STATE OF CALIFORNIA HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION GASTROSTOMY TUBE CARE CONSENT/VERIFICATION CHILD CARE FACILITIES This.
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How to fill out the CA LIC 701B online
The CA LIC 701B form is essential for obtaining consent for administering gastrostomy-tube care in child care facilities. This guide provides clear, step-by-step instructions to help you complete the form efficiently and accurately.
Follow the steps to fill out the CA LIC 701B form correctly.
- Click the ‘Get Form’ button to access the CA LIC 701B form and open it in your preferred online editor.
- In the first section, you will need to print the name of the authorized representative giving consent. Ensure this is accurate and legible.
- Next, enter the name of the licensee or staff person who will provide the G-tube care. This is crucial for identifying the individual responsible.
- Fill in the name and address of the child care facility where the G-tube care will be administered to ensure proper documentation.
- Clearly print the name of the child who will receive G-tube care. This helps in associating the consent with the correct individual.
- Indicate whether the consent includes permission to administer routine liquid medication through the G-tube by checking the applicable box and initialing your choice.
- Provide any additional written verification or documents listed on the form, including physician instructions and medical assessments, ensuring all requirements are met.
- Lastly, ensure that you sign and date the form and fill in your address and contact numbers to finalize the consent.
Complete the CA LIC 701B form online today for streamlined processing and compliance.
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