Minn. R. agency 121, ch. 2920, RESIDENT ADMISSIONS AND RECORDS, pt. 2920.4400

Current through Register Vol. 49, No. 24, December 9, 2024

Part 2920.4400 - ADMISSION FORM

The adult community-based residential correctional facility referral form on each client to be admitted into residency includes at a minimum:

A. name;

B. address;

C. date of birth;

D. sex;

E. reason for referral;

F. whom to notify in case of emergency;

G. date information gathered;

H. signature of both interviewee and interviewer gathering information;

I. name of referring agency of committing authority;

J. special medical problems or needs;

K. legal status, including jurisdiction, length, and conditions of placement;

L. financial arrangements for medical care;

M. financial arrangements for placement;

N. present medications;

O. driver's license or Minnesota state identification number; and

P. vehicle title and vehicle insurance, if applicable.

Minn. R. agency 121, ch. 2920, RESIDENT ADMISSIONS AND RECORDS, pt. 2920.4400

9 SR 1655; 36 SR 635

Statutory Authority: MS s 241.021