Get Lic701

The Lic701 form is essential for obtaining a physician's report for child care centers in California. This guide aims to provide clear instructions on how to fill out the Lic701 online, ensuring users can navigate the process smoothly and confidently.

Follow the steps to complete the Lic701 form effectively.

1. Press the ‘Get Form’ button to access the Lic701 form and open it in your preferred editor.
2. Begin by filling out Part A, which includes the child's name and date of birth. Ensure that you accurately enter the name of the child and their birth date.
3. Provide the name of the child care center or school the child will be attending, along with the operating hours for the program each day.
4. As a parent or authorized representative, sign and date the consent section at the bottom of Part A, allowing for medical information to be shared.
5. Proceed to Part B, which must be completed by the physician. Verify that the physician fills in the sections for any health problems, evaluations, and comments related to the child's health.
6. Ensure that the physician provides a comprehensive immunization history, listing each vaccine received with corresponding dates.
7. Confirm any required statements regarding tuberculosis risk factors, either indicating their absence or noting if a Mantoux TB skin test was performed.
8. Finally, the physician must sign and date the form, providing their contact information, to validate the report.
9. Once all sections are filled out, you may save the changes, download, print, or share the completed Lic701 form as needed.

Complete your Lic701 form online today for a smooth submission process.