Get Bcal 3704

This guide provides clear and supportive instructions on how to fill out the Bcal 3704 form online. Following these steps will help ensure that you accurately complete the medical clearance request needed for adult foster care and homes for the aged.

Follow the steps to complete the Bcal 3704 form efficiently.

1. Click ‘Get Form’ button to obtain the form and open it in your document management tool.
2. In the applicant/licensee information section, enter the facility/home name, license number, and address. Make sure that all details are correct and complete.
3. Fill in the city, state, and zip code for the facility. Next, provide the name, address, and phone number of the licensing consultant.
4. Indicate the license application type by selecting either adult foster care (24-hour care) or home for the aged (24-hour care).
5. In the patient information section, provide the patient's name, date of birth, address, city, state, zip code, and social security number. Ensure clarity in each entry.
6. Enter the patient's telephone number. This will aid in communication regarding their medical clearance.
7. In the release of information section, the patient must authorize the release of their medical information by signing and dating the form.
8. The physician will complete the medical information section. They must answer questions regarding tuberculosis testing and describe the patient's physical and mental condition.
9. Make sure the physician signs and dates the form, providing their name and address as required.
10. Review each section for accuracy and completeness. Once all information is confirmed, save the document or download it for submission.

Complete your Bcal 3704 form online today for a smooth application process.