Dcfs 561 B Form PDF Details

Navigating the healthcare needs of foster children in Los Angeles County involves a comprehensive approach, ensuring that every child receives not only the love and care they need but also the medical and dental attention critical to their well-being. Amidst this complex process, the DCFS 561(b) Dental Examination Form plays a pivotal role. Designed by the Department of Children and Family Services (DCFS), this form is integral to the Medical Record Procedures for foster caregivers, who may be foster parents, relatives, group homes, or Foster Family Agencies (FFAs). The form is part of the Health & Education Passport (HEP) Binder, an essential document that tracks the medical and educational journey of a foster child. The DCFS 561(b) ensures that dental health, an often-overlooked facet of overall health, receives the attention it deserves. From the initial placement of the child, it mandates an annual dental examination for children aged three and above, detailing a process for both foster caregivers and healthcare providers to follow. This ensures a seamless communication between all parties involved in the child’s care, emphasizing prompt updates on any urgent medical or dental needs and the importance of maintaining accurate and up-to-date health records. Furthermore, the form specifies procedures for the event of a child’s relocation, ensuring their health information remains intact and travels with them. Through the meticulous design of the DCFS 561(b) Dental Examination Form, Los Angeles County endeavors to uphold the highest standards of health care for its most vulnerable citizens, providing a foundation for a healthier future.

QuestionAnswer
Form NameDcfs 561 B Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesdcfs 561 c, dcfs examination form, medical examination form dcfs 561, form 561 dcfs

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COUNTY OF LOS ANGELES • DEPARTMENT OF CHILDREN AND FAMILY SERVICES

DCFS 561(b)

DENTAL EXAMINATION FORM - INSTRUCTIONS

MEDICAL RECORD PROCEDURES FOR FOSTER CAREGIVERS (Caregiver is a Foster Parent, Relative, Group Home, or FFA.)

The HEALTH & EDUCATION PASSPORT (HEP) BINDER accompanies each child at the time of placement. The Children’s Social Worker (CSW) will review the HEP BINDER with you at each visit.

The Health and Education Passport must be taken to all medical visits, including the initial examination visit. The health care provider must record all current medical services and tests on the DCFS 561(b). Please add the completed forms to the child’s HEP BINDER.

Immediately notify the child’s CSW (or Supervising CSW, if the CSW is unavailable) when there is any change in the child’s mental, medical and/or dental health that required urgent medical care.

If the child is removed from your care, the child’s complete HEP BINDER, including the Immunization Record, shall be returned to the CSW AT THE TIME OF REMOVAL, as the HEP BINDER must accompany the child upon replacement.

Dental Care Examination Periodicity Schedule: Annual dental examination required at age 3 and above.

(To be completed by CSW/Caregiver. Please print legibly.)

Child needs dental examination within thirty (30) days of initial placement.

Child does not need dental examination because child had a dental examination within one (1) year of placement. Child needs dental examination by _______________.

CHILD’s NAME: ___________________________ DOB: __________ CASE #: ______________ DATE PLACED: __________

CAREGIVER: ___________________ (Phone) _______________ (FFA) ___________________ (Phone) _______________

CSW: __________________________ (File #) __________ (Phone) ____________________ (Fax) ____________________

Dental data entered into CWS/CMS by: (Name) _____________________________ (Date) _________________

__________________________________________________________________________________________________________________

DENTAL EXAMINATION FORM (To be completed by Dentist.)

DENTAL EXAMINATION

Date of Dental Examination: _____________________ Name of Dentist: ___________________________________________

Annual Required Examination

Other/Follow-Up Visit

Dentist’s own exam form is attached. If not attached, complete below.

Dental Exam results: (Treatment given; Medications Prescribed. Please attach copies of supporting documentation; test results, etc.)

________________________________________________________________

________________________________________________________________

________________________________________________________________

(May be continued on additional pages if necessary. If so, provider to include child’s name and DOB, and sign and date additional pages.)

If follow-up care indicated, specify: __________________________________________________________________________

Signature of Health Care Provider: _________________________(Date)__________

 

 

(Dentist)

 

Address: _______________________________________ Phone: _______________

 

 

 

(Signature Stamp Required)

 

 

 

DCFS 561(b) (Rev 07/02)

Distribution: Pages 1, 2 and 3 to foster caregiver when child initially placed.

 

Page 4 to be filed in Psychological/Medical/Dental folder (purple).

DCFS 561(b) DENTAL EXAMINATION FORM

When page 1 returned, file in Psychological/Medical/Dental folder.

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