Get Sgprc 651 - San Gabriel/pomona Regional Center - Sgprc

Filling out the SGPRC 651 form is an important step in providing necessary information for placement at the San Gabriel/Pomona Regional Center. This guide offers clear, step-by-step instructions to help users complete the form accurately and efficiently.

Follow the steps to complete the form effectively.

1. Click ‘Get Form’ button to obtain the form and open it for editing.
2. Provide the client’s name in the designated field, followed by any other names they may be known by, along with their date of birth and gender.
3. Indicate the marital status of the client. Include a recent photo if required.
4. Fill in the Unique Client Identifier (UCI) and Social Security number in the appropriate fields, and list any primary languages spoken.
5. Complete the sections for benefits information, such as SSI and Medi-Cal, along with any additional insurance the client may have.
6. Document the placement date and the facility’s name, including the full street address, city, zip code, and phone number.
7. In the physical description section, provide details such as height, weight, eye color, hair color, and any distinguishing marks.
8. List any known allergies that the client may have in the designated space.
9. If relevant, enter details regarding previous placement information and any burial arrangements that have been made.
10. Complete the legal representative's contact details, including their relation to the client.
11. Fill out the placement agency's information, including phone numbers and addresses.
12. Document any other representatives and agencies associated with the client, along with their contact details.
13. If applicable, indicate the client's religious preference and provide the name of an advisor.
14. Answer whether the client has any dangerous propensities and provide descriptions if necessary.
15. Complete the medical needs, diagnosis, and any medications details including dosages and prescribing physician.
16. Enter information for the primary physician, dentist, and any other specialists the client sees.
17. Document any communicable conditions and special instructions regarding weight monitoring and allergies.
18. Specify any visitation restrictions and list individuals authorized to take the client from the home.
19. Final steps include reviewing the completed form for accuracy and ensuring all signatures and dates are correctly added.
20. Once all sections have been filled out, you can save changes, download, print, or share the completed form as needed.

Begin filling out the SGPRC 651 form online today for a smooth process.