Get Mt Dphhs-qad/ccl-113 2006-2025
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How to fill out the MT DPHHS-QAD/CCL-113 online
The MT DPHHS-QAD/CCL-113 form is a crucial document for emergency contact and parental consent when child care services are utilized. This guide provides a clear, step-by-step approach to completing the form online, ensuring that all necessary information is accurately captured.
Follow the steps to successfully complete the form online.
- Click the ‘Get Form’ button to obtain the form and open it for further editing.
- Enter the child's name in the designated field at the top of the form, followed by their birth date and current address to ensure accurate identification.
- Fill in the mother or legal guardian’s name along with their home number, address, cell number, work address, and work number. This information is essential for emergency communication.
- Provide the father's or legal guardian’s details in the same manner as for the mother, including name, home number, address, cell number, work address, and work number.
- List at least one emergency contact person, including their contact number. You may add additional emergency contacts as needed.
- Please specify the name and contact information for the physician or medical care source, along with their contact number for emergency purposes.
- Indicate the health insurance carrier and policy number to assist in medical emergencies.
- Identify persons authorized to pick up the child by entering their names in the provided fields.
- Respond to the yes/no questions regarding consent for emergency medical care and the administration of prescription or non-prescription medications, ensuring to complete related authorization forms as necessary.
- Note any special dental or dietary needs the child may have in the appropriate section, including any specific instructions for care during transportation if applicable.
- Mark any relevant health concerns the child may have to inform the care providers adequately.
- Secure a signature from the parent or guardian and indicate the date of completion to validate the form.
- After completing the form, save your changes. You may then download, print, or share the form as required.
Begin filling out the MT DPHHS-QAD/CCL-113 online today to ensure your child's safety during care.
Licensed child care meets state standards, providing a safe and regulated environment, unlike license exempt care, which is generally unregulated under MT DPHHS-QAD/CCL-113. Licensed providers undergo inspections and training, while exempt caregivers may not follow the same guidelines. Understanding this distinction helps parents choose the best option for their children.
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