Transcription of CHILDREN’S PROTECTIVE SERVICES REQUEST FOR …
{{id}} {{{paragraph}}}
Example: bankruptcy
CHILDREN’S PROTECTIVE SERVICES REQUEST FOR …
[ N a m e ] C o u n t y B o a r d : [ B o a r d M e m b e r N a m e s ] [ A D D R E S S ] [ C I T Y ] , M I C H I G A N [ Z i p C o d e ] [PhoneN u m b e r ] DHS-1163-M (Rev. 2-09) MS Word 1 STATE OF MICHIGAN DEPARTMENT OF HUMAN SERVICES CHILDREN S PROTECTIVE SERVICES REQUEST FOR MEDICAL information Case Name TO: Case Number County District Section Unit Worker Concerning Family/Household Members Date(s) of Birth There is a compelling need for the medical records held by you or your agency, pertinent to a Children s PROTECTIVE SERVICES (CPS) investigation on the family/household member(s) identified above, to determine if child abuse/neglect has occurred or to protect a child.
DHS-1163-M (Rev. 2-09) MS Word 2 Please call me at the phone number listed below if you have any questions. The information requested is essential to …
Loading..
Tags:
Information
Domain:
Source:
Link to this page:
Please notify us if you found a problem with this document:
Related search queries
Family Portability Information U.S. Department of, Family Portability Information, Information, Youth and Family Guide, Family Report, Department, Family Report U, Form 2792, Family Member Medical Summary, Family, Housing Choice Voucher Program Effective JULY, Urgent: TRICARE needs information about, Express Scripts, DEPARTMENT OF THE TREASURY, DEPARTMENT OF THE TREASURY Internal Revenue Service, Internal Revenue Service