Form Jv 225 PDF Details

At the heart of child welfare proceedings lies the JV-225 form, an instrument that serves as a bridge between the family's needs and the judicial system's mandate to safeguard the well-being of children within its purview. This form, officially titled "Your Child's Health and Education," plays a pivotal role by gathering comprehensive information about a child’s medical, dental, mental health, and educational status. Its significance cannot be overstated, as it enables social workers, probation officers, and the court to make well-informed decisions regarding the child's care and the support they require. Parents and guardians are impelled by the court to diligently complete and submit this form, which contains sections detailing the child’s and their own health histories, as well as pertinent educational information. By requiring details such as medical conditions, medications, treatment services, and educational accommodations or evaluations, the JV-225 form encapsulates a holistic view of the child’s needs. Moreover, it furnishes the court and involved professionals with crucial data about the family's medical history and the educational standings of both the child and parents, ensuring that subsequent actions taken are in the child's best interest. The form embodies a crucial step in advocating for the child’s healthcare and educational requirements, emphasizing the judicial system’s commitment to fostering environments conducive to every child’s growth and development.

QuestionAnswer
Form NameForm Jv 225
Form Length5 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min 15 sec
Other namesLegalNet, JV-225, providers, jv 225

Form Preview Example

JV-225

Your Child's Health and Education

 

 

To the social worker or probation officer: If the parent or guardian needs help completing this form, please ensure that he or she receives assistance.

To the parent or guardian: Complete and sign this form. The information requested on this form is necessary to meet the medical, dental, mental health, and educational needs of your child. The court has directed you to provide your child’s medical, dental, mental health, and educational information. The court has also directed you to provide your medical, dental, mental health, and educational information and, if you know, the same information about the other parent or guardian. If you need help, the social worker or probation officer will help you fill out this form.

1Your name:

Your relationship to child: Your home address:

 

City:

 

State:

 

Zip code:

 

 

Your mailing address:

 

 

 

 

 

 

 

 

 

 

City:

 

State:

 

Zip code:

 

 

Your telephone:

 

 

 

 

 

 

 

 

1

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2

Your child’s name:

 

 

 

 

 

 

 

 

 

 

 

 

 

a. Your child’s date of birth:

 

 

 

 

 

 

 

 

 

 

 

b. Where was your child born?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City:

 

 

 

 

 

State:

 

 

Country:

 

Clerk stamps date here when form is filed.

Fill in court name and street address:

Superior Court of California, County of

Clerk fills in case number when form is filed.

Case Number:

c.Hospital:

d.Your child’s birth weight:

Child’s Health

1

3

Does your child have any physical or mental health challenges?

Yes

No

If yes, is your child receiving any assistance, services or treatment for these problems? (Explain):

a. Allergies:

b. Injuries:

c. Diseases:

d. Disabilities:

e. Other:

f. Other:

4 Is your child taking any medication?

Yes

No

 

 

If yes, please list the medicines and explain why your child is taking them:

 

 

 

Medication and dosage

Reason for taking medication

Date began

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5When was your child last seen by a doctor? Date:

Doctor’s name:

Doctor’s office address (include city, state, zip code): Doctor’s mailing address (include city, state, zip code): Doctor’s telephone number:

Judicial Council of California, www.courtinfo.ca.gov Revised January 1, 2008, Mandatory Form Welfare and Institutions Code, § 16010

Your Child's Health and Education

JV-225, Page 1 of 5

American LegalNet, Inc. www.FormsWORKFLOW.com

Child’s name:

Case Number:

6When was your child last seen by a dentist? Date:

Dentist’s name:

Dentist’s office address (include city, state, zip code): Dentist’s mailing address (include city, state, zip code): Dentist’s telephone number:

7List the names of all doctors, nurses, dentists, hospitals, clinics, and other health-care providers and healers who have seen your child within the past two years:

Name

 

Address (city, state, zip code) Date of last visit

Reason for visit

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

8What doctor, nurse, dentist, hospital, clinic, or other person has your child’s health records?

a.Medical records:

b.Dental records:

c.Mental health records:

9When was your child’s eyesight last tested?

Date of examination:

Who examined your child’s sight:

Address (include city, state, zip code):

Telephone number:

10

Does your child wear glasses?

Yes

No

11

Does your child wear a hearing aid?

Yes

No

12Is your child covered by an insurance policy?

a. Medical

Yes

No (If yes, specify insurance policy):

b. Dental

Yes

No

(If yes, specify insurance policy):

c. Vision

Yes

No

(If yes, specify insurance policy):

Child’s Education

13Before your child was removed from your home, what school did your child attend?

Name of school:

Address (include city, state, zip code):

a.

Is your child still allowed and able to attend this school?

Yes

No

 

b.

If no, did you agree to give up your child’s right to remain at this school?

Yes

No

c.Before removal, was your child receiving or had your child received any assistance or help at school or any assessments, evaluations, services, or accommodations to help your child with any physical, mental, or

learning-related disabilities or other special educational needs?

Yes

No

(1)If yes, what assessments, evaluations, services, or accommodations was your child receiving?

(2)Who gave your child these educational services?

Revised January 1, 2008

Your Child's Health and Education

JV-225, Page 2 of 5

Child’s name:

Case Number:

13d. If applicable, do you have a copy of your child’s individualized education program (IEP), section 504 plan,

individual family plan (IFP), or quality of life assessment?

Yes

No

e.What language did your child first learn to speak?

f.What is his or her primary language?

g.What language do you most often use when speaking to your child?

h.Has your child ever been identified as English proficient or as an English language learner by a school?

Yes

No

 

 

i. Has your child ever been enrolled in a specialized program to learn English?

Yes

No

14List all other schools or day care your child has attended: School (name, city, state):

School (name, city, state): School (name, city, state): School (name, city, state):

Dates of attendance: Dates of attendance: Dates of attendance: Dates of attendance:

15a. What grade is your child in?

b. Does he or she have any special needs? If yes, please describe:

Yes

No

c.If the child is three years old or younger, do you believe that the child may be eligible for services to help with motor, developmental, or other delays?

If yes, explain why:

What assessments, evaluations, services, treatment, or accommodations do you believe the child may need for the delay?

d.Do you believe the child may have a disability? If yes, please describe:

What assessments, evaluations, services, treatment, or accommodations do you believe the child may need for the disability?

Revised January 1, 2008

Your Child's Health and Education

JV-225, Page 3 of 5

Child’s name:

Case Number:

16 Has your right to make educational decisions for the child been limited?

Yes

No

If yes, who has the right to make educational decisions for the child?

Name:

Relationship to child:

Biological Parent’s Health and Education (You are required by Welfare and Institutions Code section 16010 to provide this information about yourself. If you do not want to provide this information, please talk to your attorney.)

17a. When were you last seen by a doctor and dentist?

(1)What medical problems run in your family?

(2) Do you have medical problems or disabilities?

(3) What medications do you take?

 

Medication

Reason for taking medications

b.What is your educational history?

(1)School last attended (name, city, state):

(2)Last grade completed:

18a. If you know, provide the following information about your child’s other parent:

(1)Name of other parent:

(2)Relationship to child:

Revised January 1, 2008

Your Child's Health and Education

JV-225, Page 4 of 5

Child’s name:

Case Number:

18a. (3) Other parent’s medical problems and disabilities

(Please include physical, mental, and learning problems):

(4) The child’s other parent takes the following medications:

Medication

Reason for taking medications

 

 

 

 

 

 

 

 

 

 

 

 

(5)The following medical problems run in the family of my child’s other parent:

b. My child’s other parent has the following educational history:

(1)School last attended:

(2)Last grade completed:

I declare under penalty of perjury under the laws of California that the information on this form is true and correct to my knowledge. This means that if I lie on this form, I am guilty of a crime.

Date:

 

 

 

 

 

 

 

 

 

 

 

 

Type or print parent’s/guardian’s name

Parent/guardian signs here

 

Date:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Type or print social worker’s name

Social worker signs here

 

Date:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Type or print probation officer’s name

Probation officer signs here

 

Revised January 1, 2008

Your Child's Health and Education

JV-225, Page 5 of 5