Record Contents Sample Clauses

Record Contents. A. The TLA will file all forms, documents, and correspondence related to the ▇▇▇▇▇▇ home / applicant in the record. B. The TLA’s licensing records must contain: 1. All forms completed by the applicant or the TLA and all documents submitted in regards to licensing the ▇▇▇▇▇▇ home, examples include, but are not limited to the following: • Application for Licensure • Authorization for Release of Information - In-State • Authorization for Release of Information - Out-of-State • Request for Criminal Justice Information (Department of Public Safety form) • ▇▇▇▇▇▇ Family Characteristics Questionnaire • Parenting and Discipline Questionnaire • ▇▇▇▇▇▇ Parent Reference Questionnaire • Health History • Medical Release of Information • Mental Health Release of Information • Home Safety Checklist • Fire Escape Plan • ▇▇▇▇▇▇ Home Disaster Plan • ▇▇▇▇▇▇ Parent Provider Agreement • License • ▇▇▇▇▇▇ Parent Training Requirements • Annual Self-Monitoring Report 2. If applicable, the TLA will also maintain the following forms: • Waiver Request • Variance Request • Summary of Investigation • Plan of Correction • Family Tree 3. All correspondence, including printouts of e-mail messages; and 4. The TLA’s documentation of contacts and actions related to the ▇▇▇▇▇▇ home.