This form should be completed after a Mobile Response Team provides an in-person response or receives a direct to county call (even if an in-person response is not initiated), and to provide the details of the response to the County of Jurisdiction and to
CDSS. Please note: this report, and its content, should
not be attached to or included in a case plan/court report. The purpose of this form is to ensure linkage to ongoing supportive services.
The form should take no more than 15 minutes to complete. For additional questions, please contact
FURS@dss.ca.gov.