Common use of Progress Summary Report Clause in Contracts

Progress Summary Report. A brief report will be provide to each school district which 4 includes name of placement, student identifying information, educational progress, mental health 5 treatment progress, medications, Special Incident Reports, condition of the facility, and 6 transition/discharge plan information. Alternative summary reports or forms will be completed to the 7 extent made possible by the placement facility to meet the Local Educational Agency’s (LEA’s) or School 8 District’s NPS/NPA onsite monitoring obligations. 9 10 Services will be provided in person if clinically necessary or upon specific request by the 11 client/parent(s). Alternatively, services may be provided via telephonic or telehealth (virtual) technology 12 or methods. 13 // 14 // 15 // 16 // 17 // 18 // 19 // 20 // 21 // 22 // 23 // 24 // 25 // 26 // 27 // 28 // 29 // 30 // 31 // 32 // 33 // 34 // 35 // 36 // 37 // 1 EXHIBIT C 2 TO AGREEMENT FOR PROVISION OF 3 EDUCATIONALLY RELATED MENTAL HEALTH SERVICES 4 BETWEEN 5 COUNTY OF ORANGE 6 AND 7 SAVANNA SCHOOL DISTRICT 8 JULY 1, 2022 THROUGH JUNE 30, 2023 9 10 LIST OF HCA/CYBH SERVICE CHIEFS North Region: Xxxxxxxx Xx Xxxxxxxxx, MFT II 000 X. Xxxxx Xxxxxxx Xxxx., Xxxxx 000 Phone Number: 000-000-0000 Email: xxxxxxxxxxxx@xxxxx.xxx West Region: Xxxxxxx Xxxxxx, LCSW14140 Xxxxx Xxxx., Xxx. 000, Xxxxxxxxxxx, XX 00000 Phone Number: 000-000-0000 Email: xxxxxxx@xxxxx.xxx East Region: Xxxxxx Xxxxxxxx, LCSW 0000 X. Xxxx Xx., Xxx. 000, Xxxxx Xxx, XX 00000 Phone Number: 000-000-0000 Email: xxxxxxxxx@xxxxx.xxx South Region: (Costa Mesa) (Laguna Beach) Xxxxxx Xxxx, DSW 0000 Xxx Xxxx Xxx., Xxxxx Xxxx, XX 00000 Phone Number: 000-000-0000 Email: xxxxx@xxxxx.xxx Xxxxx Xxxxxxxxx, LCSW 00000 Xxxxxx Xx., Laguna Beach, CA 92651 Phone Number: 000-000-0000 Email: xxxxxxxxxx@xxxxx.xxx HCA/CYBH Educationally Related Mental Health Services Program Manager: Xxxxxx Xxxxx, Ph.D. 000 X. 0xx Xxxxxx, Xxx. 000, Xxxxx Xxx, XX 00000 Phone Number: 000-000-0000 Email: xxxxxx@xxxxx.xxx 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36

Progress Summary Report. A brief report will be provide to each school district which 4 includes name of placement, student identifying information, educational progress, mental health 5 treatment progress, medications, Special Incident Reports, condition of the facility, and 6 transition/discharge plan information. Alternative summary reports or forms will be completed to the 7 extent made possible by the placement facility to meet the Local Educational Agency’s (LEA’s) or School 8 District’s NPS/NPA onsite monitoring obligations. 9 10 Services will be provided in person if clinically necessary or upon specific request by the 11 client/parent(s). Alternatively, services may be provided via telephonic or telehealth (virtual) technology 12 or methods. 13 // 14 // 15 // 16 // 17 // 18 // 19 // 20 // 21 // 22 // 23 // 24 // 25 // 26 // 27 // 28 // 29 // 30 // 31 // 32 // 33 // 34 // 35 // 36 // 37 // 1 EXHIBIT C 2 TO AGREEMENT FOR PROVISION OF 3 EDUCATIONALLY RELATED MENTAL HEALTH SERVICES 4 BETWEEN 5 COUNTY OF ORANGE 6 AND 7 SAVANNA SCHOOL DISTRICT «UC_SD» 8 JULY 1, 2022 THROUGH JUNE 30, 2023 9 10 LIST OF HCA/CYBH SERVICE CHIEFS North Region: Xxxxxxxx Xx Xxxxxxxxx, MFT II 000 X. Xxxxx Xxxxxxx Xxxx., Xxxxx 000 Phone Number: 000-000-0000 Email: xxxxxxxxxxxx@xxxxx.xxx West Region: Xxxxxxx Xxxxxx, LCSW14140 Xxxxx Xxxx., Xxx. 000, Xxxxxxxxxxx, XX 00000 Phone Number: 000-000-0000 Email: xxxxxxx@xxxxx.xxx East Region: Xxxxxx Xxxxxxxx, LCSW 0000 X. Xxxx Xx., Xxx. 000, Xxxxx Xxx, XX 00000 Phone Number: 000-000-0000 Email: xxxxxxxxx@xxxxx.xxx South Region: (Costa Mesa) (Laguna Beach) Xxxxxx Xxxx, DSW 0000 Xxx Xxxx Xxx., Xxxxx Xxxx, XX 00000 Phone Number: 000-000-0000 Email: xxxxx@xxxxx.xxx (Laguna Beach) Xxxxx Xxxxxxxxx, LCSW 00000 Xxxxxx Xx., Laguna Beach, CA 92651 Phone Number: 000-000-0000 Email: xxxxxxxxxx@xxxxx.xxx HCA/CYBH Educationally Related Xxxxxx Xxxxx, Ph.D. Mental Health Services Program Manager: Xxxxxx Xxxxx, Ph.D. 000 X. 0xx Xxxxxx, Xxx. 000, Xxxxx Xxx, XX 00000 Manager: Phone Number: 000-000-0000 Email: xxxxxx@xxxxx.xxx 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36

Progress Summary Report. A brief report will be provide to each school district which 4 includes name of placement, student identifying information, educational progress, mental health 5 treatment progress, medications, Special Incident Reports, condition of the facility, and 6 transition/discharge plan information. Alternative summary reports or forms will be completed to the 7 extent made possible by the placement facility to meet the Local Educational Agency’s (LEA’s) or School 8 District’s NPS/NPA onsite monitoring obligations. 9 10 Services will be provided in person if clinically necessary or upon specific request by the 11 client/parent(s). Alternatively, services may be provided via telephonic or telehealth (virtual) technology 12 or methods. 13 // 14 // 15 // 16 // 17 // 18 // 19 // 20 // 21 // 22 // 23 // 24 // 25 // 26 // 27 // 28 // 29 // 30 // 31 // 32 // 33 // 34 // 35 // 36 // 37 // 1 EXHIBIT C 2 TO AGREEMENT FOR PROVISION OF 3 EDUCATIONALLY RELATED MENTAL HEALTH SERVICES 4 BETWEEN 5 COUNTY OF ORANGE 6 AND 7 SAVANNA SCHOOL DISTRICT ORANGE COUNTY SUPERINTENDENT OF SCHOOLS 8 JULY 1, 2022 THROUGH JUNE 30, 2023 9 10 LIST OF HCA/CYBH SERVICE CHIEFS North Region: Xxxxxxxx Xx Xxxxxxxxx, MFT II 000 X. Xxxxx Xxxxxxx Xxxx., Xxxxx 000 Phone Number: 000-000-0000 Email: xxxxxxxxxxxx@xxxxx.xxx West Region: Xxxxxxx Xxxxxx, LCSW14140 Xxxxx Xxxx., Xxx. 000, Xxxxxxxxxxx, XX 00000 Phone Number: 000-000-0000 Email: xxxxxxx@xxxxx.xxx East Region: Xxxxxx Xxxxxxxx, LCSW 0000 X. Xxxx Xx., Xxx. 000, Xxxxx Xxx, XX 00000 Phone Number: 000-000-0000 Email: xxxxxxxxx@xxxxx.xxx South Region: (Costa Mesa) (Laguna Beach) Xxxxxx Xxxx, DSW 0000 Xxx Xxxx Xxx., Xxxxx Xxxx, XX 00000 Phone Number: 000-000-0000 Email: xxxxx@xxxxx.xxx Xxxxx Xxxxxxxxx, LCSW 00000 Xxxxxx Xx., Laguna Beach, CA 92651 Phone Number: 000-000-0000 Email: xxxxxxxxxx@xxxxx.xxx HCA/CYBH Educationally Related Mental Health Services Program Manager: Xxxxxx Xxxxx, Ph.D. 000 X. 0xx Xxxxxx, Xxx. 000, Xxxxx Xxx, XX 00000 Phone Number: 000-000-0000 Email: xxxxxx@xxxxx.xxx 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36

Progress Summary Report. A brief report will be provide to each school district which 4 includes name of placement, student identifying information, educational progress, mental health 5 treatment progress, medications, Special Incident Reports, condition of the facility, and 6 transition/discharge plan information. Alternative summary reports or forms will be completed to the 7 extent made possible by the placement facility to meet the Local Educational Agency’s (LEA’s) or School // 8 District’s NPS/NPA onsite monitoring obligations. // 9 // 10 Services will be provided in person if clinically necessary or upon specific request by the // 11 client/parent(s). Alternatively, services may be provided via telephonic or telehealth (virtual) technology // 12 or methods. // 13 // 14 // 15 // 16 // 17 // 18 // 19 // 20 // 21 // 22 // 23 // 24 // 25 // 26 // 27 // 28 // 29 // 30 // 31 // 32 // 33 // 34 // 35 // 36 // 37 // 1 EXHIBIT C 2 TO AGREEMENT FOR PROVISION OF 3 EDUCATIONALLY RELATED MENTAL HEALTH SERVICES 4 BETWEEN 5 COUNTY OF ORANGE 6 AND 7 SAVANNA SCHOOL DISTRICT «UC_SD» 8 JULY 1, 2022 2020 THROUGH JUNE 30, 2023 2021 9 10 LIST OF HCA/CYBH SERVICE CHIEFS North Region: Xxxxxxxx Xx Xxxxxxxxx, MFT II 000 X. Xxxxx Xxxxxxx Xxxx., Xxxxx 000 Phone Number: 000-000-0000 Email: xxxxxxxxxxxx@xxxxx.xxx West Region: Xxxxxxx XxxxxxXxxxx, LCSW14140 Ph.D. 00000 Xxxxx Xxxx., Xxx. 000, Xxxxxxxxxxx, XX 00000 Phone Number: 000-000-0000 Email: xxxxxxx@xxxxx.xxx xxxxxx@xxxxx.xxx East Region: Xxxxxx Xxxxxxxx, LCSW 0000 X. Xxxx Xx., Xxx. 000, Xxxxx Xxx, XX 00000 Phone Number: 000-000-0000 Email: xxxxxxxxx@xxxxx.xxx South Region: (Costa Mesa) (Laguna Beach) Xxxxxx Xxxx, DSW 0000 Xxx Xxxx Xxx., Xxxxx Xxxx, XX 00000 Phone Number: 000-000-0000 Email: xxxxx@xxxxx.xxx Xxxxx Xxxxxxxxx, LCSW 00000 Xxxxxx Xx., Laguna Beach, CA 92651 Phone Number: 000-000-0000 Email: xxxxxxxxxx@xxxxx.xxx HCA/CYBH Educationally Related Mental Health Services Program Manager: Xxxxxx Xxxxx, Ph.D. 000 X. 0xx Xxxxxx, Xxx. 000, Xxxxx Xxx, XX 00000 Phone Number: 000-000-0000 Email: xxxxxx@xxxxx.xxx 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36

Progress Summary Report. A brief report will be provide to each school district which 4 includes name of placement, student identifying information, educational progress, mental health 5 treatment progress, medications, Special Incident Reports, condition of the facility, and 6 transition/discharge plan information. Alternative summary reports or forms will be completed to the 7 extent made possible by the placement facility to meet the Local Educational Agency’s (LEA’s) or School 8 District’s NPS/NPA onsite monitoring obligations. 9 10 Services will be provided in person if clinically necessary or upon specific request by the 11 client/parent(s). Alternatively, services may be provided via telephonic or telehealth (virtual) technology 12 or methods. 13 // 14 // 15 // 16 // 17 // 18 // 19 // 20 // 21 // 22 // 23 // 24 // 25 // 26 // 27 // 28 // 29 // 30 // 31 // 32 // 33 // 34 // 35 // 36 // 37 // 1 EXHIBIT C 2 TO AGREEMENT FOR PROVISION OF 3 EDUCATIONALLY RELATED MENTAL HEALTH SERVICES 4 BETWEEN 5 COUNTY OF ORANGE 6 AND 7 SAVANNA MAGNOLIA SCHOOL DISTRICT 8 JULY 1, 2022 THROUGH JUNE 30, 2023 9 10 LIST OF HCA/CYBH SERVICE CHIEFS North Region: Xxxxxxxx Xx Xxxxxxxxx, MFT II 000 X. Xxxxx Xxxxxxx Xxxx., Xxxxx 000 Phone Number: 000-000-0000 Email: xxxxxxxxxxxx@xxxxx.xxx West Region: Xxxxxxx Xxxxxx, LCSW14140 Xxxxx Xxxx., Xxx. 000, Xxxxxxxxxxx, XX 00000 Phone Number: 000-000-0000 Email: xxxxxxx@xxxxx.xxx East Region: Xxxxxx Xxxxxxxx, LCSW 0000 X. Xxxx Xx., Xxx. 000, Xxxxx Xxx, XX 00000 Phone Number: 000-000-0000 Email: xxxxxxxxx@xxxxx.xxx South Region: (Costa Mesa) (Laguna Beach) Xxxxxx Xxxx, DSW 0000 Xxx Xxxx Xxx., Xxxxx Xxxx, XX 00000 Phone Number: 000-000-0000 Email: xxxxx@xxxxx.xxx Xxxxx Xxxxxxxxx, LCSW 00000 Xxxxxx Xx., Laguna Beach, CA 92651 Phone Number: 000-000-0000 Email: xxxxxxxxxx@xxxxx.xxx HCA/CYBH Educationally Related Mental Health Services Program Manager: Xxxxxx Xxxxx, Ph.D. 000 X. 0xx Xxxxxx, Xxx. 000, Xxxxx Xxx, XX 00000 Phone Number: 000-000-0000 Email: xxxxxx@xxxxx.xxx 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36