Texas Department of Family and Protective Services Form 2649ins
HSEGH – Health, Social, Educational, and Genetic History Report October 2013
HSEGH Report Instructions for Contractors
Health, Social, Educational and Genetic History (HSEGH) Report is also known as the Adoption Readiness Report.
Designated DFPS staff will make a referral to the Contractor utilizing the following forms:
· 2700HSEGH, Routing and Approval
· 2054, Service Authorization
· 2644, HSEGH Referral
1. CASE FILE REVIEW: The following items in the DFPS client case file must be reviewed by the Contractor:
· All IMPACT narrative from SUB stage, FSU stage, and all stages previously opened, INV, FBSS, SUB, FSU,
· Initial Child’s Plan of Service (CPOS) from IMPACT,
· Current Child Plan of Service from IMPACT,
· IMPACT generated HSEGH,
· Applicable therapy notes, and
· Any other documents identified by DFPS.
2. CONTACTS: Contractor must contact individuals who have been identified on the HSEGH Referral form who may have additional information not in the DFPS client case file.
· The contractor will call the current caregiver for information as needed.
· The contractor may call/visit with staff in order to obtain information not readily available in the case file.
· Contractor must conduct a face-to-face interview with the child or biological family, when requested by DFPS.
3. DFPS CONTACT/ROUTING & APPROVAL: All referrals will go through the Designated DFPS Point of Contact for coordination, reading, and approving for payment.
· DFPS will provide copies of the files to be reviewed and mailed to the Contractor in hard copy or on a disk.
· Upon completion of the Report, the contractor will return all completed forms and documents provided/copied to the CPS office.
4. FORMAT: Compile and submit the Report in the following formats:
· Signed and dated report (usually a scanned pdf file)
· MS Word file (so you can copy/paste from document into IMPACT)
· Hard copy, with original signature (to be filed in the original case record)
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