Form 2085-B, Child Protective Services - Bed Hold Request Completed Form Examples and Samples

Case File Update: March 14, 2026. Regarding the ongoing placement of Jordan A. Miller (ID: 99482-X), we are submitting a request for an initial bed hold episode following his admission to the St. Jude Medical Hospital due to a recent acute physical health complication. The provider, Sunshine Residential Care (Provider No: SRC-7721), has been coordinating with us throughout the process. A formal staffing meeting was held on March 12, 2026, to discuss the stability of the placement. Given the medical necessity, we are requesting coverage for the period of the absence beginning March 15, 2026. 

During the initial week of observation, Jordan showed consistent vitals. Days 1 through 5 were focused on recovery; activity logs indicate bed rest, IV administration, and sleep cycle monitoring. Days 6 through 10 transitioned to light physical therapy, guided walking, and medication titration. Days 11-15 saw progress with nutritionist consultations, balanced diet adherence, and social worker check-ins. By Days 16 through 20, he was engaged in bedside tutoring, occupational therapy, and light recreational activities like reading. Days 21-25 focused on sustained physical therapy and discharge planning meetings. For the final stretch, Days 26-30 included daily vitals, mental health counseling sessions, and preparation for transition back to the facility. The caseworker on file, Sarah Jenkins (ID: SJ-550, Rate Group: B, SI: 4, FD: 30), confirms that all protocols were followed. No indication of 'no intent to return' was flagged during the staffing. Please process this as a standard medical hospital stay.