Request for Extension to Keep Case Open Instructions
This form contains 16 fields organized into 9 sections. Below is a complete list of every field, its type, and what information is expected.
| Field Name | Type | Description |
|---|---|---|
| Barriers to Safe Case Closure | ||
| Case Closure Actions and Progress | Text |
Provide details on the service plan goals established, strategies deployed, and progress achieved to date in overcoming barriers and ensuring safe case closure.
|
| Basis for Keeping Case Open | ||
| Case Justification Details | Text |
Provide a comprehensive explanation covering service plan goals, deployed strategies, progress achieved, barriers encountered, and the specific roadmap for achieving safe case closure, including the justification for keeping the case open.
|
| Basis to support the reasonable expectation that keeping the case open will be beneficial to family and is aligned with the original goals | ||
| Basis for Keeping Case Open | Text |
Provide the detailed basis to support the reasonable expectation that keeping the case open will be beneficial to the family and aligns with the original goals.
|
| Anticipated Closing Date | Date |
Enter the date by which the case is anticipated to be closed.
|
| Requestor Name | Text |
Enter the name of the person requesting this information or action.
|
| Behavioral Strategies Roadmap | ||
| Specific Behavioral Strategies Roadmap | Text |
Please provide a detailed roadmap outlining the behavioral strategies to be implemented over the next six months, including service plan objectives, case management, and monitoring strategies.
|
| Case Information | ||
| Case Name | Text |
Please provide the full name of the case.
|
| CYCIS ID | Text |
Please enter the CYCIS identification number for this case.
|
| Case Opening Date | Date |
Please provide the date when this case was opened.
|
| Agency | Text |
Please provide the name of the agency associated with this case.
|
| County | Text |
Please enter the county where this case is located.
|
| Team | Text |
Please provide the name or identifier of the team handling this case.
|
| Initial Family Goals | ||
| Initial Family Goals Description | Text |
Provide a detailed description of the initial family goals that were deemed necessary to achieve safe case closure, expressed in behavioral terms, including the behavioral patterns that must be acquired and consistently demonstrated by the caregiver.
|
| Progress Achieved to Date | ||
| Progress Achieved to Date | Text |
Please provide a detailed description of the progress achieved to date towards the service plan goals and strategies.
|
| Reason for Case Opening | ||
| Reason for Case Opening Details | Text |
Please provide a detailed explanation for the case opening, including presenting issues and any indicated allegations.
|
| Strategies for Safe Case Closure | ||
| Service Plan Goals for Closure | Text |
Please provide the service plan goals established to achieve a safe case closure.
|