Get Mi Bcal-3704-cc 2016

The MI BCAL-3704-CC is a medical clearance request form essential for child care licensing in Michigan. This guide provides a step-by-step approach to assist users in accurately completing the form online.

Follow the steps to fill out the MI BCAL-3704-CC online accurately.

1. Click ‘Get Form’ button to access the MI BCAL-3704-CC form and open it in your preferred online editor.
2. In the 'Applicant/Licensee Information' section, provide the facility or home name, license number, and the full address, including the city, state, and zip code.
3. Next, fill in the 'Licensing Consultant' information by including their name, complete address, and phone number.
4. In the 'Patient Information' section, enter the patient's name, date of birth, telephone number, and their complete address.
5. For the 'Release of Information' section, specify the date and obtain the patient's signature, as well as the physician's name printed clearly.
6. Proceed to the 'Medical Information' section to provide details regarding the patient's physical and mental health condition. Answer the questions regarding TB testing and describe the patient's condition. Use the comments section as needed for additional explanations.
7. Finally, ensure the physician signs and dates the form, providing their address and telephone number to complete the submission.
8. Once all sections are thoroughly filled, you may save changes, download, print, or share the completed form as needed.

Complete your MI BCAL-3704-CC form online today for a smooth licensing process.