Form CFS600-4 "Sharing Information With the Caregiver" - Illinois

What Is Form CFS600-4?

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

Form Details:

  • Released on January 1, 2008;
  • The latest edition provided by the Illinois Department of Children and Family Services;
  • 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 CFS600-4 by clicking the link below or browse more documents and templates provided by the Illinois Department of Children and Family Services.

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Download Form CFS600-4 "Sharing Information With the Caregiver" - Illinois

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CFS 600-4
1/2008
State of Illinois
Department of Children and Family Services
SHARING INFORMATION WITH THE CAREGIVER
Child’s Name
ID
Birthdate
Placement Date
/
/
Caregiver / Placement Provider
Name
ID
Statutory Requirements: The Children and Family Services Act [20 ILCS 505/5 (u)] requires DCFS and POS
caseworkers to provide a child’s foster parent, prospective adoptive parent, relative caregiver or other caregiver
with all of the information necessary (listed below) to care for the child in writing within 10 days of the child’s
placement. In advance of the child’s placement, the DCFS or POS worker may provide the caregiver with a
summary of the information. If the placement is an emergency placement, the caregiver may be informed verbally of
the child’s needs but the information must subsequently be provided in writing. If any of the required information is
not available at the time of the child’s placement, it must be provided to the caregiver as it becomes available.
DCFS and POS caseworkers must obtain the caregiver’s signature on this form to verify that the information has
been provided on a timely basis. Within 10 days of the child’s placement, a copy of all of the same information must
also be forwarded to the guardian ad litem for the child. After it is signed, the CFS 600-4 is filed in the child’s
section of the case record.
If the placement is or becomes an adoptive placement, the prospective adoptive parents must be provided with all of
the information described in Rule 309 Adoption Services, Section 309.150.
I,
caseworker name, have provided the
caregiver of the above-named child with all of the following information on this date:
(Please check off all informational items provided to the caregiver)
CASE INFORMATION AND HISTORY
SACWIS Service Plan (Child’s Section), including current visitation plan and arrangements
Reason the child came into care
Permanency Goal
Legal Status
Other: (List)
HEALTH AND MEDICAL
Known medical problems
Communicable Diseases
Hospitalizations
Mental health/ Emotional disorders
Current medications/prescriptions, including instructions on when and how to dispense
Immunization Status
Medical card or Insurance
Other: (List)
– over –
DISTRIBUTION:
Original – Case File
Copy – Family
CFS 600-4
1/2008
State of Illinois
Department of Children and Family Services
SHARING INFORMATION WITH THE CAREGIVER
Child’s Name
ID
Birthdate
Placement Date
/
/
Caregiver / Placement Provider
Name
ID
Statutory Requirements: The Children and Family Services Act [20 ILCS 505/5 (u)] requires DCFS and POS
caseworkers to provide a child’s foster parent, prospective adoptive parent, relative caregiver or other caregiver
with all of the information necessary (listed below) to care for the child in writing within 10 days of the child’s
placement. In advance of the child’s placement, the DCFS or POS worker may provide the caregiver with a
summary of the information. If the placement is an emergency placement, the caregiver may be informed verbally of
the child’s needs but the information must subsequently be provided in writing. If any of the required information is
not available at the time of the child’s placement, it must be provided to the caregiver as it becomes available.
DCFS and POS caseworkers must obtain the caregiver’s signature on this form to verify that the information has
been provided on a timely basis. Within 10 days of the child’s placement, a copy of all of the same information must
also be forwarded to the guardian ad litem for the child. After it is signed, the CFS 600-4 is filed in the child’s
section of the case record.
If the placement is or becomes an adoptive placement, the prospective adoptive parents must be provided with all of
the information described in Rule 309 Adoption Services, Section 309.150.
I,
caseworker name, have provided the
caregiver of the above-named child with all of the following information on this date:
(Please check off all informational items provided to the caregiver)
CASE INFORMATION AND HISTORY
SACWIS Service Plan (Child’s Section), including current visitation plan and arrangements
Reason the child came into care
Permanency Goal
Legal Status
Other: (List)
HEALTH AND MEDICAL
Known medical problems
Communicable Diseases
Hospitalizations
Mental health/ Emotional disorders
Current medications/prescriptions, including instructions on when and how to dispense
Immunization Status
Medical card or Insurance
Other: (List)
– over –
DISTRIBUTION:
Original – Case File
Copy – Family
EDUCATIONAL INFORMATION AND HISTORY
Current placement or grade level
IEP
IFSP
504 Special Needs Plan
Case study evaluation or multi-disciplinary conference evaluation from the IEP, IFSP or
504 Special Needs Plan
Other: (List)
PLACEMENT HISTORY
Dates of all previous placements
Reasons for placement changes
Other: (List)
(Do not include identifying information on/addresses of previous caregivers)
BEHAVIOR/SOCIAL INFORMATION
Criminal background
Substance / alcohol abuse
Destructive behavior
Sexual behavior problems
Physically aggressive
Fire setting
Runaway
Eating disorder
Truant
Other: (List)
EMERGENCY PLACEMENTS
Current known information has been provided verbally to the caregiver. Written
documentation will be provided within 10 business days.
I understand that this form will be placed in the child’s case record and that supporting information in the
case record that is specific to the child may be viewed by the caregiver in the presence of casework staff.
Name of Caseworker Completing Form:
DCFS
Private Agency
Caseworker Signature
Date
Caregiver Signature
Date
Information was sent to the GAL on
(date)
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