Obtain signatures on the following: (Leave a copy with caregiver. Keep a copy for the file)
 Authorization for General Medical Care for a Child Placed by the Juvenile Court
DSS CWS 421
SOC 156  Agency-Foster parent Agreement
 Notice of Emergency Shelter or Respite Care Placement
 Dangerous Propensities
 Foster Child Personal Property and Valuables Inventory
DSS CWS 512-A
Print from Database
DSS CWS 429
 Rights of Children in Foster Care
Complete as stated below:
DSS CWS 706
 SDM Placement Assessment
(Complete both sides, bring back, complete DSS CWS 769 if applicable)
 Substitute Care Provider Placement Support Plan
(Complete after the placement assessment if intervention is necessary, leave a copy and keep copy for the file.)
Complete the following forms and return as they apply:
DSS CWS 769-A
DSS CWS 769
 Authorization for Initial/Special Needs Clothing Allowance & Resource Parent Agreement DSS CWS 605
 Authorization for Reimbursement of Education Travel
Review and leave with caregiver:
 Welcome Letter for New Foster Care Placements
 About Your Child (AYC)/All About Me (AAM) Letter to Foster Parent
 About Your Child (AYC) Questionnaire (Review the form completed by prior caregiver)
 All About Me (AAM) Survey (If youth is able, have them complete for the new caregiver)
 Developmental Disability Rate
 Medi-Cal Eligibility Verification
 Whom to Call (1)
 Centrally Stored Medication and Destruction Record
 Health Encounter Form (2 copies with envelopes)
Resource/informational documents to leave with caregiver:
 Resource Family Home Insurance Fund
 Medical and Dental Examinations Letter
 CHDP Provider List/ Denti-Cal Provider List
 Director’s Letter Smoke Avoidance/CA Smoke Free Cars
 Use of Short Term Babysitters/Prudent Parent(s)
 Caregiver Information Sheet
 Standard (Universal) Precautions
 Substitute Care Provider Resource List
 RFA Grievance Review Request (with return envelope)
 Important Changes Car Safety Seat Law
 CA Child Passenger Safety Law (car seats)
 Important Information for Relatives
 Health Checkups for Children in Foster Care
 Service Satisfaction Survey
DSS CWS 326
DSS CWS 922
DSS CWS 891-A
DSS CWS 891-B
DSS CWS 891-C
DSS FC 864
DSS CWS 155
DSS CWS 879
LIC 622
DSS CWS 148
DSS CWS 515
DSS FC 873
CHDP/Denti-Cal
DSS CWS 638
DSS CWS 416
DSS CWS 417
DSS CWS 834
DSSNet
DSS CWS 710
CSSL Flyer
PUB 269
PUB 456
DSS FC 79
DSS 340
DSS CWS 715-B (Rev 03/05/14) RFA Placement Checklist
– Job 12B