The LIC 9172 form is a Functional Capability Assessment required by Adult Residential and Social Rehabilitation Facilities, Adult Day Care Facilities, and Adult Day Support Centers. The goal of the form is to obtain information on an applicant's functional ability prior to placement in order to create a Needs and Services Plan for that individual.
The LIC 200A form is an application for a Child Care Center License in California. The purpose of the form is to provide information about the applicant(s), facility/agency, and the type of child care services being provided. The form consists of 20 fields that need to be completed accurately.
Form LIC 9095 is an evaluation form used to assess a teacher's qualifications. The main purpose of this form is to gather information about a teacher's education and experience, which can determine their eligibility for certain positions.
The form consists of five parts, including personal information, education/experience, qualifying postsecondary courses, qualifying experience, and other applicable education/courses. Important fields include the applicant's name, facility information, course and employment details.
The LIC 9020 form is a crucial document used to keep track of facility clients/residents in a long-term care facility. The primary purpose of this form is to maintain an accurate and up-to-date registry of all individuals residing in the facility, including their personal information, medical history, and contact details.
The LIC 613C-2 form outlines the personal rights of residents in privately operated Residential Care Facilities for the Elderly (RCFE) in California, and provides complaint procedures for residents and their responsible persons. The purpose of this form is to ensure that each resident is aware of their rights and understands how to voice any concerns or complaints they may have.
The LIC 604A admission agreement is a legal document that must be completed by a residential care facility for the elderly when admitting a resident. The purpose of this form is to outline the terms and conditions of the resident's stay, including fees, services offered, and responsibilities of both parties.
The Resident Appraisal form (LIC 603A) is a crucial component of the application process for prospective residents of Residential Care Facilities for the Elderly. The purpose of this form is to obtain detailed information about the resident's personal background, medical history, and daily living activities to ensure that they receive proper care and accommodations.
The LIC 508 O-O-S is a form that requires disclosure of out-of-state residence for the past five years. It is intended for licensees seeking approval to work, be present at or licensed facilities, certified family homes or home of a resource family. The purpose of this form is to facilitate a criminal background check by the Caregiver Background Check Bureau.
The LIC 624A Death Report is a mandatory form that licensees must complete and submit when a client dies, regardless of the cause and location of death. The purpose of this form is to notify the licensing agency, placement agency, and responsible parties (if any) about the client's death.
The LIC 9020A is a form used to register residents in residential care facilities for the elderly. The main purpose of this form is to keep a record of all the residents who reside in these facilities. The form consists of several parts, including basic information about the resident such as their name, date of birth, and address. Other important fields on the form include medical history, medications, and emergency contact information.
