Tube care consent verification child care facilities - California - cdss ca 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the name of the authorized representative in the designated field. This is crucial for identifying who is granting consent.
3. Next, input the name of the licensee or staff person who will be administering G-tube care. Ensure this information is accurate to avoid any confusion.
4. Fill in the name and address of the child care facility where the G-tube care will take place. This helps maintain clear communication between all parties involved.
5. Provide your child's name in the appropriate section, ensuring that it matches official documents for consistency.
6. Indicate whether permission includes administering routine liquid medication through a G-tube by checking and initialing the corresponding box.
7. Review and attach any required documentation listed on the reverse side of the form, such as written verification from your child's physician and medical assessments.
8. Finally, sign and date the form at the bottom, providing your contact information to ensure easy follow-up if necessary.

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