Lic 601 2025

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4.9 out of 5

390 votes

The document outlines the identification and emergency information requirements for individuals admitted to community care facilities in California, as mandated by the Health and Safety Code. It includes sections for personal details, emergency contacts, medical plans, and specific information for residential facilities for children, ensuring that all data is kept current and secure.

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Click ‘Get Form’ to open the lic 601 in the editor.
Begin by filling in the 'Name of Client or Child' and 'Social Security Number' (optional) in the first section. Ensure accuracy as this information is crucial for identification.
Next, provide details for the 'Responsible Person or Placement Agency,' including their date of birth, age, telephone number, and address. This section helps establish accountability.
Complete the 'Nearest Relative' section if applicable, followed by admission details such as 'Date Admitted to Facility' and 'Date Left.' Include reasons for leaving if necessary.
Fill out emergency contact information, including names and relationships of individuals to be notified in case of an emergency. Be sure to include their telephone numbers.
Lastly, review all sections for completeness and accuracy before signing. Use our platform's features to save your progress or share it with others for review.

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Versions	Form popularity	Fillable & printable
2008	4.9 Satisfied (390 Votes)

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