www.MercyCareAZ.org
November 5, 2019
Reminder of Department of Child Safety required Court Forms

Applicable to: Mercy Care RBHA
As part of the court requirements for obtaining inpatient assessment and/or treatment for a child in out-of-home care, Department of Safety (DCS) staff must receive specific written reports from the inpatient psychiatrist, psychologist, or physician. This is a reminder to our providers of the requirements to complete the attached documents and the timelines the policy and statute outlines. 

These forms are designed to ensure the provider and DCS meet the statutory burden for the court to approve continued inpatient or out of home treatment for DCS youth (ARS 8-272 and 8-273). The letter from AHCCCS concerning DCS Forms is available by clicking on the link.  

The following forms need to be completed and returned to the assigned DCS Specialist at key points in the process:
 
  • Inpatient Assessment Report (CSO-1364A)
  • Must be provided by the medical provider within 72 hours of admission for an inpatient psychiatric assessment
  • Must be obtained at the point the medical provider recommends inpatient acute care and for placement/transfer to a Behavioral Health Inpatient Facility (BHIF)


  • 60 Day Review of Residential Treatment (CSO-1361)
  • If a child remains in a BHIF facility for at least 60 days or longer:
  • BHIF must submit this written progress report to the court and all parties (including attorneys)
  • The report must be submitted at least 5 days before the court’s review

 
These forms are available for your use and may be found on the Provider Forms tab on our website.  

As always, don't hesitate to contact your Mercy Care Provider Relations Representative with any questions or comments. You can find this notice and all other provider notices on our Mercy Care website.
 
We appreciate your continued assistance, support and cooperation!

                           
www.MercyCareAZ.org