AOC-DNA-12 Doc. Code: DNADR Rev. 1-15 Page 1 of 4 Commonwealth of Kentucky Court of Justice www.courts.ky.gov FCRPP 28 COM M O NW E A LT H O F K E lex et justitia Case No. ____________________ Court [ ] District [ ] Family County ______________________ NT U C KY RT OF JUS TI DEPENDENCY/NEGLECT OR ABUSE Division _____________________ DISPOSITIONAL REPORT The Cabinet for Health and Family Services, Department for Community Based Services, submits the following Dispositional Report to the Court which, pursuant to FCRPP 28, must be filed three (3) days prior to the disposition hearing. IN THE INTEREST OF: ____________________________________________________________________, A CHILD DOB Parent(s): Mother's Name: __________________________________________________________________________________ Mother's Address: ________________________________________________________________________________ DOB Sex Race SSN Sex Race SSN Father's Name: __________________________________________________________________________________ Father's Address: ________________________________________________________________________________ DOB Sex Race SSN I. Present Situation: (e.g. How are the children doing, how are the parents doing, what type of placement are the children in, etc.) _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ II. Case History: (What is the case history with the child/family and the agency?) _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ American LegalNet, Inc. www.FormsWorkFlow.com C CO U E AOC-DNA-12 Rev. 1-15 Page 2 of 4 Case No. ___________________________ III. Current Status of the Case: (If the child has NOT been removed from the home proceed to Section IV below.) 1. A description of the state child protective service agency's efforts to prevent removal of the child from home: _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ 2. If the child is removed, a description of the state child protective service agency's efforts to reunify the family: _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ 3. If removal or continued placement out of the home is recommended by the state child protective service agency, an explanation of why the child cannot safely be placed in the home: _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ 4. A description of any efforts to notify and locate absent parents: _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ 5. Identification of all relatives contacted for possible placement with child and why those relatives are not recommended for placement: _______________________________________________________________________________________________ _______________________________________________________________________________________________ ______________________________________________________