The Family Service Worker or Health Services Specialist will:

1. (1)

   1. (A) Develop and maintain the medical passport.

   2. (B) The medical passport will consist of the:

      1. (i) CFS- 352: Medical, Dental, Vision, Hearing and Psychological Episodic;
      2. (ii) CFS-353: Requested Medical Records Log;
      3. (iii) CFS-362: Medi-Alert to Foster Care Provider;
      4. (iv) CFS-366: Health Screening;
      5. (v) CFS-368: Child’s Health Services Plan;
      6. (vi) CFS-6007: Placement Plan-Placement Provider Information; and
      7. (vii) CFS-6012: Client Medical and Psychological Information;
2. (2) Provide the CFS-365: Receipt for Medical Passport to the out-of-home placement provider for completion to verify receipt of the medical passport; and

3. (3) Provide a copy of the medical passport to:

   1. (A) The out-of-home placement provider and to the child’s new caretaker if the child is moved;
   2. (B) The child (if the child is in the Transitional Youth Services Program);
   3. (C) The child when he or she reaches the age of majority; or
   4. (D) The parents, if the child returns home.