|
340:75-6-40.2. Placement provider information
|
|
|
|
|
• 1
Revised 3-26-10
Form 04KI004E, Placement Provider Information, is a component of the case plan and accompanies the child placed in out-of-home care. This form includes information about the child required by Section 1-7-104 of Title 10A of the Oklahoma Statutes, but is not limited to, the most recent information available regarding:
- (1) demographic information;
- (2) strengths, needs, and general behavior of the child;
- (3) circumstances necessitating placement;
- (4) type of custody and previous placement;
- (5) pertinent family information including, but not limited to:
- (A) names of family members who are and who are not, by court order, allowed to visit the child; and
- (B) the child's relationship to family that might affect placement;
- (6) known and important life experiences and relationships that may significantly affect the child's feelings, behavior, attitudes, or adjustment;
- (7) whether the child has third-party insurance coverage that may be available to the child;
- (8) education history including present grade placement, last school attended, and special strengths and weaknesses. OKDHS assists the foster parents in getting the child admitted into school and obtaining the child's school records;
- (9) known or available medical history including, but not limited to:
- (A) allergies;
- (B) immunizations;
- (C) childhood diseases;
- (D) physical handicaps;
- (E) psycho-social information; and
- (F) the name of the child's last doctor, if known; and
- (10) sufficient medical information to enable the placement providers to care for the child safely and appropriately, including, but not limited to:
- (A) any medical or psychological conditions;
- (B) diseases, illnesses, accidents, allergies, and congenital defects;
- (C) the child's SoonerCare card or information on any other third-party insurer, if any; and
- (D) immunization history.
INSTRUCTIONS TO STAFF 340:75-6-40.2
Revised 3-26-10
1. Placement provider information. When a child in the custody of Oklahoma Department of Human Services (OKDHS) is placed in out-of-home care or moved from one placement to another, the Child Welfare (CW) worker has specific responsibilities to provide the placement provider certain information as soon as the information becomes available. The CW worker furnishes the placement provider with all known information concerning the child at the time of the placement. When any information is not available, the CW worker takes immediate steps to acquire and furnish the information to the placement provider, with all required information furnished no later than 14 days from the time of placement. Form 04KI004E, Placement Provider Information, is printed from the reports icon in KIDS, and builds from information input into the KIDS system. This report is dynamic and will change as information is added or modified within KIDS. Re-printing of this report for the provider is recommended every six months.
(1) The CW worker ensures the placement provider signs Form 04KI004E and provides a copy to the placement provider.
(2) Form 04KI004E is completed on all changes of placement for a child in OKDHS custody except when the child is placed in own home or a shelter.
|