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LICENSEE MUST REPORT THE DEATH OF A CLIENT OF ANY CAUSE, REGARDLESS OF WHERE THE DEATH OCCURRED. INSTRUCTIONS : NOTIFY LICENSING AGENCY, PLACEMENT AGENCY AND RESPONSIBLE PERSONS, IF ANY, BY NEXT WORKING DAY. SUBMIT WRITTEN REPORT WITHIN 7 DAYS OF OCCURRENCE. RETAIN COPY OF REPORT IN CLIENT’S FILE. MEDICAL TREATMENT NECESSARY?
- LIC 602A
state of california - health and human services agency...
- LIC 602A
death report licensee must report the death of a client of any cause, regardless of where the death occurred. instructions : notify licensing agency, placement agency and responsible persons, if any, by next working day. submit written report within 7 days of occurrence. retain copy of report in client’s file. name of facility facility file ...
LIC 602 (7/22) - Physician's Report For Community Care Facilities ; LIC 602A (8/11) - Physician's Report For Residential Care Facilities For The Elderly (RCFE) LIC 603 (6/22) - Preplacement Appraisal Information ; LIC 603A (7/99) - Resident Appraisal ; LIC 604 (10/05) - Admission Agreement Guide For Residential Facilities
state of california - health and human services agency california department of social services . physician's report for residential care facilities for the elderly (rcfe) i. facility information (to be completed by the licensee/designee) 1. name of facility 2. telephone ( ) 3. address . city . zip code . 4. licensee’s name . 5. telephone ( ) 6.
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Fill out and download the LIC624A Death Report form in California. Create a PDF version or fill it out online and save as a ready-to-print PDF. Completely free to use.
Title: LIC 602A.pdf Author: ecotrials Created Date: 4/14/2020 1:20:09 PM
