CMS-07-021/023 - Los Angeles County Department of Children and ...

LOS ANGELES COUNTY PROBATION DEPARTMENT
FOSTER CARE CASE PLAN
EXHIBIT A-V
Date Completed ________________________
Minor’s Name: _______________________________________ PDJ# _________________
Date of Birth: ______________ Place of Birth: ___________________________ School Grade _______
SS# ________________________ Medical # __________________________
Parents/Guardian
Parent Name: Address Relationship
1. ______________________________ _____________________________________ _______________
2. ______________________________ _____________________________________ _______________
3. ______________________________ _____________________________________ _______________
4. ______________________________ _____________________________________ _______________
Siblings
Child’s Name: D.O.B. Address Relationship
1. ___________________________ ___________ ____________________________ _____________
2. ___________________________ ___________ ____________________________ _____________
3. ___________________________ ___________ ____________________________ _____________
4. ___________________________ ___________ ____________________________ _____________
Date of Suitable Placement Order: ____________________________________________________________
Date of Placement: ________________________________________________________________________
Minor’s Current Placement: _________________________________________________________________
Placement Address: _______________________________________________________________________
Case Plan Dates: From: _____________________ To: _____________________
Reassessment Updated Case Plan
CASE PLAN GOAL
Family Reunification Permanency Planning
Long term Foster Care
Legal Guardianship
Adoption
Services and Steps to Be Taken to Implement the Permanency Alternative Should Reunification Fail:
Probation Officer to Consider Sanctions for Any Violations of Court Order
Probation Officer Will Review Minor’s Progress in Completing Case Plan Objectives During Placement
Facility Visits and Via Phone Contacts
Emancipation Program
Adoption Assessment & Planning
Other.
PROB 1385 (Rev. 07-03)
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