Maine DHHS - Questionnaire - Child Private Non-Medical Institution (PNMI)

Status: Incomplete

Child Private Non-Medical Institution (PNMI)

1. Is member involved with the corrections system?

(Please select one.)

2. Provide rationale why member requires structure and supervised living with active treatment seven days per week, twenty four hours per day:

3. What is frequency of meetings with guardian?

4. What specific behaviors have occurred since last review period that pose a risk of harm to self or others?

Disclaimers (please check to confirm acceptance):