Get Lic 858a (7/00) - Additional Child Records Review - California ...

Filling out the LIC 858A form is essential for the accurate review of child records in specialized foster care homes in California. This guide will provide you with clear instructions on how to complete the form efficiently and accurately online.

Follow the steps to complete the LIC 858A form online.

1. Click ‘Get Form’ button to access the LIC 858A form and open it in your preferred editor.
2. Begin by entering the facility name in the designated section at the top of the form. This identifies the establishment you are reviewing.
3. Next, fill in the license report (LIC 809) date and facility number. These details are crucial for identification and tracking purposes.
4. Indicate the type of visit by checking the appropriate box: follow-up, complaint, or evaluation. This reflects the nature of the assessment being performed.
5. Provide the child’s name in the specified field. If the child has special health care needs, denote this by marking the SHCNC box as applicable.
6. For each child being reviewed, complete the certification fields to confirm if their needs can be met by the facility and if there are no other placements available.
7. Indicate if there is an individualized healthcare plan for children with special health care needs by checking the corresponding box.
8. Document any relevant comments in the comments section to provide additional context or information regarding the review.
9. Finally, ensure the licensing evaluator signature and date are filled out to validate the review process.
10. Once all fields are completed, save your changes, and download or print the form for your records or share it as necessary.

Complete your LIC 858A form online today for efficient child records management.