Face Sheet - Virginia Department Of Social Services Page 2

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Other Adults living in Removal Home?___________________________ ______________________________
Name & Age
Name & Age
:__________________________________________________________
Current Visitation Resources/Contacts
Next Foster Care Plan Due:______________ Next Court Date: ____________ Next FAPT:_____________
Special Considerations, Issues or Safety Concerns:________________________________________________
_________________________________________________________________________________________
Current Behavioral Information – Medical Information – Educational Information-LAST 3 MONTHS
Medical Needs
Current Medications
Behaviors & Symptoms
MH Diagnosis (
If applicable)
Does Child have a P.O?
If yes, Name_________________________ Tel:_______________________
Yes
No
Education
School:
Grade:
Exceptionality-LD, ED, etc. (
):
If applicable
Additional Information/Remarks (include any information about necessary supports needed for child to
successfully step-down, Barriers to Placement with Biological Family or in the Community):
Updated by lucomdm-C:\Documents and Settings\mmn900\Desktop\Local Resources\TDM FACE Sheet - Richmond City Department of Social Services.doc (Rev. 1/09)
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