Department of Social Services Children’s Division Prior History Log 164A in Narrative Format
To be completed in chronological order with the most recent case first, not including the critical event. (Include relevant and/or active reports/cases)
Incident or Case #	Report Date or Case Opening Date	Case Type
Detailed Summary of Case/Services Provided or Offered/Family’s Response

Incident or Case #	Report Date or Case Opening Date	Case Type
Detailed Summary of Case/Services Provided or Offered/Family’s Response

Incident or Case #	Report Date or Case Opening Date	Case Type
Detailed Summary of Case/Services Provided or Offered/Family’s Response

Incident or Case #	Report Date or Case Opening Date	Case Type
Detailed Summary of Case/Services Provided or Offered/Family’s Response

Incident or Case #	Report Date or Case Opening Date	Case Type
Detailed Summary of Case/Services Provided or Offered/Family’s Response

Incident or Case #	Report Date or Case Opening Date	Case Type
Detailed Summary of Case/Services Provided or Offered/Family’s Response

Incident or Case #	Report Date or Case Opening Date	Case Type
Detailed Summary of Case/Services Provided or Offered/Family’s Response

Incident or Case #	Report Date or Case Opening Date	Case Type
Detailed Summary of Case/Services Provided or Offered/Family’s Response

Incident or Case #	Report Date or Case Opening Date	Case Type
Detailed Summary of Case/Services Provided or Offered/Family’s Response

Incident or Case #	Report Date or Case Opening Date	Case Type
Detailed Summary of Case/Services Provided or Offered/Family’s Response

Incident or Case #	Report Date or Case Opening Date	Case Type
Detailed Summary of Case/Services Provided or Offered/Family’s Response

Incident or Case #	Report Date or Case Opening Date	Case Type
Detailed Summary of Case/Services Provided or Offered/Family’s Response

Incident or Case #	Report Date or Case Opening Date	Case Type
Detailed Summary of Case/Services Provided or Offered/Family’s Response

Incident or Case #	Report Date or Case Opening Date	Case Type
Detailed Summary of Case/Services Provided or Offered/Family’s Response

Incident or Case #	Report Date or Case Opening Date	Case Type
Detailed Summary of Case/Services Provided or Offered/Family’s Response

Incident or Case #	Report Date or Case Opening Date	Case Type
Detailed Summary of Case/Services Provided or Offered/Family’s Response

Incident or Case #	Report Date or Case Opening Date	Case Type
Detailed Summary of Case/Services Provided or Offered/Family’s Response