Revised Health Care Examination Forms (Revised)

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REVISED HEALTH CARE EXAMINATION FORMS (Revised)

The following forms have been cancelled and replaced:

 The DCFS 561, Initial Examination Form

 The DCFS 562, Health Care Visit Log

The above forms have been replaced with:

 The DCFS 561(a), Medical Examination Form

 The DCFS 561(b), Dental Examination Form

 The DCFS 561(c), Psychological/Other Examination Form

The Department is under a State mandate to assure full utilization of CWS/CMS and to that end, current DCFS policy states that child’s health care information must be entered into the Health and Education Passport in CWS/CMS. See Procedural Guide 0600-510.15, Health and Education Passport. http://dcfs.co.la.ca.us/Handbook CWS/0600/0600-510-15.doc

To assist in meeting full utilization requirements, the Public Health Nursing staff has agreed to assist in entering health and medical care information into CWS/CMS. In order to do so, the Public Health Nurses must receive documentation that is authenticated via signature or stamp by the health care provider for all medical, dental, psychological, etc., care. See Procedural Guide 0600-510.15, Health and Education Passport. ISSUE 02-26 DATE: 07/02 NO:

If you have any questions regarding this release please e-mail your question to:

[email protected] The new forms have been developed to document initial examinations, ongoing health care and health care provider authentication when documenting treatment/services provided to the child. The new DCFS 561 (a), (b) and (c) are specific as to type of health care provider and require the health care providers’ signature and signature stamp to document each and every office visit the child has. The forms are attached to this release.

HOW TO USE THE NEW DCFS 561 (a), (b) AND (c):

At initial placement or replacement: (applies to DCFS 561 (a) & (b) only; and DCFS 561 (c) if at the time of placement it is known that psychological services are needed)

 The CSW completes the top portion of the form and gives pages 1, 2 and 3 to the foster caregiver. Page 4 is retained in the DCFS case file, Psychological/Medical/Dental/School Records-folder.

 The foster caregiver takes pages 1, 2 and 3 to the health care provider who completes the lower portion of the form, signs and provides signature stamp where indicated. NOTE: Health care providers may wish to make a photocopy of the completed DCFS 561(a), (b) for their records.

 The foster caregiver places page 2 in the child’s Health and Education Passport binder, retains page 3 for his or her record keeping and returns page 1 (the original) to the CSW.

 The CSW files the completed page 1 in the DCFS case file, Psychological/Medical/Dental/School Records-folder, and discards page 4.

For ongoing health care during placement: [applies to DCFS 561 (a), (b) or (c)]

 The CSW should provide the foster caregiver with several blank forms to be completed at future health care provider office visits. The CSW will collect the completed forms during the regular face-to-face contact with the child. The CSW will file page 4 in the DCFS case file, Psychological/Medical/Dental/School Records-folder and provide pages 1, 2 and 3 to the foster caregiver, who will take the forms to the treating physician at the time of a child’s medical appointment. The health care provider completes the lower portion of the form, signs and provides signature stamp where indicated. The foster caregiver files page 2 of the completed 561 (a), (b) and/or (c) in the child’s Health and Education Passport binder, retains page 3 for his or her record keeping and returns page 1 (the original) to the CSW.

Documentation in the Health and Education Passport:

 On an ongoing basis, the Public Health Nurse or other assigned DCFS staff, enters the information from the DCFS 561(a), (b) or (c) into the child’s Health Notebook or the Associated Services page of the Contact Notebook in CWS/CMS, as appropriate.