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LIFE CARE INSTRUCTIONS FOR ERRAND RECEIPT FORM LC-280 / 2/08 PURPOSE This form is used to provide documentation and a clear audit trail when a worker is assigned to pay bills or make purchases for a client with cash check money order or charge to a client s account. DISTRIBUTION The form is printed as an original to be distributed as follows each time a new form is completed Original-retained in client s clinical record. GENERAL INSTRUCTIONS Print client s name and/or name of responsible person* Print name of employee who will be performing errands. Check the appropriate boxes and fill out blanks as they apply. Check this box if employee receives cash and enter the amount received in the blank before errands. check in the blank before errands. money order in the blank before errands. the name of the resource in the blank. enter the amount in the blank after errands. client/responsible person upon return from errands. returned to client/responsible person and enter the name of resource in the blank. Employee completing form signs to signify information on form is correct. Enter date form is completed* Use the comments section to record any other pertinent information* 02/04/08be. DISTRIBUTION The form is printed as an original to be distributed as follows each time a new form is completed Original-retained in client s clinical record. GENERAL INSTRUCTIONS Print client s name and/or name of responsible person* Print name of employee who will be performing errands. GENERAL INSTRUCTIONS Print client s name and/or name of responsible person* Print name of employee who will be performing errands. Check the appropriate boxes and fill out blanks as they apply. Check this box if employee receives cash and enter the amount received in the blank before errands. Check the appropriate boxes and fill out blanks as they apply. Check this box if employee receives cash and enter the amount received in the blank before errands. check in the blank before errands. money order in the blank before errands. the name of the resource in the blank. check in the blank before errands. money order in the blank before errands. the name of the resource in the blank. enter the amount in the blank after errands. client/responsible person upon return from errands. returned to client/responsible person and enter the name of resource in the blank. enter the amount in the blank after errands. client/responsible person upon return from errands. returned to client/responsible person and enter the name of resource in the blank. Employee completing form signs to signify information on form is correct. Enter date form is completed* Use the comments section to record any other pertinent information* 02/04/08be. DISTRIBUTION The form is printed as an original to be distributed as follows each time a new form is completed Original-retained in client s clinical record. GENERAL INSTRUCTIONS Print client s name and/or name of responsible person* Print name of employee who will be performing errands. Check the appropriate boxes and fill out blanks as they apply. Check this box if employee receives cash and enter the amount received in the blank before errands..

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