WPCg  
      c      Rʹ&?LQ=xE؅WJ5ຂ6{u)6kEjjh>m"khڸ:ln}]gWs	⽁xf&L%,Z3R%Lsj]NpM}SU'# u9j2(hWz/@=H^5 IOp'_ 7<|Z.Q`I;5P[VZc7:<2J'5+ǭ$"+Q%S즅q1C쭹BggXebG\D,Q&g#CDM~ͩFA+>~ӝgz!QXjLHMw2R@e"YS0JNo1EjF[-v7M&5z043y#pkm9            M      l
   U?   >   p
  0     
  0   <   K  0   d    0   2       &       Z   C  0              *  0      @            @            @            @            @   b                                         UD   >                    (      U   >                                                                                                                                          	      -   	      ?   	      Q            Q            Q            Q            Q            Q            Q            Q            Q            Q            Q            Q            Q            Q            Q            Q            Q            Q            Q            Q            Q            Q            Q            Q            Q            Q            Q            Q   	      c   	      w            w   	         	                                             	                                                                     	         	                                                                     	         	                                                                     	         	      %   	      9            9            9            9            9            9            9            9            9            9            9            9            9            9            9            9            9            9   	      K        ]  0   r   m  #        U	   N     	%        N        ^        w      
  4              "  	m      $            $            $            $            $            $            $            $            $            $            $            $            $            $            $            $            $            $            $            $   	      ;            ;            ;            ;            ;            ;            ;            ;            ;   	      O      \	  	   `   & T i m e s   N e w   R o m a n             6                4 H e a d i n g   1                  x   (#      X      XX S            \	  	   `   & T i m e s   N e w   R o m a n         S 
                  8  .    `	   h   p    x   (#8 S            \	  	   `   & T i m e s   N e w   R o m a n         S     X      XX     <                    : D e f a u l t   P a r a         0                . H e a d e r           (#     X      XX S            \	  	   `   & T i m e s   N e w   R o m a n         S  A  7        X   `	   h   p    x   (#A S            \	  	   `   & T i m e s   N e w   R o m a n         S     X      XX     0   m             . F o o t e r           (# S            \	  	   `   & T i m e s   N e w   R o m a n         S  A  7        X   `	   h   p    x   (#A S            \	  	   `   & T i m e s   N e w   R o m a n         S  '                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
       
       
 0      
 .      
       
            I N   T H E   D I S T R I C T   C O U R T   O F                                                                                                         C O U N T Y ,   K A N S A S   8         D o c u m e n t M a n a g e m e n t : : M o d i f i e d B o o l e a n T R U E     (   e               2n@$       
 s  \!        u  X i  X  Xu X      X i  X  Xu X i      
              (   e               2n@$       
 s  \!        u  X i  X  Xu X      X i  X  Xu X i     -  -    
      
 	  n@'        u  X'i  X  Xu X      X'i  X  Xu X'i     _           "   X     A " 11/23/10  \	  	   `   & T i m e s   N e w   R o m a n                                                 \	  	   `  & T i m e s   N e w   R o m a n          T e x t 5 2    T e x t 5 3    T e x t 5 4    C h e c k 2 0    T e x t 2 7    T e x t 2 9    C h e c k 2 1    C h e c k 2 2    T e x t 3 3    C h e c k 2 3    C h e c k 2 7    C h e c k 2 8    C h e c k 3 1    C h e c k 3 2    T e x t 3 9    T e x t 5 1   #| x            (   J               \$              u  X  X  Xu X      X  X  Xu X  \ \ K J C D C 0 1 \ S A V I N   9 0 6 0                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      0                                                                                                                                                                 ( 9  	   Z  6 T i m e s   N e w   R o m a n   R e g u l a r          u X  v=e         }i=    D M I N   0             U   C h e c k 7 1    D r o p d o w n 1   
 s  \!        u  X'i  X  Xu X      X'i  X  Xu X'i     _             @    VV)  312@ @  *     	                `	               h               p             
  [         8 u  'iu X  X       d                  d  8 =    'i  X   X       d                 d=              X'i  X  X X'i @    @@  INTHEDISTRICTCOURTOF__________________COUNTY,KANSAS   	 z         INTHEMATTEROF   	 R         Name_________________________,Juvenile         p      CaseNo._____________   	 *
   DOBxx/xx/____#   X'i  X  X X'i  #    X'i  X  X X'i A&#   X'i  X  X X'iT  #    X'i  X  X X'i Ԁmale&#   X'i  X  X X'i  #    X'i  X  X X'i Ԁfemale#   X'i  X  X X'i  #    	 t      X'i  X  X X'i #   X'i  X  X X'iH  #          *        x   (#   X*    X'i  X  X X'i    X'i  X  X X'i 
                      0         x   (#  X0        X X'i *#   X'i  X     # ORDERAUTHORIZINGREMOVALOFJUVENILE     .        
   Ԍ   	 8	
   Ќ     $  
    X   X$    X'i  X  X X'i    X'i  X  X X'i 	     @    tt  PursuanttoSupremeCourtAdministrativeOrder155   	 r
   @    <<  Separatejournalentryorordermustbeattached   	  ^   !     (#   X!    &Y %  X X'i           Onthis% #       X'i  X % &Y    X'i  X  X X'i _____% #      Ԁdayof% $    -     __________________-     % $   @   ,% %    -     20____-     % %      ,thismattercomesbeforetheCourt,   	 "   Judge___________________presiding.   	         THECOURTHEREBYFINDSTHAT:(Checkallthatapply)   	 t   !  
    X  (#! % A    % A   	      X'i  X  X X'i &#   X'i  X  X X'i	  # 0     Reasonableefforts   X'i  X  X X'i &#   X'i  X  X X'iS
  # Ԁhavebeenmadeandhavefailed   X'i  X  X X'i &#   X'i  X  X X'i
  # Ԁhavenotbeenmadetomaintain   	 L   thefamilyandpreventthe

removalofthejuvenilefromthejuvenileshomeasfollows:    < (#(#       (Specifybasisforfinding.)__________________________________________________   	 (   Ѐ     ______% B    -     __________________________________________________________________   	 r        % B   I   ________________________________________________________________________% D    % D   $      	  ^       and/or   	 6      X          
  (#   X       % E    % E      &     Reasonableeffortsarenotrequiredtomaintainthejuvenileinthehomebecausean   	 "   emergencyexistswhichthreatensthesafetyofthejuvenile.(   X'i  X  X X'i Specifybasisforfinding#   X'i  X  X X'i  # .)   	    ________________________________________________________________________   	         ________________________________________________________________________   	     ________________________________________________________________________   	 t!      	 `"       	 L#!              X !     (# (#!      and/or   	 8$"        % I    % I         X'i  X  X X'i &#   X'i  X  X X'i  #      Reasonableeffortsarenotrequiredduetotherisktopublicsafety,specifically:   	 $% #         B  + `	 4 `	   h   p    x   (#  (#B       (Specifybasisforfinding% O    .)_________________________________________________   	 &n!$   _______________________________________________________________________   	 &Z"%   _______________________________________________________________________   	 'F#&      	 (2$'       4 0    `	 % O   :       `	(#`	(#                   $     (#`	 4 `	X$ and/or   	 *
&)        % P    % P         X'i  X  X X'i 0           &#   X'i  X  X X'i4  #      Reasonableefforts   X'i  X  X X'i &#   X'i  X  X X'i  # Ԁhavebeenmade   X'i  X  X X'i &#   X'i  X  X X'i  # Ԁhavenotbeenmadetofacilitatethe   	 +&*   permanencyplan.(Specifybasisforfinding.)__________________________________   	       _______________________________________________________________________   	     _______________________________________________________________________    z (#(#     .  .  E  .    `	   h   p    x   (#  (#E '     , X X'          4 THECOURTFURTHERFINDSTHAT&% V    % V   w   Ԁremaininginthehomeorreturning   	 >	        homeiscontrarytothewelfareofthejuvenileand/or&% W    % W      Ԁimmediateplacementisin   	 .
        thebestinterestofthejuvenile.(Specifybasisforfinding.)______________________   	 |      _  .   *     (#  , X*      _______________________________________________________________________   	 l        _______________________________________________________________________   	 X	   @    )  or   	 0
   '      4(#  (#'      &   X'i  X  X X'i Ԁ0    4 TheCourthasdeterminedthatthejuvenile'sremovalfromthehomeisduetotherisk   	    thejuvenilepresentstothesafetyofthecommunityandacontrarytothewelfare   	    findingisnotnecessary.(Specifybasisforfinding.)    (#(#K (#_  J       4(#4(#       _______________________________________________________________________   	         _______________________________________________________________________   	 r      e Ҁ#   X'i  X  X X'ip  #      THECOURTTHEREFOREORDERSTHATthefollowingorderforremovalshallissue:   	 6        (AttachthefollowingorderforremovaltothisOrderAuthorizingRemoval.)   	 "      e      % ]    &% ]      ԀWarrant(Form311,attachcopyhereto.)   	 l        % ^    &% ^   W   Ԁ% _    Orderfordetention(Form314or316,attachoriginalhereto.)   	 X        -     % _   ~      X'i  X  X X'i &#   X'i  X  X X'i  # 0    4 Ordercommittingincompetentjuvenile   X'i  X  X X'i (Form324or325,attachoriginalhereto.)#   X'i  X  X X'i  #     D 4(#4(#          X'i  X  X X'i &#   X'i  X  X X'i,   #    X'i  X  X X'i 0    4 Adjudicationwithtemporarycustodyorder(Form341,attachoriginalhereto.)#   X'i  X  X X'ir   #     0 4(#4(#          X'i  X  X X'i &#   X'i  X  X X'i>!  #     4 Adjudicationwithimmediatesentencing(Form342,attachoriginalhereto.)   	            X'i  X  X X'i &#   X'i  X  X X'i"  # 0    4 Sentencingorder   X'i  X  X X'i (Form350or351,attachoriginal#   X'i  X  X X'id"  #    X'i  X  X X'i hereto.)#   X'i  X  X X'i"  #      4(#4(#          X'i  X  X X'i &#   X'i  X  X X'iC#  # 0    4 Probationviolationorder   X'i  X  X X'i (Form370,attachoriginal#   X'i  X  X X'i#  #    X'i  X  X X'i hereto.)#   X'i  X  X X'i$  #      4(#4(#          X'i  X  X X'i &#   X'i  X  X X'i$  # 0    4 Modificationofsentenceorder   X'i  X  X X'i (Form373,attachoriginal#   X'i  X  X X'i$  #    X'i  X  X X'i hereto.)#   X'i  X  X X'iX%  #      4(#4(#          X'i  X  X X'i &#   X'i  X  X X'i%  # 0    4 Orderrescindingconditionalrelease/aftercare(Form376,attach   X'i  X  X X'i original#   X'i  X  X X'if&  # hereto.)    n 4(#4(#            THECOURTTHEREFOREORDERSTHATtheabovenamedjuvenile   X'i  X  X X'i &#   X'i  X  X X'i6'  # Ԁshallbe   X'i  X  X X'i Ԁ   	 F!   &#   X'i  X  X X'i'  # Ԁshallcontinuetobeplacedinthecustodyof:   	 6"            X'i  X  X X'i &#   X'i  X  X X'i9(  # 0    4 TheCommissioner,or    &#! 4(#4(#          X'i  X  X X'i &0    4 _________________________________________________________________#   X'i  X  X X'i(  #     $p" 4(#4(#     X'i  X  X X'i @    \\)  and   	 $\ #        &#   X'i  X  X X'i|)  #    X'i  X  X X'i ԀAchildsupportordershallissue.   	 %H!$   #   X'i  X  X X'i)  #    X'i  X  X X'i      &#   X'i  X  X X'iu*  #    X'i  X  X X'i ԀEachparentshallsubmitinformationtothechildsupportofficeforachildsupport   	 &4"%   ordertobeprepared,orpresentdocumentationofacurrentchildsupportorderwithin____days#   X'i  X  X X'i*  #    X'i  X  X X'i .#   X'i  X  X X'i+  #    X'i  X  X X'i    	 ' #&   #   X'i  X  X X'i,  #         X'i  X  X X'i dTHECOURTFURTHERORDERSallprovidersofservices#   X'i  X  X X'i,  # L
   
 M
   
    X'i  X  X X'i Ԁ#   X'i  X  X X'i-  # L
   
 M
   
    X'i  X  X X'i includingeducational   	 *%)   services#   X'i  X  X X'it-  # L
   
 M
   
    X'i  X  X X'i ,treatment,#   X'i  X  X X'i-  # L
   
 M
   
    X'i  X  X X'i education#   X'i  X  X X'i_.  # L
   
 M
   
    X'i  X  X X'i Ԁorcareofthechildandfamily,evenifnotspecificallyreferredto   	 v+&*   herein,toprovideinformation#   X'i  X  X X'i.  # L
   
 M
   
    X'i  X  X X'i including#   X'i  X  X X'i/  # L
   
 M
   
    X'i  X  X X'i Ԁ#   X'i  X  X X'i/  # L
   
 M
   
    X'i  X  X X'i anyandalleducationalrecords#   X'i  X  X X'iD0  # L
   
 M
   
    X'i  X  X X'i Ԁtothesecretary,any   	       entityprovidingservicestothechildandfamily,counselforthepartiesincludingthecountyor   	     districtattorney,appointedCASA,CitizenReviewBoardmembers,thecourt,andeachotherto   	 z   theextentneededtoensurethesafetyofthechild,preventfurtherabuseorneglect,andto   	 f   provideappropriatetreatment#   X'i  X  X X'i0  # L
   
 M
   
    X'i  X  X X'i ,careandservices#   X'i  X  X X'i2  # L
   
 M
   
    X'i  X  X X'i Ԁtothechildandfamily.Thisorderencompasses   	 R   #   X'i  X  X X'i3  # L
   
 M
   
    X'i  X  X X'i andcomplieswith#   X'i  X  X X'i3  # L
   
 M
   
    X'i  X  X X'i Ԁtheprovisionsofthe#   X'i  X  X X'i4  # L
   
 M
   
    X'i  X  X X'i FamilyEducationRightsandPrivacyAct(20U.S.C.   	 >	   1232g;34_        C.F.R._        Ԁ99#   X'i  X  X X'i4  # L
   
 M
   
    X'i  X  X X'i Ԁ#   X'i  X  X X'iZ5  # L
   
 M
   
    X'i  X  X X'i andthe#   X'i  X  X X'i5  # L
   
 M
   
    X'i  X  X X'i ԀPrivacyRuleoftheHealthInsurancePortabilityandAccountability   	 *
   Actof1996(_        HIPAA_        ),45_        C.F.R._        Ԁ164.512(e)(1).#   X'i  X  X X'i6  # d   	 t      .  _   H  .    `	   h   p    x   (#   4(#H         X'i  X  X X'i      %     %    7   #   X'i  X  X X'i7  #    X'i  X  X X'i 3   	  r  p    x   (# X3      THECOURTFURTHERORDERSthismattersetfor-     ______________-     _____hearing   	 L	   before0#   X'i  X  X X'i8  #    X'i  X  X X'i ԀtheCourt0#   X'i  X  X X'i9  #    X'i  X  X X'i Ԁ#   X'i  X  X X'if9  #    X'i  X  X X'i the#   X'i  X  X X'i9  #    X'i  X  X X'i _        CRB_        #   X'i  X  X X'i9  #    X'i  X  X X'i Ԁonthe________dayof______________,_____,at-     ________   	 8	
   Ѐ0#   X'i  X  X X'iW:  #    X'i  X  X X'i Ԁa.m0#   X'i  X  X X'i;  #    X'i  X  X X'i Ԁp.m.%     %    ;      	 (
   #   X'i  X  X X'iX;  #    X'i  X  X X'i     r ITISSOORDERED#   X'i  X  X X'i;  # THIS___________dayof_________________,% q    _____-     % q   j<   .   	    -      p(#  r  pX-      0    p _____________________________    V p(#p(#  -      p 2(#   p(#-          p JudgeoftheDistrictCourt    (#(#K (#    	 B    u  X'i  X  X X'i      @    jj&  Authority   	 d            p     2 K.S.A.382334,382336,andSupremeCourtAdministrativeOrderNo.155.   	 <   @    $  NotesonUse   	         ThisformprovidesfortherequirementsoftheAdoptionandSafeFamiliesAct(_        ASFA_        ),42   	    _        USC_        Ԁ671etseq.,assetoutinK.S.A.382334and382335,andSupremeCourtAdministrative   	 z   OrderNo.155.Thoserequirementsmandatetheuseofthisformoranother_        ASFA_        Ԁformapproved   	 f   bytheSupremeCourtwhenajuvenileisremovedfromthehome.Itmustbeattachedtoajournal   	 R    entryoftheproceedinginwhichremovalwasorderedbythecourt,ortheorderdirectingremoval   	 >!   iftherewasnohearing,asinthecircumstancesofawarrant.Theoriginaljournalentryororder   	 *"    mustbeattachedexceptwhentheorderisawarrant.Acopyofthewarrantispermittedtobe   	 #t!   attached,becausetheoriginalwarrantisissuedtolawenforcementforexecution.   	 $`"        Priortoanorderremovingajuvenilefromthehome,orremovingajuvenilefromthehome   	 $L #   after6monthsplacementinthehome,reasonableeffortsfindingsmustbemadetocomplywith   	 %8!$   K.S.A.382334and382335.Alsorequiredisa contrarytothewelfareor bestinterestfinding,   	 &$"%   unlessthejuvenileisremovedfromthehomeduetotheriskthejuvenileposes.Thosefindingsare   	 '#&   setoutinthisform.   	 (#'        Thereislanguageprovidedtoallowachildsupportordertoissue,ortorequiretheparents   	 )$(   toprovideinformationsothatachildsupportordermaybeissued.Thejuvenilejusticecode   	 v*%)   requiresthecourttoorderchildsupport,unlessgoodcauseisshowntothecontrary.K.S.A.38   	 b+&*     
 [  
   
        
     
  
   
 2319.   	            Ifajuvenileisremovedduetotheriskthejuvenileposestothecommunityorpublicsafety,   	     andreasonableeffortsarenotrequiredforthatreason,federalfundingisnotprovidedtosupportthe   	 z   placement.#   X'i  X  Xu X'i=  #    	 f               X X'i *#   X'i  X   H  #  u  X'i  X  X X'i ThisformhasbeenapprovedbytheJudicialAdministratorpursuanttoSupremeCourt   	 t   AdministrativeOrderNo.155,firstenteredSeptember22,2000.#   X'i  X  Xu X'iEH  # 
