Form LIC 701A. Gastrostomy - Tube Care: Physician's Checklist (Child Care Facilities) - California

Form LIC 701A is used in California by child care facilities when a child requires gastrostomy tube care. The main purpose of this form is to ensure that proper care and management of the gastrostomy tube are provided according to the child's specific needs.

The form consists of a checklist that is completed by the child's physician or healthcare provider. It includes sections covering important aspects of gastrostomy tube care, such as cleaning procedures, feeding protocols, medication administration, monitoring for complications, emergency response, and contact information for the healthcare provider. The form may also include space for additional instructions or notes.

Important fields on this form include accurately documenting the specific care requirements for the child's gastrostomy tube, ensuring compliance with medical orders and instructions, and providing clear guidance for child care providers. It is crucial for child care facilities to have this form on file and follow the guidelines outlined to maintain the health and safety of children requiring gastrostomy tube care.

Application Example: A child with a gastrostomy tube is enrolled in a licensed child care facility in California. Form LIC 701A would be completed by the child's physician, who outlines the specific care instructions related to the gastrostomy tube. By following the checklist and adhering to the physician's guidance, child care providers can ensure proper care and minimize the risk of complications related to the gastrostomy tube.