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Intake Forms

Various forms required for the admission of a new resident
File Complete Intake Packet 1/3
File Complete Intake Packet 2/3
File Complete Intake Packet 3/3
Index of intake forms
These forms are downloadable individually or as a complete packet in ZIP format. Click on the form name in the table below to download.
File Resident Handbook
File Authorization for Emergency Treatment
File Community Services Waiver
File Consent for Medical Treatment
File Insurance Information
File Info Letter for Family
File Letter to Parents regarding medical bills
File Medical Screening Pre Intake
File Parent Contract
File Parent Questionnaire
File Photo Authorization
File Probation Officer Checklist
File Release of Information
File Reporting Responsibilities
File Special Accommodations Form
File Visitor Confidentiality Form
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Board Meeting Oct 17, 2023 10:00 AM - 12:00 PM — PMCJF-1625 Commerce Drive, New Lexington, Ohio 43764
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