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

EXHIBIT I
CSW in Concurrent Planning Redesign (CPR) offices shall use Family Background 1, 2
and 3, in lieu of DCFS 4344 I, II and III, to collect medical information. CSW in non-
Concurrent Planning Redesign (CPR) offices shall continue to use DCFS 4344 I, II and
III, to collect medical information.
CSW shall use DCFS 1726 to request the child’s school information from the school.
The purpose of the HEP is to:
1. Provide a summary of the child’s health and education records.
2. Assist in the initiation and continuity of medical assessment and treatment.
3. Avoid duplication of medical services.
4. Preserve essential medical data on a child in out-of-home care.
5. Increase the willingness of health care providers to accept a child in out-of-home
care as a patient by providing better background information on the child in an
easily accessible format.
6. Consolidate all educational information, including current and former schools,
special education information and grade level performance, in a location readily
accessible to the caregiver, the child, educators and social workers.
CSW is to use DCFS 1726 to collect information from the education provider. CSW
may send out the form to school 45 days before the next court hearing date, or request
the unit clerk for assistance before the required 45-day cut-off date.
Health care information is to be documented by the health care provider on the
appropriate DCFS 561(a), (b), or (c). The DCFS 561(a), (b) and (c) are used to
document initial examinations, ongoing health care, and health care provider
authentication when documenting treatment/services provided to the child. The DCFS
561 (a), (b) and (c) are specific as to type of health care provider and require the health
care provider’s signature to document each and every office visit with the child.
At initial placement or replacement:
The CSW completes the top portion of DCFS 561(a), (b) and (c) and give them to the
foster caregiver. A copy of DCFS 561(a), (b) and (c) is retained in the DCFS case file,
Psychological/Medical/Dental/School Records folder. The foster caregiver takes the
form to the health care provider who completes the lower portion of the form (health
care providers may make a photocopy of DCFS 561 for their record). The foster
caregiver places a copy in the child’s HEP Binder, retains a copy for the record keeping
and returns the original to the CSW. The CSW submits a copy to the PHN for
documentation in CWS/CMS (see below). When documentation in CWS/CMS is
complete, the PHN returns the copy to the CSW. The CSW files the completed copy in
the DCFS case file, Psychological/ Medical/Dental/School Records folder.
PG 0080-505.20 (Rev 010/06) Page 4 of 12