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AFCRESIDENT INFORMATIONAND IDENTIFICATION RECORD Michigan Department of Licensing and Regulatory Affairs Division of Adult Foster Care Licensing Instructions: 1. Please complete all applicable information.

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How to fill out the Resident Information And Identification Record Sheet online

Completing the Resident Information And Identification Record Sheet is essential for documenting important details about a resident's admission. This guide provides clear instructions to help you navigate the process effectively and ensure all necessary information is accurately recorded.

Follow the steps to complete the form accurately

  1. Press the ‘Get Form’ button to access the document and open it in the online editor.
  2. Enter the license number in the designated field. This number identifies the facility offering foster care.
  3. Fill in the resident's name as it appears on their legal identification.
  4. Provide the case number associated with the resident, if applicable.
  5. Enter the social security number of the resident, ensuring confidentiality and accuracy.
  6. Indicate the veteran status and number if the resident has served in the military.
  7. Select the marital status from the provided options.
  8. Input the resident's home address, including street, city, and zip code.
  9. Fill in the date of birth for accurate identification purposes.
  10. Record the name and contact information of the next of kin, guardian, or designated representative.
  11. Enter a telephone number where the resident can be reached.
  12. Specify the resident's sex, ensuring that all entries align with provided options.
  13. Input the address of the placing agency or person, including street, city, and zip code.
  14. Provide the date of admission to the facility.
  15. If applicable, fill in the date of discharge.
  16. Record the name and contact information of the resident's physician.
  17. Enter the name of the preferred hospital along with its address.
  18. Indicate the resident's religious preference, if any.
  19. Fill out insurance information and any burial provisions as necessary.
  20. Complete the resident valuables inventory on page 2, documenting all items accurately.
  21. After ensuring all sections are filled out correctly, save your changes. You can download, print, or share the completed form as needed.

Complete the Resident Information And Identification Record Sheet online today for comprehensive record-keeping.

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You must submit form BCC-979 with your plans. This form, and the fire safety administrative rules for AFC's of 7 or more, may be obtained by visiting the LARA-BCCFS website. The local health authority completes inspections for private water supply and/or sewage disposal systems for family and group homes.

You can only receive residents in your group home after you have been granted a license by the State of Michigan. After you receive the license, you must continue to comply with the same requirements you had to meet to obtain your first license. Your license lasts for two years.

You must submit form BCC-979 with your plans. This form, and the fire safety administrative rules for AFC's of 7 or more, may be obtained by visiting the LARA-BCCFS website. The local health authority completes inspections for private water supply and/or sewage disposal systems for family and group homes.

You must file an application with the state, which will review the application and provide a license if you satisfy all criteria for your type of adult foster care home. The state wants to determine whether you can handle emergencies and whether you have the appropriate temperament to care for the elderly.

The Department of Licensing and Regulatory Affairs provides licensing and regulation of homes for the aged (HFA) and adult foster care (AFC).

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