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Progress Report per month (Monthly report should be on Provider Letterhead) Report Period:1 Date to Date Parent(s) Name 2 Child(ren) 3 Referral Agency: (County DCS or County Probation Office) 4 Case Manager/Probation Officer: 5 List Service Standard Provider Agency Staff for each Service 6 7 8 Reason for Referral and Presenting Issues: 9 Family Functional Strengths: 10 Overall recommendation and progress summary: 11 Next scheduled contact with family: 12 13 Signature Date: Individual Service Standard Monthly Report Report Period:14to Complete the following information for each DCS service standard Service Provide (Service Standard) 15 Begin/End Date of Referral: 16 Service Provider Staff 17 Number of Service Unit Authorized 18 Number of service units delivered to end of report period 19 Contact Date Time Duration Method Location Those Present 20 21 22 23 24 25 Method includes such things as Face to Face(ff), Phone(ph), Collateral Contacts(cc), DCS Contacts(dcs), CFTM Attendance (cftm), Court Testimony (ct), Add more lines as appropriate..