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Description automatically generated

Policy Manual

Manual:

CP&P

Child Protection & Permanency

Effective Date: 8-17-2020

Volume:

X

Forms

Chapter:

A

Forms

Revised Date: 8-17-2020

Subchapter:

1

Forms

Issuance:

26.65

CP&P Form 26-65, Plan of Safe Care Termination Letter

 

Click here to view CP&P 26-65, Plan of Safe Care Termination Letter.

 

Click here to view CP&P 26-65(S), Spanish version of Plan of Safe Care Termination Letter. 

 

WHEN TO USE IT

 

This federally required form is used to identify and plan for newborns affected by substance use or withdrawal symptoms. This form allows the Worker to document service needs for the child and family. This form is a template designed for on-line use.

 

HOW TO USE IT

 

This form is currently not a NJ SPIRIT form. The Worker accesses the form by the hyperlink above. The Worker fills out the information on the form using the “Tab” key to navigate from field to field. Embedded instructions have been provided for clarity. Note: Use official agency letterhead while utilizing this form.

 

OTHER RELATED INFORMATION

 

The companion policy for this form can be accessed at clicking the hyperlink below.

Plan of Safe Care for Infants Identified at Birth and Affected by Substance Use or Drug Withdrawal

 

DISTRIBUTION

Original          -           Parent(s)

Copy               -           Case Record