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Signature of Notary Public My commission expires Signature Date Name of Requesting Agency DHR Contract if available Phone Number Address of Requesting Agency DHR-CHC-2175 Revised February 2009. 44. 25 Fee Required Criminal History Information Release Form Mail Release Form Fingerprint Cards and Mandatory History Notice to Send Money Order Cashier s Check or Certified check payable to Alabama Dept. of Human Resources Office of Criminal History Checks P. O. Box 304000 Montgomery Alabama...
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The DHR CHC 2175 form is a document for requesting a criminal history record check in the state of Alabama. It is typically used by employers or organizations that require information about an individual's criminal background for employment or volunteer purposes. This form is filled out by the person being checked, and upon submission, the Alabama Department of Human Resources (DHR) conducts the background check.
The DHR CHC 2175 form is typically required to be filed by individuals or organizations that provide residential child care services. This can include foster care agencies, group homes, residential treatment centers, or any other facility that provides care for children in a residential setting. The specific requirements for filing the form may vary depending on the state or jurisdiction. It is advisable to consult with local authorities or legal experts for accurate information regarding the filing requirements in a particular area.
The DHR CHC 2175 form, also known as the Child Health Check form, is used to assess the health and development of children. It is typically completed by medical professionals during routine check-ups or physical exams for children under the age of 21. The purpose of the form is to record and monitor the child's growth, as well as detect any potential health issues or developmental delays. The information gathered on the form is used to ensure that children receive appropriate care and interventions if needed. It may also be used for public health monitoring and research purposes.
The DHR CHC 2175 form typically requires the following information to be reported: 1. General information: - Child's name, date of birth, and address - Parent or guardian's name, address, and contact information 2. Incident details: - Date, time, and location of the incident - Description of the incident and circumstances leading up to it - Any injuries, physical or emotional harm caused, or threatened harm - Any witnesses present during the incident - Any actions taken to address the immediate safety of the child 3. Child's current and past conditions: - Details of any current or past physical or emotional health conditions, disabilities, or special needs of the child - Medications or treatments being taken or received by the child 4. Perpetrator information: - Identity and relationship of the alleged perpetrator(s) involved in the incident - If the alleged perpetrator is known to the child protective services or has prior incidents of abuse or neglect - Information about any other children or vulnerable individuals in the perpetrator's care 5. Additional information: - Any relevant history or prior reports of abuse or neglect involving the child or other individuals involved - Any ongoing or previous child protection, law enforcement, or legal involvement related to the child or the alleged perpetrator - Any immediate safety concerns for the child (e.g., access to weapons, drugs, or unsafe living conditions) - Any other pertinent details or observations related to the incident It is important to note that the specific requirements and guidelines for completing the DHR CHC 2175 form may vary depending on the state or jurisdiction. It is recommended to consult the official guidelines or instructions provided by the local Department of Human Resources (DHR) or Child Protective Services (CPS) for accurate and complete reporting.
The penalty for the late filing of the DHR CHC 2175 form may vary depending on the specific regulations and guidelines established by the relevant authority. It is advised to consult the specific regulations or contact the appropriate authority for accurate and up-to-date information regarding penalties.
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