va YYCN Afterhours Interview Form Date: 3/0 [Ip Time: 22.0 Youth Name: Ah Conde | Name of Calor: \Jholy Conde Relatonship to Youth: So~. (iy...) Telephone Number of Caller: 14-945-20e. Current Location: Sahoo! tending: BAH buts Hoy 3 Cable ree Are There Safety Concems Tonight: Thm fad ot Mom, Sid bee call. twa th Me bokchen, Werke) alberta, Mabe shebd yootle Wa Wh lar on A realty cee History of Violence, Drug/Alcohol Use, or Suicidal History: Urela , Desp © Bledl, [Any Current Agency/Profession involved with Youth: Rewh) & Oulelr fr PPR. RE | Summarize Recommendations & Response for Tonight: Wilke TE Gane. ody col) be eters Seneewlhy ) Sheginy Me fe Neckrmnds Adon Mele fe cell I, uo 4 rete te ctl beck e Ja’ So WY eke eal von becles Ley enfbotemert wa) ex The Sete. doling Ute te sNechle era BH sxrmas Hino} sesseszsey —zgite gtez/tzye0Yellowstone County Youth Services Center Secunia ors ga To ie aya ase ones as FACSIMILE COVER SHEET pare? 24 [IL To: Company Nae; YY CU _ te: Fax agi 4G . FROM: Company Name: _Youh Senzes Conter Sender: end y AIL Phone: 406.256.6825 Fax 408-256-6836, ‘Number of pages including this cover sheot:_2_ COMMENTS: YYCK) Atfelene) Taerune Fares Note: This message (including any attachments) may contain confidential information ‘and/or Protected Health Information (PH!) as defined in the Health Insurance Portability ‘and Accountability Act (HIPPA). This transmitted information is intended for use only by the individual(s) named above and is protected by law. Unless you are the employee ot agent responsible for delivery of this. message to the intended recipients), you are stricly prohibited from disseminating, distributing, copying or taking any action based ‘upon it. If you have received this fax in errr, please notify tho sender immediately by calling 406-256-6825. zo/t 304 spines Hunan seessgzsay — ast1z 9100/12/60