Form LIC 9236. Entrance Checklist Short - Term Residential Therapeutic Program - California

Form LIC 9236 is used in California by short-term residential therapeutic programs to document and track the process of admitting a client into their program. This form is completed by program personnel when welcoming a new client to the short-term residential therapeutic program.

The form consists of sections that require information about the client being admitted, including personal details, medical history, treatment goals, and any special needs or considerations. Important fields include the client's name, date of birth, diagnoses, medications, and emergency contact information. Accurate completion of this form ensures that relevant information is gathered to support the client's treatment and meet their individual needs within the program.

An application example of this form would involve a short-term residential therapeutic program using Form LIC 9236 when admitting a new client into their program. Program personnel would gather the necessary information about the client, including personal details, medical history, and treatment goals. By completing this form, short-term residential therapeutic programs can maintain accurate records and ensure effective communication among staff members regarding the client's needs.

Related forms: A related form is Form LIC 9220, Admission Agreement - California. While Form LIC 9236 focuses on entrance information for short-term residential therapeutic programs, Form LIC 9220 is used to document the agreement between the program and the client upon admission. The main difference lies in the purpose and content of each form, with Form LIC 9236 focusing on gathering essential client information and Form LIC 9220 addressing legal and contractual aspects of the admission process.