Downloading a Form to Your Computer

Fillable forms cannot be viewed on mobile or tablet devices. Follow the steps below to download and view the form on a desktop PC or Mac.

  1. Right Click for PC or Ctrl + Click for Mac on the PDF link and click “Save link as” from the menu.
  2. Select the folder you want to save the file in and then click "Save."
  3. Navigate to the folder you saved the file in and Right Click for PC or Ctrl + Click for Mac, then select "Open With" from the menu and select Adobe Acrobat Reader DC.

Note: Open the PDF file from your desktop or Adobe Acrobat Reader DC. Do not click on the downloaded file at the bottom of the browser since it will not open the PDF in Adobe Acrobat Reader DC. It will try to open the file in the browser that results in the same browser error message.

If still having trouble viewing or downloading a form, click here.

Effective Date: 



Updated: 6/2014


Use this form to document information not captured in other forms. Examples include, but are not limited to, telephone calls, age-out task tracking, etc.

Use of this form is optional.


When to Prepare

Prepare as needed. Completion of this form is not required by policy.


The original form is maintained in the case record.

Form Retention

The form is maintained in the case record as long as the case is open.

Detailed Instructions

Action Date — Enter the date the action occurred.

Type of Contact — Record home visit, phone contact, office visit, etc.

Action/Narrative — Use this section as needed to record actions taken.

Initial and Date — Enter the initials of person documenting the activity and the date the recording is done.