Effective Date: 5-1-19
This section describes the manner in which case records are composed, maintained, and expunged. This section also explores a person’s access to records, sharing of confidential information, case documentation and case transfer procedures.
This Section contains the following chapters:
Chapter 1 – Case Records and Filing
1.3 – Adoption/Guardianship Subsidy File
1.4 – Resource Home (Licensing) Records
2.1 – Recording Guidelines – general
2.2.1 – Documenting the mapping Conversation
2.3 – Discussion with Division of Legal Services
2.4 – Policy Requirements Related to FACES Recording
2.5 – Recording and Documenting e-mail correspondence
2.6 – Documentation of Information Regarding Intimate Partner Violence
2.7 – Specifics on Documentation in Response to Investigations
2.8 – Specifics on Documentation in Case Management
2.9 – Specifics on Documentation in Resource Licensing
3.1 – CA/N Investigations/Family Assessments
3.3 – Alternative Care Records
3.4 – Procedures for Sharing Information
3.4.1 – Exceptions to a Person’s Right of Access
3.4.2 – Duty to Warn
3.5 – Other Persons/Agencies Entitled to Care Record Information
3.5.1 – Individuals
3.5.2 – Courts and Law Enforcement
3.5.3 – CA/N Reporters
3.5.4 – Physicians
3.5.5 – Researchers
3.5.6 – News Media, Legislators, Students, the Public
3.5.7 – Interdisciplinary Teams
3.5.8 – Interstate Requests
3.5.9 – Other Division Employees
3.5.10 – Minor Children
3.6 – Resource Provider Records
3.6.1 Foster Family, Relative and Respite Record Access
3.6.2 – Adoptive Family Record Access
3.6.3 – Adopted Adult Requesting Identifying Information
3.6.4 – Release of Information in Adoptions 3.6.4.1 Confirming the Identity of Individuals Requesting the Release of Information in Adoptions
3.6.4.2 – Searching for a Biological Parent
3.6.5 – Adopted Adult Requesting Non-Identifying Information
3.6.6 – Adoption Information Registry
3.7 – Health Insurance Portability and Accountability Act (HIPAA)
3.7.1 – “Minimum Necessary” Requirements for Sharing Protected Health Information
3.7.2 – Uses and Disclosures of Protected Health Information (PHI) which do not Require Authorization for Disclosure of Health Information
3.7.3 – Uses and Disclosures Requiring Authorizations for Disclosure of Health Information by DSS
3.7.4 – Client Requests to Restrict the Use and Disclosure of Protected Health Information
3.7.5 – Amendment of Protected Health Information
3.7.6 – Client’s Right to Access their Health Information on File in Children’s Division Records
3.7.7 – Accounting Disclosures of Protected Health Information
3.7.8 – Privacy Notices
3.7.9 – No Intimidation or Retaliation
3.7.10- Staff Access to Protected Health Information and Acknowledgement of Privacy Requirements
3.7.11 – Duty to Mitigate
3.7.12 – Emergency Policy
3.7.13 – Retention/Destruction of Protected Health Information
3.7.14 – Other General Documentation Requirements
3.7.15 – Complaint Process
3.7.16 – Workforce Training
3.7.17 – Sanctions
Chapter 4 – Case Record Transfer Procedures
4.1.1 – Intact Family Moves from County
4.1.2 – Intact Family Remains in State
4.1.3 – Intact Family Moves from State
4.2 – Child in Alternative Care
4.2.1 – Placed within State
4.2.2 – Placed out of State
4.3 – Parent of Child in Out-of-Home Care
4.3.1 – Moves within the State
4.3.2 – Moves out of State
4.4 – Change in Court Jurisdiction
4.5 – Family/Child Changes Children’s Service Worker
4.6 – Resource Home Licensure Supervision Transfer between Agencies
4.7 – Alternative Case Transfer to Subsidy/Subsequent Subsidy Case Transfer
Chapter 5 – Record Retention and Expungement
5.1.1 – Family Assessments
5.1.2 – Non-CA/N Referrals
5.1.3 – Unable to Locate Records
5.2 – Retention and Destruction – Other Records
5.2.1 – Removing Extraneous Material from the Record at Closure
5.2.2 – Removing Criminal History from Records
5.2.3 – Family-Centered Services (FCS) Case Records
5.2.4 – Family-Centered Out-of-Home Care Case (FCOOHC) Records
5.2.5 – Foster/Relative Resource Records
5.2.6 – Potential Adoptive Resource Records
5.2.7 – Adoption and Legal Guardianship Resource Records
5.2.8 – Residential Child Care and Child Placing Licensing Records
Definition of Terms
When discussing the composition of a case record the follow definitions are used:
Case Record: This refers to the entire amount of information the Children’s Division has on a family. This includes electronic and non-electronic information. There can be different types of records established in working with families. These include adoption records, licensing records and case records.
Chronological order: This is defined as oldest to newest (book-style). When deciding what date to use to determine chronological order, the following hierarchy will be used (in order of preference):
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- The date the document was written
- The date the document was signed
- The date the document was sent
- The date the document was received
- The date the document was found
The overall guiding principle when filing a case record is as follows: if a document or information is maintained electronically (i.e. in FACES, in Outlook, or scanned and uploaded to Document Imaging) then it does not need to be maintained in the paper case file. It is staff’s responsibility to ensure the scanned document is complete and legible.
NOTE: Paper copies of the birth certificate and social security card for a child should always be kept and not shredded.