Form LIC 9239 EBSH. Entrance Checklist - Enhanced Behavioral Supports Homes - California

Form LIC 9239 EBSH is used in California by enhanced behavioral supports homes (EBSH) to document and track the process of admitting an individual with behavioral support needs into their home. This form is completed by EBSH personnel when accepting an individual for residential care and specialized behavioral support.

The form consists of sections that require information about the individual being admitted, including personal details, behavioral history, support needs, and any specific accommodations or interventions required. Important fields include the individual's name, date of birth, diagnoses, behavior support plan goals, and emergency contact information. Accurate completion of this form ensures that relevant information is gathered to provide tailored behavioral support and residential care within the EBSH.

An application example of this form would involve an EBSH using Form LIC 9239 EBSH when admitting an individual with behavioral support needs into their home. EBSH personnel would gather the necessary information, review the individual's behavior support plan, and establish appropriate strategies to promote positive behaviors and enhance quality of life. By completing this form, EBSH can maintain accurate records and provide specialized care and support to individuals with behavioral challenges.

Alternative forms: An alternative form to consider is the Form LIC 9218, Behavioral Support Services Plan - California. While Form LIC 9239 EBSH focuses on gathering entrance information for enhanced behavioral supports homes, Form LIC 9218 is used to develop and document a comprehensive plan for behavioral support services. The main difference lies in the purpose and content of each form, with Form LIC 9239 EBSH focusing on admission details and Form LIC 9218 addressing the ongoing planning and implementation of behavioral support services within the home setting.