Dear Relative/Non-Relative Caregiver: by 11yflme

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									Dear Relative/Non-Relative Caregiver:

BSO and ChildNet are grateful for your commitment to provide a safe and nurturing environment for the
child(ren) entrusted to your care. Your role as caregiver is very important, and provides you with the
responsibility of ensuring the child(ren)’s medical needs are met. ChildNet is responsible for ensuring that
you have met these needs as the child’s caregiver.

Florida law requires that the child(ren) in your care receives a medical screening known as an EPSDT
(Early Periodic Screening and Diagnostic Testing). This screening must be completed within 72 hours of
the time that the child(ren) was removed from their home, or within 48 hours of the Shelter hearing in
which you were granted custody. You may take the child to one of the following to obtain this screening:

1.      William Dandy Health Center
        2400 NW 26th St
        Fort Lauderdale, FL 33311

If you chose the William Dandy Health Center, you must contact ChildNet’s medical unit by telephone at
(954) 414-6000 to schedule the appointment. You are not able to take the child(ren) to William Dandy
without a scheduled appointment through ChildNet. You will be responsible for providing transportation to
the appointment. William Dandy will provide the completed screening form to ChildNet following the
completion of the visit. You should also request a copy of this form and place it in the Child Resource
Record, which is a green book that will be provided to you by the ChildNet Child Advocate.

OR

2.      Child’s Primary Care Physician

If you chose to take the child to their primary care physician, you must ensure the appointment is
scheduled within the designated timeframe. The Primary Care Provider will also need to fax a copy of the
completed screening form to ChildNet at (954) 414-6026. As stated above, you should request a copy
and place it in the Child Resource Record, which is a green book that will be provided to you by the
ChildNet Child Advocate.

*If you are not sure that the child(ren) in your care has active Medicaid, then the child must be seen by
the William Dandy Health Center. There will be no charge to you as the caregiver.

Preventative and regular medical and dental care are very important in ensuring the continued health of
the child(ren) in your care. For this reason, it is very important that you obtain Medicaid coverage or other
insurance for the child immediately. The assigned Child Advocate will also provide assistance in how you
can do this if you are unsure. Once you have obtained insurance for the child(ren) please be sure that
you schedule a dentist appointment if the child is 3 years or older.

Please be sure that anytime you take the child(ren) for a dental or medical appointment, you ask for
documentation of the care that has been provided on that date. This information needs to be provided to
the Child Advocate and also placed in the Child Resource Record.

Thank you again for your dedication and commitment to the child(ren) who have been placed in your
care. Your cooperation and assistance is appreciated. Please discuss any questions or concerns that
you may have with your Child Advocate. ChildNet can be contacted at (954) 414-6000.

Provided to:    __________________________________________                  ______________
                (Name of Caregiver)                                         (Date)

In regard to:   ____________________________________________________________
                (Name of Child(ren)

Provided by:    ___________________________________________                 _______________
                (Broward Sheriff’s Office/ChildNet staff)                   (Date)

*Please complete 2 copies of this form; one for caregiver’s records and one for ChildNet’s records*

								
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