Transcription of Children’s Residential Facilities Programs DHS …
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Children’s Residential Facilities Programs DHS …
Children s Residential Facilities Programs DHS critical incident reporting form Within 10 days of the incident , submit one copy of this form with any attachments to your licensor: Division of Licensing Fax Number: 651-431-7673 (please include licensor s name on cover page) Facility License Number Facility Name Person reporting Date of Report Telephone Number Date of incident Time AM PM Staff Involved All Resident(s) Involved - Full Name(s) incident Type (check as applicable incident definitions)
Children’s Residential Facilities Programs DHS Critical Incident Reporting Form . Within 10 days of the incident, submit one copy of this form …
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