Service Coordination Forms

Service Coordination Mechanism-
The Service Coordination Mechanism is a document that guides Service Coordination throughout the county.  The FCFC must follow the guidelines in the mechanism.

Service Coordination Brochure-
The brochure provides basic information regarding Service Coordination to families or agency workers.       (Microsoft Publisher is needed to open this brochure.)

Dispute Resolution Brochure-
This brochure provides basic information about the dispute resolution process.  (Microsoft Publisher is needed to open this brochure.)   

Quick Guide to Service Coordination-
This document serves as a quick guide to Service Coordination by outlining the Mechanism.  Included on the document is an outline of paperwork to be completed at certain meetings as well as who is responsible for certain tasks.

Authorization for Release of Information-
This form should be filled out and signed by the family before the referral packet is completed.  Please explain to families that by signing this release, agencies will be able to share information with each other.

Referral Packet-
This packet is to be completed by the agency worker in cooperation with the family to refer a child/family to Service Coordination.  It should be completed and returned to the Council Coordinator before the initial family meeting. 

Parent Advocate Form-
A parent advocate must be offered to a family before the Service Coordiation process begins.  This form must be signed by the family and returned to the Coordinator with the referral packet.  A parent advocate can be provided for a family at any time during Service Coordination.

Consent to Participate-
When a Family Team has been chosen, each member will sign this form as an agreement to participate on the Team.  It will also serve as an accountability tool for the family, Family Team Leader and Coordinator to ensure team members have agreed to their responsibilities as team members.

Family Team Meeting Tracking Log-
This form is to be completed at every meeting.  Please attach the Family Team Meeting Sign-In Sheet (found below) to the Tracking Log. 

Family Team Meeting Sign-In Sheet-
This form should be signed by members of the Family Team at every meeting held for the family and child. 

Family Service Coordination Plan-
The FSCP should be completed with cooperation from the family, team members, Family Team Leader and Coordinator.  It will serve as the individual plan for each family and should be specific to their needs.  The family should receive a copy of their plan.

Crisis Plan-
If deemed necessary by the family or Family Team, a Crisis Plan will be constructed along with the FSCP. 

Resource Directory-
This a directory of services available in Gallia County.