Foster/Adoptive Placement Questions

What is her name?
How old is she?
Why is she coming into care? (Has she been in care before?)
Does she have any special medical or physical needs?
Medication_____________________ Pharmacy___________________ Doctor________________________
Allergies to Medication _____________________ Other Allergies__________________________________
Where do we pick her up at? ________________________________________________________________
Who will meet us? _________________________ Phone Number _________________________________
Do we need to bring a car seat for her? ________ Clothes, Diapers, A Bottle? _______________________
Does she have any special dietary needs?
* What type of formula is she on?
* Has she had any baby food or solids?
Do you see this as a long-term placement? (Estimated guess at how long/timeline)
At this point, what are reunification plans for her and her family? (Hearing dates)
Are there any ‘No Contact’ orders? (If yes, actions to take if order is violated)
Does she have any siblings? (If yes, in foster care too? Visits?)
What are your plans for us – what do you want us to do? (Any special requests for documentation or needed observations of the child; cultural needs to be met; how do we best communicate with to you)?
What involvement would you like us to have with the birth parents? (Siblings?)
Do the parents know our names and address?
When will she have her first visit?
Who will do the visits?
When and how often will she have visits?
Who are the professionals we will be working with?
DHS Worker: Name ____________________________________ Email _________________________
Phone #s____________________________________ Agency ___________________________________
Other: Name ______________________________________ Email ____________________________
Phone #s ___________________________________________ Agency __________________________
Other: Name ______________________________________ Email ___________________________
Phone #s ___________________________________________ Agency __________________________
Other: Name ______________________________________ Email ___________________________
Phone #s ___________________________________________ Agency __________________________
Other: Name ______________________________________ Email ____________________________
Phone #s ___________________________________________ Agency __________________________
Other: Name ______________________________________ Email ____________________________
Phone #s ___________________________________________ Agency __________________________
Does she have a family doctor? Dr. _____________________ @. _______________________________
Phone#_______________________________ Address ________________________________________
Does the bio parent have a hospital preference? Hospital _______________________________________
How do you want us to handle doctor’s visits? (Paperwork?, bio parent involvement?, call you first?)
Does she have a Title 19 medical number or any other insurance?
Title 19 # _________________________________________________________________
Other Insurance: ___________________________________________________________
When and how often will you update us on hearings and family reunification progress?
How do we best communicate information to you? Get information from you?
Best time to contact you: ____________________________________________________________________
Best way to contact you: ____________________________________________________________________
Questions or issues would you like us to contact you about immediately:
What types of issues or questions would you like us to refer to our support worker on?
Do you have any suggestions/recommendations for setting up morning day care (8:30 – 12:00, Sept – May)?
How do you want us to record and turn-in reimbursement/receipts?
Additional Questions/Notes…
***Sign Placement Agreement***