I am a caseworker in need of assistance.
What is your name?
Your answer
What is the name of your agency?
What is the child's name?
Your answer
What age range is the child?
Has the child been previously screened for admission to Miami Bridge and denied?
Where is the child now?
Is the youth prescribed any medication?
Is there a safety plan?
Describe safety plan if one is in place.
If no, please type N/A.
Your answer
Mental Health Diagnosis and Baker Act History:
If no, please type N/A.
Your answer
Has the youth been convicted of a sexual related crime?
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