
Ddress: _______________________________________ Phone: _______________ (Signature Stamp Required) DCFS 561(b) (Rev 07/02) DCFS 561(b) DENTAL EXAMINATION FORM Distribution: Pages 1, 2 and 3 to foster caregiver when child initially placed. Page 4 to be filed in Psychological/Medical/Dental folder (purple). When page 1 returned, file in Psychological/Medical/Dental folder. .
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How to fill out the CA DCFS 561(b) online
The CA DCFS 561(b) form is an essential document required for documenting dental examinations for children placed in foster care. This guide will provide you with a thorough, step-by-step approach to filling out this form online, ensuring clarity and accuracy in the submission process.
Follow the steps to fill out the CA DCFS 561(b) form effectively.
- Press the ‘Get Form’ button to access the CA DCFS 561(b) form and open it in the online editor.
- Review the instructions at the top of the form, which outline the importance of the Health & Education Passport during the child's medical visits.
- Provide the child's name, date of birth, case number, and date of placement in the designated fields.
- Indicate whether the child needs a dental examination within thirty days of placement or if they have had an examination within the past year.
- Fill in the caregiver's contact information, including name and phone number, as well as the information for the Foster Family Agency (FFA) and the Children’s Social Worker (CSW).
- Complete the dental examination section with the date of examination and the name of the dentist, ensuring to select whether it is an annual required examination or a follow-up visit.
- If applicable, summarize the dental exam results, including any treatments given or medications prescribed. Remember to attach supporting documentation if necessary.
- Finalize the form by having the health care provider sign and date it, ensuring their address and phone number are completed.
- Upon completing all sections, save the changes made to the form. You can also download, print, or share the completed document as needed.
Complete your CA DCFS 561(b) form online today for a smooth documentation process.
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