Get Lic 811 - Confidential Names - Dss Cahwnet

The LIC 811 - Confidential Names form is a crucial document used in California for maintaining the confidentiality of clients and residents during licensing processes. This guide provides clear, step-by-step instructions to help users complete the form accurately and efficiently online.

Follow the steps to fill out the LIC 811 form online

1. Press the ‘Get Form’ button to access the LIC 811 form and open it in your preferred editing tool.
2. Begin filling out the form by entering the date of the field visit in the designated space. This refers to the date when the licensing evaluation took place.
3. Next, input the date of the licensing report (LIC 809). This date signifies when the report was generated.
4. Enter the date the licensing report was issued or provided to the licensee or facility representative.
5. Fill in the facility name where the clients or residents reside.
6. Input the facility number, which serves as an identifier for the establishment.
7. In the table provided, enter the reference number alongside each client's name. The reference number should match the one used in the licensing report.
8. Add the names, dates of birth, and addresses or locations of each client/resident in the table.
9. Include any relevant comments regarding the clients or residents in the designated comment section.
10. After completing all sections, print the form and review for accuracy.
11. Finally, save the changes, download the form, and print copies as needed for your records or submission.

Complete your documentation online confidently and ensure accuracy in your submissions.