Get Lic627c

The Lic627c form is a crucial document for consenting to emergency medical treatment for individuals in adult and elderly residential facilities in California. This guide provides clear instructions to help you complete the form accurately and efficiently online.

Follow the steps to complete the Lic627c online

1. Click the ‘Get Form’ button to access the Lic627c form and open it in your preferred online editor.
2. In the first blank, enter the name of the facility that will provide the emergency medical or dental care.
3. Next, provide the name of the individual for whom consent is being given in the appropriate space.
4. Indicate any medication allergies the client has by listing them clearly in the designated area.
5. Select the date on which you are filling out the form in the appropriate format.
6. Sign the form as the client, authorized representative, or conservator, making sure to circle the appropriate title you hold.
7. Fill in your home address and provide both your home and work phone numbers in the required fields.
8. Once all sections are completed, save your changes, and choose options to download, print, or share the completed Lic627c form as necessary.

Take the next step and complete your Lic627c form online today.