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Get Ca Hhsa Dss Lic 9020 2011-2025
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How to fill out the CA HHSA DSS LIC 9020 online
Filling out the CA HHSA DSS LIC 9020 form is an important step in managing the registration of clients or residents in a facility. This guide provides a clear and supportive approach to completing this form online, ensuring that users can successfully navigate each section.
Follow the steps to complete the CA HHSA DSS LIC 9020 online.
- Click the ‘Get Form’ button to obtain the form and open it in the editor.
- Enter the facility name, which is the name used to designate the single facility under application.
- Input the facility number assigned to the facility.
- Provide the name of the licensee, which is the individual or entity responsible for the operation of the facility.
- Include the date when the information is being recorded or updated.
- If applicable, enter the room identifier that identifies the resident’s room.
- Fill in the client/resident's legal name.
- Select the appropriate box to indicate the client/resident’s ambulatory status, choosing from ‘ambulatory’, ‘non-ambulatory’, or ‘bedridden’.
- Provide the name, address, and telephone number of the attending physician for the client/resident.
- Enter the name, address, and telephone number of the responsible person for the client/resident, ensuring clarity on their role.
- Once all fields have been completed, you may save your changes, download the form, print it, or share it as necessary.
Get started on completing your CA HHSA DSS LIC 9020 form online today.
The LIC 500 form is a comprehensive application used for licensing within the California Department of Social Services. It gathers essential information necessary for verifying compliance with regulations like those in the CA HHSA DSS LIC 9020. Properly completing the LIC 500 strengthens your position in achieving and maintaining the required licensing status.
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