Get Ca Lic 624 1999-2026

The CA LIC 624 is an essential document required to report the death of a client in a facility. This guide will provide you with clear instructions on how to complete the form accurately and efficiently online.

Follow the steps to fill out the CA LIC 624 form successfully.

1. Click the ‘Get Form’ button to access the form and open it in the editing interface.
2. Begin by entering the name of the facility where the incident occurred. Ensure this is accurate and corresponds with your records.
3. Fill in the facility file number, followed by the complete address, including city, state, and ZIP code.
4. Provide the client's name and date of birth to clearly identify the individual. This information is crucial for documentation purposes.
5. Input the telephone number of the facility, ensuring it is correct for follow-up communication.
6. Select the client's sex and enter the date of admission into the facility.
7. Indicate the place and time of death, as well as briefly describing the immediate cause of death. If a coroner's report has been made, specify that a copy will be sent within the required timeframe.
8. Describe any conditions leading up to or contributing to the client's death. Provide detail to assist in understanding the circumstances.
9. Explain the immediate actions taken following the death, including any individuals contacted during the process.
10. Indicate whether medical treatment was necessary. If 'Yes,' be sure to provide details about the nature of the treatment administered.
11. Fill in the name of the attending physician and the name of the mortician responsible for arrangements.
12. Complete the report by entering your name and title as well as the date of submission. If applicable, include the names and titles of those who reviewed and approved the report.
13. Lastly, ensure to notify the necessary agencies and individuals by providing their names and telephone numbers as required.
14. Once you've completed the form and reviewed all your entries, you can save changes, download the form, print it, or share it as necessary.

Complete your CA LIC 624 form online to ensure proper compliance and reporting.