decision MakingPersons in Need of Supervision (PINS)Family Team Conference follow-upReturn of Child During Trial DischargeRequest to file FCA Article 10 Petition on Voluntary Placed ChildHomemaking ServicesDay Care Services for Child in CareConsent for Medical Care/HIV testingSpecial/Exceptional Board RateSuspend Payment/Lift Suspended Payment (Other than Trial Discharge)Out of State VisitsInitiate Interstate CompactTermination or Limitation of Parental VisitationRequest for Utilization Review Level of Care ExceptionsChange PPGEnlistment in the Armed Forces or Job CorpsMarriageReport of Accident or IllnessPlan Amendment – OtherPlan Amendment – Preventive Services Are Started/Ended for a ChildPlan Amendment – Case is Closed to CPSPlan Amendment – Child is Entering or Re-entering Foster CarePlan Amendment – Child is Moved for One Foster Care Setting to AnotherPlan Amendment – child Becomes Legally Freed for AdoptionPlan Amendment – Trial DischargedPlan Amendment – Final DischargePlan Amendment – Child Entering/Reentering Direct Placement with a Relative/ResourcePlan Amendment – Child Returned Home from a Non-LDSS Placement LDSS Exec Level ApprovalVA Exec Level ApprovalCandidacyCase ClosingTransferCoached Family VisitCourt Ordered InvestigationCriminal ClearanceCritical IncidentReasonable & Prudent Parenting ActivityCredit CheckTransition MeetingParent to ParentFirst VisitOther ParticipantCommunity ResourceIndian Tribe/CouncilJuvenile DetentionDay Care StaffAdministratorLaw EnforcementLegal/AttorneyMedicalDistrict/Agency StaffRelativeMental HealthProbationService ProviderParent AdvocateOtherSchool StaffAlcohol/Other Drug ServiceVolunteer/MentorClergyFoster/Adoptive ParentThird Party ReviewerPrimary Resource PersonDay Care ProviderCaseworkerSupervisorCase ManagerChild Evaluation SpecialistCase PlannerReporter/SourceCongregate Care StaffFriend ................
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