HomeMy WebLinkAbout20153879.tiff RESOLUTION
RE: APPROVE STANDARD FORM FOR AUTHORIZATION FOR HEALTH CARE FOR
VARIOUS FOSTER CARE CHILDREN AND AUTHORIZE DIRECTOR OF THE
DEPARTMENT OF HUMAN SERVICES TO SIGN DOCUMENTS CONSISTENT WITH
SAID FORM
WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to
Colorado statute and the Weld County Home Rule Charter, is vested with the authority of
administering the affairs of Weld County, Colorado, and
WHEREAS, the Board, sitting as the Weld County Board of Human Services, has been
presented with the Authorization for Health Care from the Weld County Department of Human
Services, Division of Child Welfare, on behalf of various Foster Care children, and
WHEREAS, after review, the Board deems it advisable to approve said form, a copy of
which is attached hereto and incorporated herein by reference, and to delegate standing authority
to the Director of the Department of Human Services to execute individual authorization on behalf
of various Foster Care children.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld
County, Colorado, sitting as the Weld County Board of Human Services, that the form of said
Authorization for Health Care from the Weld County Department of Human Services, Division of
Child Welfare, on behalf of various Foster Care children, and hereby is, approved.
BE IT FURTHER RESOLVED by the Board that the Director of the Department of Human
Services be, and hereby is, authorized to sign any authorizations consistent with said form.
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 14th day of December, A.D., 2015.
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO
ATTEST: (LU
arbara Kirkmey r, Chair
Weld C• my Clerk to thef `` a�
EXCUSED
ike Freeman, Pro-Tem
BY:
Deputy Cler3to the Bo',•%' Igor
\ Sean P. Co way
APP AS TO 1ZO
0116-A. Cozad
bounty Attorney EXCUSED
/ Steve Moreno
Date of signature: �1 ���/� , 0- Citc)•
�/✓ /� 2015-3879
/l
HR0086
MEMORANDUM
DATE: December 1, 2015
TO: Board of County Commissioners—Pass-Around
i ,i ! it', FR: Judy A. Griego, Director, Human Services
2 COUNTY
RE: Weld County Department of Human Services' Child
Welfare Medical Authorization Form
Please review and indicate if you would like a work session prior to placing this item on the
Board's agenda.
Request Board Approval for the Departments Child Welfare Medical Authorization Form
(Attachment 1).The Authorization for Health Care form (CWS-25) is a State form that is utilized
by all counties. The Weld County Department of Human Services utilizes the form to assist Foster
Parents or Guardians in accessing Medical Services for children and/or youth in their care. The
form requires the signature of the Department's Director, Judy Griego, confirming that the
Department has been granted legal custody and therefore, is able to give consent to the Foster
Parent or Guardian to seek medical services.The form was updated by the State in 2014, and is
reviewed and required for all Foster Care Reviews and Foster Care Audits. The Department is
updating its form at this time to comply with the State requirements;this form has been reviewed
and approved by Bob Choate.
I do not recommend a Work Session. I recommend approval of this Form with Director
Signature.
Approve Request
BOCC Agenda Work Session
Sean Conway
Steve Moreno
Barbara Kirkmeyer
Mike Freeman
Julie Cozad 'Se
Pass-Around Memorandum; December 1, 2015 Page 1
CWS-25
COLORADO DEPARTMENT OF HUMAN SERVICES
Weld County
AUTHORIZATION FOR HEALTH CARE
1, Judy Griego Director of Weld
County Department of Social Services,have responsibility for the foster care placement of
by virtue of: (check one)
(Name of Child)
1. A court order giving the County Department guardianship
2. A court order giving the County Department legal custody;or
3. A placement contract with the parent(s)of said child.
I do hereby authorize to consent
to 1)ordinary medical and dental care; and, 2)to consent to any emergency surgical and dental treatment
for said child after having made reasonable effort to contact the County Department to obtain its consent.
The County Department shall be notified by the facility no later than the following working day of
any administration of emergency medical or surgical services provided under this authorization.
The facility is required to maintain a complete record of all medical and surgical services provided
and drugs administered to the above named child.
The facility will provide an up-to-date copy of the above medical record to the County Department at
the time of submittal of each progress report including the progress report submitted at the time of the child's
termination from the facility's care.
This authorization shall be in effect during the period of time the child is in the care of the facility.
Please Note:
Between 8arn and 5pm,Monday through Friday,please
contact your caseworker if emergency medical issues arise. Director,County Department of Social Services
If not available,ask the Customer Navigator at(970)352-1551
to direct you to a caseworker supervisor or manager.
After 5pm and before 8am,or on weekends or holidays,
please contact your local police department who will contact Date
the Department's after hours staff member to assist you.
CWS-25
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