cessor . Rev. 72013 ‘Caseworker Name: Cher ones. ‘Caseworker Phone: 8. 651-9509, Cswwavker Fax: 87888-7677 Sia of aos Deparment of Chilren and Fay Sevies DCFS RESOURCE REFERRAL FORM (1) Name ofrequested provider iobby Hore ‘Contact #9627726 Provider adress 314SMainge jckeonils IL 62650 Powe ts 207-265-7708 2) Service(Cheekone): _ E]Visiaion Cabin) Transporation for appointments) Corer Training —C]Generl Couseting C)Serual Abuse Counseing [1] Pre-Adoption Couneling Citearng impaired nerpreter Language nerprcter C]Mentoring/Advocacy C] Toxicology Cocsnp Cl Adut sexual Perctator — C] Therapie Counseling Services| Cloter éspcit Servie is Court Ordered: BINo Cl Yer(ifyes atch Onder) ©) Client name (Head of household: Jessen Fliman Adiress: 246E.Raihoad Ave, ‘Gene, 60155 = [DCFS Open CYCIS Family IDW (Ends in 0): 54361900, RSF Code; 24-03 Bat eterrat Revision (Clestension/Continuation For dhisreferal, 12___~ Maximum tal numberof ours fequested per MONTH Requested tar date: 070972001, Anticipated stop date: 0092022 (8 more thax 6 montis way be authorized ote hor ops on page 4) Amtcipate date of DCFS eas losing: UKN (9) Name of referred lent: Emmeimo Referred len DCFS CYCIS IDI; $561903 MedicsgH RIN, 223332610 Clint Adress: 123 Sherwood Drive Gevesso e698 ‘Work phone: 308.985.6429 HomaCel phone: 308.5. (6 Other persons who willbe nvalved (Explainieserbe): None(lieot name (Head of household: Jessica Foiman Hi mE Involved hidren | p.0.8. | wat | cvcisipe | cose curent Adseos Phone [Ena lech [ves] 34861903 | PHB [15 Stenvond Drive, Gens, ILO [RRB © (9) ay Permaneney Goal fr above children who are wands: Return home within 2 mont “Targeted Achievement Ds ‘ext court die 07180001 Type of hearing: PRE ‘Special communication needs andlor instructions tthe provider: None, Describe in deat the service(s) tobe provided and the problem areas he service(s) will address: “Transporation oan fam Monarch Trauma Counseling Cente, 1600 30th Ave Moline, I, 61263 for appointments 24 Limes per menth “Transporation to physical therapy appointments at Genesis Medial Center, 1227 E Risholme St, Davenport. TA 0805 or appoinasents 2 times per month Documentation thats ATTACHED to his referral: C] Famity Service Plan C].CANTS metrias (Medical Casal — Chintegrted Assessment Mental Hes Date sation in Lcerar Rete otrormation [other (Speci ‘or PROMISED by (Enter & Cluny Service Pn] CANTS materia CMecics! Clega! — Cnegrted Assessment Menta eats = CUCERAP CPRetete of normeton Hlother Specify:Dirks, Misty M. From: Marshal Ericka Sent: Tuesday, August 31,2021 3:07 PM To: Dirks, sy Subject PW. [Ester] Transport for EE wi From: Taunyo McGee (maitoitmegeeM@geneseoschools.o9) Sent: Tuesday, August 31, 2021 3:03 PM To: Marshal, Ericka ‘Subject: [External] Transport for EE Hello, {'m contacting you about transport for Emma Emo. Today she hd her frst physical therapy appointment. All follow-up appointments can be transported by your company. Her next appointment is ‘Thursday, September 9th at 3:00pm. Location- Genesis Pediatric Therapy Center 12535 Maplecrest Rd Ste 23, Bettendorf 1A. $2722 Contact number: 563-421-3497 She should be picked up et 2:15pm at Southwest Elementary School: 715 $ Center St, Geneseo, IL 61254 and retuned to our home at 123 Sherwood Drive, Geneseo, IL 61254. Please reply to confirm you can make this transport happen, And, just to review, you already have Emma dovn for transport + Wednesday, September 15th at 3:00pm ‘+ Location- Monarch Trauma Counseling Center 1600 30th Ave, Moline, I 61265 She should be picked up a 2:30pm at Southwest Elementary School: 715 $ Center St, Geneseo, IL 61254 and returned to the home of her piano lesson (I willbe there waiting): 919 Kadel Crt, Geneseo, IL 61254. ‘Waiting for your confirmation. Thanks! ‘Taunya MeGee ‘State of lncis - CONFIDENTIALITY NOTICE: The information contained inthis communication is confident may be ‘tome}-clent privileged or attomey work product. may censiute sige information or intemal dabberatve stat ‘commnicatin, and fs intended onl forthe use of Ie adresses. Unauihorzed usa. dcosure or copying of hs ‘communication or any pat teteo! is stl prise and may be Una you have received tis communication in ‘ror plesse notify the sender immediatly by returse-mal and destoy this communion and all copies erect, including al stachments. Receipt by an unintended recpent does nol waive tlornay-clentprvlege,atoriey work product pivlege, oF anyother exemption rom siclosure,