Child Folders and Records

All Children and Families enrolled in the GHC Children Services Department must have key folders titled by content. These file folders should contain a checklist of content that applies to that specific folder. These folders have pre-assigned colors and unless authorized may not be changed. These folders must be stored in a secured locked cabinet and must remain confidential to all members not employed by GHC Children Services department. Each folder must be kept current and adhere to the standards of GHC record keeping at all times

DCFS Child folder

ð Pick Up Authorization/Emergency Contact Form

ð Parent Authorization for Release of Information

ð Family Engagement Survey

ð Voter Registration Survey

ð Civic Engagement Survey

ð Arrival & Departure Policy

ð Child Guidance and Discipline Policy

ð Parent Handbook w/Verification of Receipt

ð DCFS Licensing Standards w/Verification of Receipt

ð Proof of School Dental Examination Form

ð State of Illinois Certificate of Child Health Examination

ð Birth Certificate

ð Copy of Insurance Card

ERSEA Child Folder

COPA Forms/ Enrollment Documents (Left-Pocket)

q COPA Child Application

q Waitlist Application

q Over Income Approval (If necessary)

q Enrollment Verification Form

(All programs except PI)

Dates must match Data Base System

Verified documents must be listed, i.e.- 2- consecutive check stubs, Handwritten Family Statement, SNAP or TANF doc, etc.

q Documents used to verify income

(i.e.- Two (2-4) check stubs, Handwritten Family Statement, Third Party Verification Sheet, W2, SNAP or TANF doc, etc.)

q Documents used to Verify Age

(i.e., - Birth certificate, Medical Card, Passport

q Proof of Pregnancy (if Applicable)

(PI & EHS Home Visiting Only)

q Third Party Verification (If necessary)

q Photo I.D.

q COPA Checklist (Documents Verified)

q COPA Emergency Contact Sheet

Internal Documents (Right-Prong)

q Internal Emergency Contact Sheet

q Parent Permission Consent Form

(Developmental)

q Parent Signature Form

(Parent Handbook)

q Authorization for Mutual Exchange of Information

(PI Only)

q Parent Letters& Correspondences

q Data Base Consent Form

Education 3-5 Child Folder

NAVY

Social Service Child Folder

COPA Forms:

q COPA Family Strengths & Needs Assessment

(Completed at Enrollment / annually and or when rolling over to new program year)

q COPA Family Partnership Agreement

(Completed and signed by parent and FSS at enrollment / annually and or when rolling over to new program year)

q COPA Family Case Notes

(Printed quarterly – At the end of November, Feb, May, and August)

q Family Goal follow-up: COPA Case Notes printed once goals are completed.

(Two Family Goals per Program Year)

q Developmental Screening Score Page (Copy of front page-ESI-R)

q Developmental Screening Results (Parent)

q Transition Plans (if applicable)

q Court Ordered Documents

Internal Agency Surveys:

q Parent Engagement Pre-Assessment

q Parent Reflection Pre-Assessment

q Parent Involvement Survey

q Civic Engagement Survey

q Home Language Survey

Disabilities File Folder

Health File Folder

Education 0-3 File Folder

____ COPA Disabilities Contact Notes/Case Notes (print at least quarterly to show progress and monitoring of referral and services, keep most recent on top)

____ Sign-in/sign Out Sheet for Reviewing the File

____ Procedures for Referral Checklist

____ IFSP Referral Packet

____ Copy of the Child’s IFSP

____ Copy of the Child’s Individualization

____ Staffing Review Documentation

____ Copy of Any Written Communication with Parent/Guardian Pertaining to Disabilities

____ Signed Copy of the Parental Rights Form

____ Parent Consent for Individual Observation (Mental Health Consultant, SME, etc.)

____ IFSP Progress Notes (if applicable)

____ Copy of Child’s Clinical or Hospital Reports Regarding Disability (if applicable)

____ Specialized Healthcare Plan (if applicable)

____ Copy of the OT/Physician Referral Form (if applicable)

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