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h)

Current Educational Passport and School Enrollment Letter (CS-0657) with all supporting school documents including Individual Education Plan, Social Security Card and Birth Certificates or equivalency.

i)

TFACTS Health Summary, with supporting documents.  

12.

Other documents, which provide pertinent information about the child and family and are not included in the required attachments listed in #11 above also may be submitted by TN DCS Regional staff electronically by scan/e-mail, mail or fax, directed to the designated TN ICPC Administrator/Alternate.         

13.

In some instances, the Receiving State Administrator will “require” some of these secondary documents to be included as part of the Referral or may request some of the secondary documents prior to issuing a decision regarding placement.   If requested, TN DCS Regional staff will submit the requested information prior to placement electronically by scan/e-mail, mail or fax to the designated TN ICPC Administrator/ Alternate.  Such documents may include but not limited to:

a)

Current specific or specialty medical assessment;  

b)

Immunization records if not previously submitted;  

c)

Current Medication/Prescription records including dosages;

d)

Copy of Social Security Card if not previously submitted;  

e)

Birth Certificate if not previously submitted;  

f)

Current psychological assessment and treatment plan/regimen;  

g)

Current psychiatric assessment and treatment plan/regimen;  

h)

Current behavioral assessment and treatment plan/regimen;  

i)

Current counseling reports/ pertinent history including discharge summaries;     

j)

History and discharge Summaries on Residential Treatment placements;  

k)

Judicial and administrative reviews for children in care; and     

l)

If negotiated, a signed purchase of services agreement between TN DCS and a private licensed child-placing agency in the receiving state.  

Note: Placement decisions and placements may be delayed based upon when the receiving state gets this information and can accommodate any adjustments or support planning which may need to be modified.

Requirements for ICPC Referral packets which involve a child who is under the jurisdiction of a Tennessee court or in the custody/guardianship of a TN private licensed agency or any person including parents and relatives are listed in 2 separate manuals entitled ICPC Practice and Procedure Manual: Judicial Bench book and ICPC Practice and Procedure Manual: Private Agency/Parent Guardian proposed to be accessible on the TN DCS Web Page by March, 2012.

The Interstate Compact on the Placement of Children Procedures Manual

Revised: January, 2012                                                                                                                           Page 16

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