Get Lic 613

The Lic 613 form is essential for ensuring that individuals admitted to adult community care facilities are informed of their personal rights. This guide offers clear, step-by-step instructions for completing the form online, ensuring all users can navigate this process effectively.

Follow the steps to complete the Lic 613 form online.

1. Click the 'Get Form' button to access the Lic 613 form and open it in the editing interface.
2. Begin by entering the name of the facility in the designated field. Ensure the spelling is accurate, as this identifies the location where personal rights are being acknowledged.
3. Next, input the address of the facility in the corresponding field, including street address, city, and ZIP code. This helps to clearly identify the facility location.
4. Complete the field for the client's name by entering the name of the individual being admitted to the facility. This is crucial for maintaining accurate records.
5. Have the client sign in the signature field to acknowledge that they have been informed of their rights. If a representative or conservator is involved, they should also sign in the designated area.
6. In the next section, the representative or conservator should enter their title if applicable. This helps clarify their relationship to the client.
7. Fill in the date of signing in the designated fields for both the client and the representative/conservator to ensure proper documentation.
8. Provide the required information regarding the appropriate licensing agency to contact for complaints. This includes the agency's name, address, city, ZIP code, and telephone number.
9. Review all entered information for accuracy and completeness, ensuring that there are no missed fields or errors.
10. Finally, save the completed form. You can choose to download, print, or share it as needed, and ensure a copy is provided to the client or their representative.

Start completing your Lic 613 form online today to ensure all personal rights are acknowledged.