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.
The LIC 610E form is an Emergency Disaster Plan designed for Residential Care Facilities for the Elderly. Its main purpose is to ensure the safety of elderly residents in case of emergencies or disasters such as earthquakes, wildfires, or floods.
The LIC 279B form is an application for a Family Child Care Home License. This form is used to provide detailed information about the children currently residing in your home when applying for a license to operate a family child care business.
The LIC 279 form is an application for a Family Child Care Home License in California. The purpose of this form is to apply for a license to operate a family child care home, which is a small-scale child care facility located in the provider's home.
The LIC 622 form, also known as the Centrally Stored Medication and Destruction Record, is a document used to record the inventory and destruction of centrally stored medications. The primary purpose of the form is to ensure that medications are safely stored and disposed of in compliance with applicable laws and regulations.
When running a licensed care facility, there are various forms that need to be filled out and submitted to the appropriate agencies. These forms are designed to ensure compliance with regulations and provide important information about the facility's operations. In this list, we have compiled some of the most commonly used forms in California for licensed care facilities.
The LIC 503 (Health Screening Report for Facility Personnel) is the form used by California health care facilities to determine the health of personnel prior to employment or assignment. It consists of three parts: health history, immunizations and health screening.
LIC 9052 is a form used in California to provide notice to employees about their rights under the California Family Rights Act (CFRA). This form must be provided to all California employees, along with other documents such as a CFRA claim form and a Health Provider Certification Form.
