Form LIC 9241. Entrance Checklist Adult Care Facilities - California

Form LIC 9241 is used in California by adult care facilities to document and track the process of admitting an individual into their facility. This form is completed by facility personnel when accepting residents for care and support.

The form consists of sections that require information about the individual being admitted, including personal details, medical history, support needs, and any immediate safety concerns. Important fields include the resident's name, date of birth, diagnoses, medications, allergies, and emergency contact information. Accurate completion of this form ensures that relevant information is gathered to provide appropriate care and support within the adult care facility.

An application example of this form would involve an adult care facility using Form LIC 9241 when admitting a resident into their facility. Facility personnel would gather the necessary information, conduct assessments of the resident's physical and cognitive abilities, and develop an individualized care plan. By completing this form, adult care facilities can maintain accurate records and provide specialized care and support to individuals in need.

Alternative forms: An alternative form to consider is the Form LIC 9107, Residential Care Facility for the Elderly Application - California. While Form LIC 9241 focuses on entrance information for adult care facilities, Form LIC 9107 is used specifically for the application and licensing process of residential care facilities for the elderly (RCFE). The main difference lies in the target population and purpose of each form. Form LIC 9241 is designed for adult care facilities serving a broader range of adults, while Form LIC 9107 is tailored towards facilities specializing in the care of elderly individuals.