Form DCF-2126 "Regional Resource Group Consultation Request" - Connecticut

What Is Form DCF-2126?

This is a legal form that was released by the Connecticut State Department of Children and Families - a government authority operating within Connecticut. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on February 1, 2018;
  • The latest edition provided by the Connecticut State Department of Children and Families;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form DCF-2126 by clicking the link below or browse more documents and templates provided by the Connecticut State Department of Children and Families.

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Download Form DCF-2126 "Regional Resource Group Consultation Request" - Connecticut

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State of Connecticut Department of Children and Families
REGIONAL RESOURCE GROUP CONSULTATION REQUEST
DCF-2126
2/18 (Rev.)
Page 1 of 1
DCF Office:
(or) Regional Unit:
Assigned to:
Please Select DCF Office
Name of Person Making Referral:
Phone:
Date:
Case Type:
Adolescent
FAR
FASU
Intake
Juvenile Services
Ongoing Services
Permanency
Probate
Special Investigations Unit
Voluntary Services
Reason for Consultation: (check the ONE box that applies)
There is an emergency we have become aware of in the last 24 hours.
The child is in the hospital (inpatient) and is in need of discharge planning.
Case needs to be reviewed for treatment recommendations due to mental health, substance use, intimate partner violence, education or medical issues.
We are updating the RRG on issues from a prior consultation.
Type of Consult:
Education
Intimate Partner Violence
Medication
Mental Health
Nursing
Substance Use
(check all that apply)
Case Name:
Date Case Opened:
DCF Legal Status:
LINK #:
Please Select One
Child’s Name:
DOB:
Race:
Ethnicity:
Gender:
Please Select One
Please Select One
Is Child in Placement?
Yes
No
If Yes, where?:
What are the questions for the RRG?
Brief History: (relevant to the type of consult and questions above)
Has the RRG been previously involved in this case?
Yes
No. If Yes, who and when?
State of Connecticut Department of Children and Families
REGIONAL RESOURCE GROUP CONSULTATION REQUEST
DCF-2126
2/18 (Rev.)
Page 1 of 1
DCF Office:
(or) Regional Unit:
Assigned to:
Please Select DCF Office
Name of Person Making Referral:
Phone:
Date:
Case Type:
Adolescent
FAR
FASU
Intake
Juvenile Services
Ongoing Services
Permanency
Probate
Special Investigations Unit
Voluntary Services
Reason for Consultation: (check the ONE box that applies)
There is an emergency we have become aware of in the last 24 hours.
The child is in the hospital (inpatient) and is in need of discharge planning.
Case needs to be reviewed for treatment recommendations due to mental health, substance use, intimate partner violence, education or medical issues.
We are updating the RRG on issues from a prior consultation.
Type of Consult:
Education
Intimate Partner Violence
Medication
Mental Health
Nursing
Substance Use
(check all that apply)
Case Name:
Date Case Opened:
DCF Legal Status:
LINK #:
Please Select One
Child’s Name:
DOB:
Race:
Ethnicity:
Gender:
Please Select One
Please Select One
Is Child in Placement?
Yes
No
If Yes, where?:
What are the questions for the RRG?
Brief History: (relevant to the type of consult and questions above)
Has the RRG been previously involved in this case?
Yes
No. If Yes, who and when?