Form LIC 624A. Death Report

The LIC 624A Death Report is a mandatory form that licensees must complete and submit when a client dies, regardless of the cause and location of death. The purpose of this form is to notify the licensing agency, placement agency, and responsible parties (if any) about the client's death.

The form consists of instructions, notification requirements, and a written report submission deadline. Licensees are required to notify all relevant parties by the next working day and submit a written report within seven days of the occurrence. A copy of the report must be retained in the client's file.

When filling out the form, important fields include the client's name, date of birth, date of death, cause of death, and location of death. Additional documents may need to be attached, such as a death certificate or medical examiner's report.

Application examples and use cases for this form include situations where a licensee is providing care for elderly or disabled clients who may be at higher risk of death due to their health conditions. By completing and submitting the form promptly, licensing agencies and other parties can take appropriate action to ensure the well-being of other clients and prevent potential legal issues.

Strengths of the form include its simplicity and clear instructions, which make it easy for licensees to comply with reporting requirements. A weakness is that failure to complete and submit the form accurately and on time can result in penalties or legal consequences for the licensee. An opportunity for improvement could be to provide more detailed guidance on how to complete the form correctly.

There are no direct analogues or alternative forms to the LIC 624A Death Report, but other similar forms may exist depending on the jurisdiction or industry. For example, healthcare providers may be required to submit a similar form to their state health department following a patient's death.

The completion and submission of this form can have significant implications for all parties involved. It allows licensing and placement agencies to monitor the quality of care provided by licensees and take appropriate action if necessary. It also helps to protect the legal rights of clients and their families.

The form can be submitted to the licensing agency, placement agency, and responsible parties via mail or email, depending on the agency's procedures. The licensee should retain a copy of the report in the client's file for future reference.