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Attorney Name:
Case Name:
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Abuse
Neglect
Abuse/Neglect
CHINS
Delinquency
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Client's Name:
Client's Address:
Client's Current Caregiver:
Caregiver Phone:
Case Resolution: (permanency achieved, not adjudicated, etc.)
Permanency: (reunification, adoption, aged-out, etc.)
There is no pending appeal or termination of parental rights action.
I certify that I will comply with Program policies for retention of this client's file.