RPU – RECORD REVIEWS - CHILD

CHILDREN’S RECORDS	FILE #1	FILE #2
CHILD’S NAME:
DATE OF ADMISSION:
DATE OF BIRTH:
IDENTIFYING INFORMATION: 13 CSR 35-71.090(2)(A)
ADMISSION ASSESSMENT 13 CSR 35-71.060(C)2,A through L
Non-emergency admissions 13 CSR 35-71.060(C)1A the admission assessment must be completed before a child is accepted for care.
Emergency admissions 13 CSR 35-71.060(C)1B the admission assessment must be completed within five (5) days of admission.
COURT ORDERS 13CSR 35-71.090(2)(D)
SCHOOL REPORTS 13CSR 35-71.090(2)(F)
MEDICAL EXAMINATION 13 CSR 35-71.060(C)3 within thirty (30) days before or within ten (10) days after admission.
13 CSR 35-71.075(2)(D) subsequent Physical Examination
DENTAL EXAMINATION 13 CSR 35-71.075(1)(K)1&2 within one (1) year before admission or arrangements must be made for an examination within three (3) months after admission, and shall have a dental examination at least annually while in care.
TUBERCULOSIS testing 13 CSR 35-71.075.(1)(J) shall be done according to the recommendations of the state or local public health authorities.
EYE EXAMINATION 13CSR 35-71.075(1)(I) Each child shall be given an annual eye examination and corrective treatment shall be provided as prescribed.
HEARING Testing 13CSR 35-71.075(1)(A)
IMMUNIZATIONS Record 13 CSR 35-71.075(1)(F)&(G)
Preventative HEALTH CARE 13 CSR 35-71.075(1)(A)
PSYCHOTROPIC MEDICATION 13 CSR 35-71.075(6)(B)1.A-E
TREATMENT PLAN and treatment plan reviews 13 CSR 35-71.060(2)(A)5&6
A. The progress of a child and his/her family shall be evaluated at least every three (3) months, and the treatment plan shall be modified when appropriate.
B. In crisis placement, an evaluation shall be conducted at least every thirty (30) days. 13 CSR 35-71.060(2)(A)6.
C. The treatment plan review with the date and signature of the program director/qualified professional staff and a signed and dated attendance sheet of all other participants in the treatment plan review must be documented in the child's record. 13 CSR 35-71.060(2)(A)3G
Date of Initial Treatment Plan 13 CSR 35-71.060(2)1&2
Subsequent Treatment Plan Dates 13 CSR 35-71.060(2)(A)6
CASE RECORDINGS/MONTHLY PROGRESS SUMMARIES 13CSR 35-71.090(2)(H)
PLANS FOR DISCHARGE 13CSR 35-71.090(2)(I) aftercare and supervision
RECREATIONAL and other adjunctive staff 13CSR 35-71.090(2)(J)
RECORD OF A CHILD’S EARNINGS and dispersal’s 13CSR 35-71.070(1)(H)10.
ALLOWANCES & MONEY 13 CSR 35-71.070.(I)1 If a child does not work and earn his/her own spending money, each child shall receive a regular allowance.
WRITTEN PLACEMENT AGREEMENT 13 CSR 35-71.060(C)5 between the agency and the child's parent(s) or guardian must be completed at or before placement.
MEDICAL CONSENT 13 CSR 35-71.060(C)5&6
CONSENT FOR RELEASE 13CSR 35-71.070(1)(C)4.
WRITTEN INVENTORY of child’s possessions 13 CSR 35-71.070(2)(E)
Mandatory RELIGIOUS OBSERVANCE consent 13 CSR 35-71.070(2)(G)2
CHANGE IN RELIGIOUS AFFILIATION consent 13 CSR 35-71.070(2)(G)4
Consent for Emergency Medical Care, Necessary Immunizations and Routine Medical Care. 13 CSR 35-71.075(1)(C)
MATERNITY CARE / Medical Record Requirements 13 CSR 35-71.120(2)(D) The resident’s medical record shall include the name of the health care provider, a schedule of appointments, the expected date of delivery and any special needs or problems.