• Step Ahead Enterprises

    Complete with available information. Attach or identify existing records instead of retyping. Mark unknown information. Step Ahead completes its separate admission review.
  • Facility
  • Admission Date
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    2 digit month, 2 digit day, 4 digit year
  • Date of Birth*
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  • Gender

  • Case Manager Contacts

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  • Health and Safety

  • Does the youth currently take medication?*
  • Allergies*
  • Any current health or dietary needs?*
  • Any upcoming appointments?*
  • Current safety information*
  • Known safety concerns
  • Probation Status*

  • Education and Family Connections

  • Education Plan Status
  • Additional school supports needed?*

  • Family Contacts and Restrictions

  • Any contact or court-ordered restrictions?*
  • Routine activities support normalcy and reflect the youth's needs and applicable restrictions. Transportation is provided by authorized drivers using approved vehicles under Step Ahead policy.
  • Any activity or transportation restrictions?*
  • Any language, communication, cultural or religious support needs?*
  • Support requested

  • Records and Attachments

  • Upload supporting records and select their status below. For a previously provided record, identify its title/date in the relevant answer.
  • Upload a File
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  • Records Provided
    Rows

  • Acknowledgments and Signature

  • Medication Consent

  • Selecting Consent granted confirms I have legal authority to consent for this youth. I authorize Step Ahead's trained, authorized staff to administer prescribed medications under current prescriber orders and over-the-counter medications with the youth's authorized medical provider's approval and written directions. Staff follow allergies, precautions and agency policy. My signature and date below cover my selections. Required medication-specific informed consent, court orders and DCS approvals still apply.
  • Prescribed medication consent*
  • Over-the-counter medication consent*
  • Step Ahead verifies authority and required consents and tracks pending authorizations for follow-up.
  • Written authorization for routine medical and dental care*
  • This form does not replace required placement documents, medical authorizations, medication orders, or court approvals. Step Ahead will verify required authorization before relying on it. Emergency care will follow applicable law and agency procedures.
  • Program information covers services, daily routines, living arrangements, behavior support, visitation/communication, education, religious practices and agency contacts.
  • Step Ahead program/ facility information received?*
  • Case Manager Signature*
  • Today's Date*
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