Get Lic 9222.pdf. Dfa 256 (11/03) Form And Instructions Revision - Cdss Ca

Filling out the LIC 9222.PDF. DFA 256 (11/03) form is a crucial step for obtaining consent for blood glucose testing in child care facilities. This guide will provide you with clear, step-by-step instructions to ensure the process is straightforward and effective.

Follow the steps to accurately complete the form online.

1. Click the ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the name of the authorized representative in the designated field. This is the individual providing consent for the blood glucose testing.
3. Next, input the name of the licensee or staff person who will be performing the blood glucose testing.
4. Complete the section requesting the name and address of the child care facility where the testing will take place.
5. Provide the name of the child who will undergo the blood glucose testing in the specified field.
6. Ensure that you certify the instruction process for the licensee or staff person on how to perform the blood glucose testing by checking the appropriate boxes.
7. List the written instructions provided by the child's physician or health care provider in the highlighted areas, ensuring all required details about the testing process, possible side effects, and storage instructions are included.
8. Sign and date the form in the designated signature section to confirm your consent.
9. Fill in the address, home telephone number, and work telephone number of the authorized representative for contact purposes.
10. Once you have filled out the form completely, review all entered information for accuracy before saving changes, downloading, or printing the form.

Complete your documents online for a smoother and more efficient process.