Get Nc Dss-5295 2021-2026

The NC DSS-5295 form, known as the North Carolina Monthly Permanency Planning Contact Record, is essential for documenting visits related to out-of-home placements. This guide will provide clear, step-by-step instructions on how to complete this form online to facilitate accurate reporting and ensure continuity of care for the child involved.

Follow the steps to effectively complete the NC DSS-5295 form online.

1. Start by clicking the ‘Get Form’ button to obtain the NC DSS-5295 and open it in the editor of your choice.
2. Fill in the agency name at the top of the form to identify your organization.
3. Enter the visit date in the designated format (MM/DD/YYYY) for accurate tracking of visits.
4. Select the placement type from the available options such as Foster Care, Kinship Care, or Group Home, based on the child's living situation.
5. Provide the first and last names, ages, and permanent plans for all children or sibling groups being visited. Check the box if the child participated in the conversation.
6. List any other children in the home, identifying only their gender, age, and status (adoptive, birth, or foster). If the child is in a group setting, note that as N/A.
7. Fill out the names of foster or kinship parents, marking their participation in the discussion if applicable.
8. For placements in group homes or residential settings, list the names of direct care providers and note their participation as well.
9. Describe the placement environment, noting any changes in the household or the group home that may affect the child.
10. Address the well-being of the placement provider, including social support, services needed, and health status.
11. Report on the safety and supervision in the placement, verifying that children feel secure and appropriate boundaries are respected.
12. Assess the child’s behavior, schooling, health, and engagements, documenting any concerns or notable points.
13. Conclude with a general narrative summarizing the visit and any follow-up activities identified during your assessment.
14. Ensure that the agency representative completing the tool signs and dates the form before submission.
15. Finally, distribute the document to relevant parties such as licensing workers, foster/kinship parents, and supervisors.

Complete your NC DSS-5295 form online today to ensure accurate documentation and support for children in out-of-home placements.