Form DCFS-126 "Community-Based Residential Care (Cbrc) Leave Tracking" - Oklahoma

What Is Form DCFS-126?

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

Form Details:

  • Released on March 15, 2005;
  • The latest edition provided by the Oklahoma Department of Human 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 printable version of Form DCFS-126 by clicking the link below or browse more documents and templates provided by the Oklahoma Department of Human Services.

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Download Form DCFS-126 "Community-Based Residential Care (Cbrc) Leave Tracking" - Oklahoma

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State of Oklahoma
Department of Human Services
Community-Based Residential Care (CBRC) Leave Tracking
Child
Date of admission
Agency
Placement year
to
Specialized community home (SCH)
Date
Date
Type
Total number
Number of
Number of
Approved
left
returned
of leave
of days
days paid
days not paid
Total AWOL allotted:
5
Total AWOL used:
Total AWOL claimed:
Total leave allotted:
10 Total leave used:
Total leave claimed:
Total hospital allotted:
10
Total hospital used:
Total hospital claimed:
Monthly liaison signature
Date
OKDHS ISSUED 3-15-2005
DCFS-126
State of Oklahoma
Department of Human Services
Community-Based Residential Care (CBRC) Leave Tracking
Child
Date of admission
Agency
Placement year
to
Specialized community home (SCH)
Date
Date
Type
Total number
Number of
Number of
Approved
left
returned
of leave
of days
days paid
days not paid
Total AWOL allotted:
5
Total AWOL used:
Total AWOL claimed:
Total leave allotted:
10 Total leave used:
Total leave claimed:
Total hospital allotted:
10
Total hospital used:
Total hospital claimed:
Monthly liaison signature
Date
OKDHS ISSUED 3-15-2005
DCFS-126
DCFS-126
Community-Based Residential Care (CBRC) Leave Tracking
Child
Date of admission
Agency
Placement year
to
Level B and residential maternity services
Date
Date
Type
Total number
Number of
Number of
Approved
left
returned
of leave
of days
days paid
days not paid
Total AWOL allotted:
5
Total AWOL used:
Total AWOL claimed:
Total leave allotted:
10 Total leave used:
Total leave claimed:
Monthly liaison signature
Date
2
OKDHS ISSUED 3-15-2005
Community-Based Residential Care (CBRC) Leave Tracking
DCFS-126
Child
Date of admission
Agency
Placement year
to
Level C
Date
Date
Type
Total number
Number of
Number of
Approved
left
returned
of leave
of days
days paid
days not paid
Total AWOL allotted:
5
Total AWOL used:
Total AWOL claimed:
Total leave allotted:
28 Total leave used:
Total leave claimed:
Monthly liaison signature
Date
OKDHS ISSUED 3-15-2005
3
DCFS-126
Community-Based Residential Care (CBRC) Leave Tracking
Child
Date of admission
Agency
Placement year
to
Level D
Date
Date
Type
Total number
Number of
Number of
Approved
left
returned
of leave
of days
days paid
days not paid
Total AWOL allotted:
20 Total AWOL used:
Total AWOL claimed:
Total leave allotted:
28 Total leave used:
Total leave claimed:
Monthly liaison signature
Date
4
OKDHS ISSUED 3-15-2005
Community-Based Residential Care (CBRC) Leave Tracking
DCFS-126
Child
Date of admission
Agency
Placement year
to
Level D+ and Level E
Date
Date
Type
Total number
Number of
Number of
Approved
left
returned
of leave
of days
days paid
days not paid
Total AWOL allotted:
Total AWOL used:
Total AWOL claimed:
Total leave allotted:
28
Total leave used:
Total leave claimed:
Monthly liaison signature
Date
OKDHS ISSUED 3-15-2005
5
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