Form LIC 701B. Gastrostomy - Tube Care Consent/Verification (Child Care Facilities) - California

Form LIC 701B is used in California by child care facilities to obtain consent and verify the ability of their staff members to provide care for a child with a gastrostomy tube. The main purpose of this form is to ensure that child care providers are trained and authorized to perform gastrostomy tube-related tasks.

The form consists of sections where the parent or legal guardian provides consent for the child's gastrostomy tube care at the child care facility. It also includes sections to verify that designated staff members have received appropriate training in gastrostomy tube care, including cleaning procedures, feeding protocols, medication administration, recognizing complications, and emergency response. The form may require signatures from both the parent or legal guardian and the child care facility representative.

Important fields on this form include obtaining parental consent for gastrostomy tube care, verifying staff member competencies, and ensuring compliance with training requirements. It is crucial for child care facilities to have this form completed and on file as evidence of staff readiness and parental authorization to provide care for children with gastrostomy tubes.

Application Example: A child with a gastrostomy tube is enrolled in a licensed child care facility in California. Form LIC 701B would be completed by the parents or legal guardians, granting consent for the child's gastrostomy tube care at the facility. The form would also be used to verify that staff members responsible for the child's care have received appropriate training in gastrostomy tube care.