Intake & Placement Tracker | Shari

Facility / placement name

This name is how the tracker tells your saved entries apart — one entry per place your child has been.

1Placement Basics

Child's name

Admission date

Facility address

Main facility phone

Expected length of stay / level of care

2Who's on the Care Team

Every name, title, and number so you're not hunting for it during a crisis.

3Communication Plan

Get this in writing at intake — one less thing to guess at later.

When will the nurse/team call you?

When can your child call you?

Visiting hours / policy

Best direct number for updates

Other communication notes

4Medications Going In

What your child was taking, and what changes once they're admitted.

Full medication history

5Insurance & Authorization

Insurance company

Insurance phone

Member / policy ID

Group number

Prior authorization contact

Authorization / reference number

6Items Left With Child

What you sent, and when — helpful for discharge and for the next placement.

7Visit & Update Log

The living part of this document — add a line every time someone calls or something changes.

8Emergency & Legal Contacts

Parent / guardian 1

Parent / guardian 2

Custody / legal notes

9Notes & Questions for Next Time

Shari — On The Record · Intake & Placement Tracker · Not medical, legal, or insurance advice — an organizational tool for what your child's care team tells you.