A program provider must maintain a current one to two-page summary sheet for each child receiving services from the program provider. A copy of the summary sheet must be maintained by the program provider and at the Host Home. The record must include all of the following:

1. (1) The child's name, current and previous address, date of entry into the Host Home, date of birth, gender identity, sex, religious preference, current hospital, medical prime number and private insurance number (where applicable), and guardianship information.
2. (2) A photo of the child taken within the last year.

3. (3) The name, address, and telephone number of the following:

   1. (a) The child's family, parent, guardian, advocate, or other significant person.
   2. (b) The child's current physician, secondary physician, or clinic.
   3. (c) The child's current dentist.
   4. (d) The child's current pharmacy.
   5. (e) The child's current school and educational surrogate, if applicable.
   6. (f) The child's CDDP services coordinator.
   7. (g) The child's behavior professional, when professional behavior services are actively involved with the development of a Temporary Emergency Safety Plan, Functional Behavior Assessment, or Positive Behavior Support Plan, or the maintenance of the Positive Behavior Support Plan.
   8. (h) Other representatives providing services to the child including an attorney or CASA (Court Appointed Special Advocates) representative.
4. (4) Any court-ordered, or parent or guardian authorized, contacts or limitations.

Statutory/Other Authority

ORS 409.050, 427.104, 441.715, 443.450 & 443.455

Statutes/Other Implemented

ORS 427.104, 441.705-441.720, 441.740, 441.745, 443.384, 443.392, 443.400-443.445, 443.450, 443.455, 443.880, 443.881 & 443.991

History

APD 36-2019, adopt filed 10/29/2019, effective 11/01/2019