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Get Ca Hhsa Dss Lic 601 2008-2025
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How to fill out the CA HHSA DSS LIC 601 online
The CA HHSA DSS LIC 601 form is essential for gathering identification and emergency information for individuals admitted to community care facilities. This guide offers a clear, step-by-step approach to filling out the form online effectively.
Follow the steps to complete the CA HHSA DSS LIC 601 form online.
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- Enter the name of the client or child in the designated field. You may also provide the optional social security number here.
- Fill in the responsible person or placement agency, along with the date of birth, age, telephone number, and address of the individual.
- If applicable, include the name of the nearest relative and their relationship to the client or child.
- Specify the date admitted to the facility and provide the address prior to admission, along with details of the date left, sex, telephone number, and forwarding address.
- Describe the reasons for leaving the facility, if applicable.
- Document the names and contact details of persons responsible for financial affairs, payment for care, and legal guardians, if any.
- List emergency contacts, including their roles (dentist, mental health provider, friends, relatives), alongside their names, addresses, and telephone numbers.
- Indicate the name and address of the hospital where the individual would be taken in an emergency, along with the medical and dental plan details.
- Provide any other required information such as ambulatory status, religious preference, and contact details of the religious advisor, if any.
- Add any additional comments as necessary.
- Ensure the signatures of the resident and the person completing the form are included, along with the title and date.
- Once all fields are filled out, save your changes, then download, print, or share the completed form as needed.
Complete your CA HHSA DSS LIC 601 form online today for a seamless experience.
A LIC DAT file is a data file associated with licensing records and applications within the CA HHSA DSS system. These files contain important information and help track licensing statuses and updates. When managing licensing data, it’s vital to ensure these files are kept accurate and accessible for ongoing compliance and review.
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