Monthly Summary
Providers are required to complete Monthly RBWO Summary Forms for all RBWO children in placement. These forms should be submitted to the DFCS Case Manager. Please see below for forms and instructions for CCIs, CPAs, and ILP programs.
- CCI Monthly RBWO Summary Form and Instructions (used to document monthly services to any child or youth placed in a CCI)
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CPA Monthly RBWO Summary Form and Instructions (used to document monthly services to any child or youth placed in a CPA)
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Independent Living Monthly RBWO Summary Form and Instructions (used to document IL activities for all youth age 14 years and older who are placed in CPAs and CCIs)
Individual Service Plans (ISP) Summaries
- 7-Day Individual Service Plan (template)
- 30-Day Individual Service Plan (template)
Discharge Summary
- Discharge Summary (template)
Information Disclosure and DHS HIPAA Form
- Information Collection, Use and Disclosure Statement - This is an informational document for caregivers. It is recommended that it be provided at the Information Session.
- DHS HIPAA Statement - Effective 12/9/2013, the DHS HIPAA must be signed by caregivers at initial approval. Existing caregivers must sign the HIPAA statement by March 1, 2014. The signed statement must be uploaded to GA SCORE under the Initial Approval or Reevaluation tab as applicable.
