(1) The provider shall maintain a written case record for each child which shall include administrative, treatment, and educational data from the time of admission until the time the child leaves the group home. A child's case record shall include the following:

(a) the name, sex, birthdate and birthplace of the child;

(b) the name, address, and telephone number of the parent(s) or guardian of the child;

(c) date of admission and placing agency;

(d) when the child was not living with his parents prior to admission, the name, address, telephone number and relationship to the child of the person with whom the child was living;

(e) date of discharge, reason for discharge, and the name, telephone number and address of the person or agency to whom the child was discharged;

(f) all documents related to the referral of the child to the facility as provided by the placing agency;

(g) documentation of the current custody and legal guardianship as provided by the placing agency;

(h) the child's court status, if applicable;

(i) a copy of the child's birth certificate or a written statement of the child's birthdate including the source of this information;

(j) consent forms signed by the parents or guardian prior to placement allowing the group home to authorize all necessary medical care, routine tests, immunization and emergency medical or surgical treatment;

(k) cumulative health records including medical history and immunization records as provided by the placing agency;

(l) education records and reports;

(m) treatment or clinical records and reports;

(n) records of special or critical incidents;

(o) case plans and related material; and

(p) social summary current to date of placement.

(2) The case record of each child receiving moderate, campus based or intensive level therapeutic youth group home services must contain the additional documentation set out in ARM 11.13.116.