Initial Relative Safety Screen - Michigan
INITIAL RELATIVE SAFETY SCREEN Michigan Department of Health and Human Services Caseworker Name Caseworker Phone MDHHS County or PAFC Name Date of Home Visit Child(ren) Names DOB Legal Relationship to Prospective Caregiver Person ID DEMOGRAPHICS Caregiver(s) Name Maiden Name, Aliases, AKA (if applicable) DOB Date of Central Registry Request Date of … ................
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