FDR Mediation Outcomes Mediator:* First Last Mediator's Email* Enter Email Confirm Email FDR Centre Case Number and Name:*Did the parties engage in PFM or Voice of the Child?* PFM Voice of the Child None of the above Preparation for MediationDate PFM provider met with party (or parties)*If PFM was provided on multiple days, please enter the last date. Time of PFM session*Again, if PFM was provided on multiple days, please enter the time the last session started. : HH MM AM PM How many hours of PFM services were provided to the parties?*Please provide this to the closest 15 minutes. : HH MM Please upload a copy of the PFM provider's invoice for this matter if this has not been provided directly by the PFM provider.The PFM provider's invoice should be based on payment of $160.00 per hour. Drop files here or Voice of the ChildDate Child Inclusion Specialist last engaged with children and/or parties* Time of the last session with the Child Inclusion Specialist* : HH MM AM PM How many hours of Voice of the Child services were provided to the parties?*Please provide this to the closest 15 minutes. : HH MM Please upload a copy of the Child Inclusion Specialist's invoice for this matter if this has not been provided directly by the Voice of the Child provider.The Child Inclusion Specialist's invoice should be based on payment of $160.00 per hour. Drop files here or Agreement to Mediate and ConfidentialityIf you haven't already provided a copy of the FDR Centre Agreement to Mediate, please upload a signed copy here. Drop files here or If applicable: if you haven't already provided a copy of the FDR Centre Confidentiality Agreement, please upload a signed copy here. Drop files here or MediationDate of Mediation*If Mediation was provided on multiple days, please enter the last date. Was there any difficulty arranging the Mediation and/or any factors that delayed it?Time of Mediation*Time of the last session : HH MM AM PM How many hours of Mediation services were provided to the parties?*Please do not include time spent on the FDR Assessment (ie only include time that goes to the 12 hours for mediation, PFM, and Voice of the Child). Please provide this to the closest 15 minutes. : HH MM How many hours of FDR services were provided to the parties in total?*This should include PFM, Voice of the Child, and FDR Mediation (total available hours is twelve). : HH MM How was the Mediation undertaken?* In person Telephone Videoconference (eg Skype) Select as many options as are relevant.Location of in person Mediation.*If more than one location was used, please use the last address. Street Address Address Line 2 City Outcome Decision*Joint withdrawal by all partiesFDR Completed - no matters resolvedFDR Completed - some matters resolvedFDR Completed - all matters resolvedFDR ExemptMediation in progress (there will be another round of mediation at a later date)Individual Session (pre-mediation)Please enter the parties name who you met withBriefly list matters still in dispute below.*This will be entered in the Section 12 form.Briefly list matters which were agreed on below.*This will be entered in the Section 12 form.Do you recommend the parties attend a settlement conference?*YesNoDo you recommend the parties receive legal representation?*YesNoWho should the exemption be issued to?*Name(s) of those to whom the exemption is to be issued.Why was the case FDR exempt?*Select oneInappropriate to continue with FDRParty at riskParty did not participateUnable to participate effectivelyWhat is the estimated or agreed date for the second round of mediation?TravelDo you wish to claim travel for the Mediation?*Only answer "yes" if you wish to claim your travel time as a disbursement. Please note that you can only claim the travel time from your work address to the location of the mediation where the travel distance is over 50km. Please note the Ministry of Justice’s prior approval is required for any travel expenses and room hire which will in total exceed $575 (including GST) per event.YesNoHow many hours travel time are you claiming?*To the nearest 15 minutes. : HH MM How many kilometres did you travel?*Work Address* Street Address Address Line 2 City Address of Mediation* Street Address Address Line 2 City If you are claiming travel time as a disbursement for multiple days and/or locations, please explain below.Please ensure you include the travel cost as a disbursement in your invoice.Room HireageDo you wish to claim room hireage as a disbursement?*Room hireage can be claimed up to a maximum of $230 (including GST) per day pro-rated, ie if room is required for a half-day, funding will be limited to $115 (including GST).YesNoPlease indicate the amount you are claiming for room hireage excluding GSTPlease ensure you include the room hireage charge as a disbursement in your invoice.Invoice and payment for FDR MediationFor payment of your fee for Mediation services, please provide us with a tax invoice by uploading it below. Your invoice should be based on an hourly rate of $160.00 including GST.If you wish to claim travel or room hireage as a disbursement, please ensure this is included in your invoice as well. Drop files here or Final CommentsIs there anything further that your case manager should know at this time?