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Get CA LIC 624B 2008-2024

the report submitted to the Department in the (affected) child’s record. GENERAL INSTRUCTIONS FOR COMPLETION 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. Enter the facility number as shown on the license Enter the licensee’s name as shown on license. Enter the name of the facility as shown on the license. Enter the number and street address, city, and zip code. Enter the first and last name of each child involved in the incident or injury. En.

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