Parole Form

Parole Form
Email Address (hidden field for submission purpose)
Your email address will be used to confirm submission
Consent for referral provided by the client
- IMPORTANT – Mandatory Documents Required
  
  Please ensure the following mandatory documents are uploaded before proceeding:
  
  - Victoria Police Criminal Record Check
  - Parole Order or eJustice screenshots clearly showing:
  
  - Order dates
  - Conditions
  
  Referrals submitted without the correct or complete documentation cannot progress to COATS Assessment and may be returned for resubmission.
- Upload Parole Order or eJustice screenshots containing order dates, conditions and charges.
  
  Cancelof
- Upload Victoria Police Criminal Record
  
  Cancelof
- Client Details
- Personal Information
- First name
- Middle name
- Last name
- Date of birth
  
  DayMonthYear
- JAID
- CRN
- Identity and Culture
- Country of birth
- Cultural background
- Client identifies as First Nations
- Gender
- Communication details
- Contact number
- Contact email
  example@example.com
- Interpreter required
- Preferred language
- Contact address
- Post-release address known?
- Address
- Suburb
- Postal Code
- Housing type
- Legal Details
- Offence History
- Current Offences
- Risks
- Primary Drug of choice
- Other substances of concern
- Safety concerns
- Other safety concern
- Risk Assessment
- LS/RNR score
- Parole
- Parole Details
- Parole status
- Prison location
- Release Details
- Parole start date
  
  DayMonthYear
- Parole end date
  
  DayMonthYear
- Current Parole Officer Information
- First name
- Last name
- CCS Location
- Contact number
- Contact email
  example@example.com
- Will you be the post-release parole officer?
- Post-Release parole officer information
- First name
- Last name
- Supervising CCS Location
- Contact number
- Contact email
  example@example.com
- Post-Release
- Client referred to ReConnect
- ReConnect Details
- Case worker allocated
- Reconnect Case Manager Information
- First name
- Last name
- Contact number
- Contact email
  example@example.com
- Consent Details
- Consent to share information with ReConnect
- Appointment
- Treatment Details
- Client treatment appointment preferences if a treatment is recommended by COATS
- Appointment Preferences
- Preferred Service Provider(s)
- Other Agency
- Alternate option if preferred service provider is unavailable
- Other option
- Referrer Information
- Referrer Role
- Are you the current parole officer?
- Referring Person Information
- First name
- Last name
- CCS location of referrer
- Contact number
- Contact email
  example@example.com
- Please note, the referrer's primary email address is required to communicate the referral updates.
Should be Empty:

Parole Form

Client Details

Personal Information

Identity and Culture

Communication details

Contact address

Legal Details

Risks

Risk Assessment

Parole

Parole Details

Release Details

Current Parole Officer Information

Post-Release parole officer information

Post-Release

ReConnect Details

Reconnect Case Manager Information

Consent Details

Appointment

Treatment Details

Appointment Preferences

Referrer Information

Referrer Role

Referring Person Information

Please note, the referrer's primary email address is required to communicate the referral updates.