Juvenile Justice Face Sheet
JUVENILE JUSTICE FACE SHEET
Initial Date (mm/dd/yyyy)[c1] / Six Month Review Date (mm/dd/yyyy)
[c2] / Closing Summary Date (mm/dd/yyyy)
[c3]
JUVENILE IDENTIFYING INFORMATION
Name - Juvenile
[c4] / Birthdate - Juvenile
[c5]
Address - Juvenile (Street, City, State, Zip Code)
[c6] / Telephone Number - Juvenile
[c7]
Name - Juvenile's Therapist
[c8] / Diagnosis
[c9]
Medications
[c10]
Physical Description - Juvenile
Height - Juvenile
[c11] / Weight - Juvenile
[c12] / Hair Color - Juvenile
[c13] / Eye Color - Juvenile
[c14]
Identifying Marks - Juvenile
[c15]
Parent Information
Name - Mother Role: [c16] Biological[c17] Adoptive[c18]Step [c19]Other / Birthdate - Mother
[c20] / [c21]
Address - Mother (Street, City, State, Zip Code)
[c22] / Telephone Number - Mother
[c23]
Significant Other – Mother
[c24]
Name - Father Role: [c25] Biological [c26] Adoptive [c27]Step [c28]Other / Birthdate - Father
[c29] / [c30]
Address - Father (Street, City, State, Zip Code)
[c31] / Telephone Number - Father
[c32]
Significant Other - Father
[c33]
Siblings Living at Home
Name
[c34] / Birthdate (mm/dd/yyyy)
[c35] / Age
[c36]
Name
[c37] / Birthdate (mm/dd/yyyy)
[c38] / Age
[c39]
Name
[c40] / Birthdate(mm/dd/yyyy)
[c41] / Age
[c42]
Name
[c43] / Birthdate (mm/dd/yyyy)
[c44] / Age
[c45]
Name
[c46] / Birthdate (mm/dd/yyyy)
[c47] / Age
[c48]
Others Living in the Home
Name
[c49] / Relationship
[c50]
Name
[c51] / Relationship
[c52]
Name
[c53] / Relationship
[c54]
Name
[c55] / Relationship
[c56]
Name
[c57] / Relationship
[c58]
PLACEMENT INFORMATION
Name - Caretaker
[c59] / Telephone Number - Caretaker
[c60]
Address (Street, City, State, Zip Code)
[c61] / School
[c62]
Agency / Social Worker
[c63] / Placement Begin Date
[c64]
SUPERVISION STATUS
Judge
[c65] / Case Type
[c66] / Case Number
[c67]
Offense
[c68]
Effective Date (mm/dd/yyyy)
[c69] / Expiration Date (mm/dd/yyyy)
[c70] / Case Extension (mm/dd/yyyy)
[c71]
Victim
[c72] / Restitution Amount
[c73] / Community Service Hours
[c74]
Other
[c75]
Judge
[c76] / Case Type
[c77] / Case Number
[c78]
Offense
[c79]
Effective Date (mm/dd/yyyy)
[c80] / Expiration Date (mm/dd/yyyy)
[c81] / Case Extension (mm/dd/yyyy)
[c82]
Victim
[c83] / Restitution Amount
[c84] / Community Service Hours
[c85]
Other
[c86]
Judge
[c87] / Case Type
[c88] / Case Number
[c89]
Offense
[c90]
Effective Date (mm/dd/yyyy)
[c91] / Expiration Date (mm/dd/yyyy)
[c92] / Case Extension (mm/dd/yyyy)
[c93]
Victim
[c94] / Restitution Amount
[c95] / Community Service Hours
[c96]
Other
[c97]
[c98]
AGENCY REFERRALS / COURT HISTORY
(Please note referral dates / charges / outcomes)
[c99]
DETENTION PLACEMENTS
(Please note start dates / end dates / placements / reasons / outcomes)
[c100]
SERVICES / SIGNIFICANT INFORMATION
(Please note referral dates / services / agencies / service dates / addresses / telephone numbers / actions / other)
[c101]
Juvenile Justice Face Sheet
DCF-F (CFS 2235) (R. 03/2009) Page 1 of 2
[c1]This is a user entered field.
This field can be edited on the template.
[c2]This is a user entered field.
This field can be edited on the template.
[c3]This is a user entered field.
This field can be edited on the template.
[c4]This field is pre-filled.
This field is not editable on the template.
The data can be corrected as follows: the child’s Name can be changed in the First/Last Name fields on the Person Management page/Basic tab.
[c5]This field is pre-filled.
This field is not editable on the template.
The data can be corrected as follows: the child’s Birth Date can be changed in the Birth Date field on the Person Management page/Basic tab
[c6]This field is pre-filled.
This field is not editable on the template.
The data can be corrected as follows: the child’s address can be changed in the Address field on the Person Management page/Address tab.
[c7]This field is pre-filled.
This field is not editable on the template.
The data can be corrected as follows: the child’s telephonenumber can be changed in the Home Phone field on the child's Person Management page/Address tab.
[c8]This is a user entered field.
This field can be edited on the template.
[c9]This is a user entered field.
This field can be edited on the template.
[c10]This is a user entered field.
This field can be edited on the template.
[c11]This is a user entered field.
This field can be edited on the template.
[c12]This is a user entered field.
This field can be edited on the template.
[c13]This is a user entered field.
This field can be edited on the template.
[c14]This is a user entered field.
This field can be edited on the template.
[c15]This is a user entered field.
This field can be edited on the template.
[c16]This checkbox is user selected.
This field can be updated on the template.
[c17]This checkbox is user selected.
This field can be updated on the template.
[c18]This checkbox is user selected.
This field can be updated on the template.
[c19]This checkbox is user selected.
This field can be updated on the template.
[c20]1This field is pre-filled.
The field is not editable on the template.
The data can be corrected as follows: the mother's name can be changed on the mother's Person Management page/Basic tab. A new person can be selected as Mother on the child's Person Management page/Parent Info tab.
[c21]This field is pre-filled.
This field is not editable on the template.
The data can be corrected as follows: the mother’s Birth Date can be changed in the Birth Date field on the mother's Person Management page/Basic tab.
[c22]This field is pre-filled.
This field is not editable on the template.
The data can be corrected as follows: the address can be changed in the Address field on the mother's Person Management page/Address tab.
[c23]This field is pre-filled.
This field is not editable on the template.
The data can be corrected as follows: the telephone number can be changed in the Phone field on the mother's Person Management page/Addresstab.
[c24]This is a user entered field.
This field can be edited on the template.
[c25]This checkbox is user selected.
This field can be updated on the template.
[c26]This checkbox is user selected.
This field can be updated on the template.
[c27]This checkbox is user selected.
This field can be updated on the template.
[c28]This checkbox is user selected.
This field can be updated on the template.
[c29]This field is pre-filled.
The field is not editable on the template.
The data can be corrected as follows: the father's name can be changed on the father's Person Management page/Basic tab. A new person can be selected as Father on the child's Person Management page/Parent Info tab.
[c30]This field is pre-filled.
This field is not editable on the template.
The data can be corrected as follows: the father’s Birth Date can be changed in the Birth Date field on the father's Person Management page/Basic tab.
[c31]This field is pre-filled.
This field is not editable on the template.
The data can be corrected as follows: the address can be changed in the Address field on the father's Person Management page/Address tab.
[c32]This field is pre-filled.
This field is not editable on the template.
The data can be corrected as follows: the telephone number can be changed on the father's Person Management page/Addresstab.
[c33]This is a user entered field.
This field can be edited on the template.
[c34]This is a user entered field.
This field can be edited on the template.
[c35]This is a user entered field.
This field can be edited on the template.
[c36]This is a user entered field.
This field can be edited on the template.
[c37]This is a user entered field.
This field can be edited on the template.
[c38]This is a user entered field.
This field can be edited on the template.
[c39]This is a user entered field.
This field can be edited on the template.
[c40]This is a user entered field.
This field can be edited on the template.
[c41]This is a user entered field.
This field can be edited on the template.
[c42]This is a user entered field.
This field can be edited on the template.
[c43]This is a user entered field.
This field can be edited on the template.
[c44]This is a user entered field.
This field can be edited on the template.
[c45]This is a user entered field.
This field can be edited on the template.
[c46]This is a user entered field.
This field can be edited on the template.
[c47]This is a user entered field.
This field can be edited on the template.
[c48]This is a user entered field.
This field can be edited on the template.
[c49]This is a user entered field.
This field can be edited on the template.
[c50]This is a user entered field.
This field can be edited on the template.
[c51]This is a user entered field.
This field can be edited on the template.
[c52]This is a user entered field.
This field can be edited on the template.
[c53]This is a user entered field.
This field can be edited on the template.
[c54]This is a user entered field.
This field can be edited on the template.
[c55]This is a user entered field.
This field can be edited on the template.
[c56]This is a user entered field.
This field can be edited on the template.
[c57]This is a user entered field.
This field can be edited on the template.
[c58]This is a user entered field.
This field can be edited on the template.
[c59]This field is pre-filled (if no open placement, the field will be blank).
This field is not editable on the template.
The data can be corrected as follows: a change to the caretaker name can be updated on Parent 1's Provider Maintenance page/Home tab.
[c60]This field is pre-filled (if no open placement, the field will be blank).
This field is not editable on the template.
The data can be corrected as follows: a change to the caretaker telephone number can be updated on the Maintain Physical Address page for the provider.
[c61]This field is pre-filled (if no open placement, the field will be blank).
This field is not editable on the template.
The data can be corrected as follows: a change to the caretaker address can be updated on the Maintain Physical Address page for the provider.
[c62]This is a user entered field.
This field can be edited on the template.
[c63]This field is pre-filled (if no open placement, the field will be blank).
This field is editable on the template (for printing purposes only).
The data can be corrected as follows: the worker name will be updated if another worker is assigned to the provider (Maintain Worker Information page).
[c64]This field is pre-filled (if no open placement, the field will be blank).
This field is not editable on the template.
The data can be corrected as follows: end the current placement and creating a new (current) placement.
[c65]This is a user entered field.
This field can be edited on the template.
[c66]This is a user entered field.
This field can be edited on the template.
[c67]This is a user entered field.
This field can be edited on the template.
[c68]This is a user entered field.
This field can be edited on the template.
[c69]This is a user entered field.
This field can be edited on the template.
[c70]This is a user entered field.
This field can be edited on the template.
[c71]This is a user entered field.
This field can be edited on the template.
[c72]This is a user entered field.
This field can be edited on the template.
[c73]This is a user entered field.
This field can be edited on the template.
[c74]This is a user entered field.
This field can be edited on the template.
[c75]This is a user entered field.
This field can be edited on the template.
[c76]This is a user entered field.
This field can be edited on the template.
[c77]This is a user entered field.
This field can be edited on the template.
[c78]This is a user entered field.
This field can be edited on the template.
[c79]This is a user entered field.
This field can be edited on the template.
[c80]This is a user entered field.
This field can be edited on the template.
[c81]This is a user entered field.
This field can be edited on the template.
[c82]This is a user entered field.
This field can be edited on the template.
[c83]This is a user entered field.
This field can be edited on the template.
[c84]This is a user entered field.
This field can be edited on the template.
[c85]This is a user entered field.
This field can be edited on the template.
[c86]This is a user entered field.
This field can be edited on the template.
[c87]This is a user entered field.
This field can be edited on the template.
[c88]This is a user entered field.
This field can be edited on the template.
[c89]This is a user entered field.
This field can be edited on the template.
[c90]This is a user entered field.
This field can be edited on the template.
[c91]This is a user entered field.
This field can be edited on the template.
[c92]This is a user entered field.
This field can be edited on the template.
[c93]This is a user entered field.
This field can be edited on the template.
[c94]This is a user entered field.
This field can be edited on the template.
[c95]This is a user entered field.
This field can be edited on the template.
[c96]This is a user entered field.
This field can be edited on the template.
[c97]This is a user entered field.
This field can be edited on the template.
[c98]This is a user entered field.
This field can be edited on the template.
[c99]This is a user entered field.
This field can be edited on the template.
[c100]This is a user entered field.
This field can be edited on the template.
[c101]This is a user entered field.
This field can be edited on the template.