California Department Of Social Services Templates

472
total templates

Documents

472

Form SOC 873 In-home Supportive Services (Ihss) Program Health Care Certification Form - California

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4.3(4.3 / 5) 36 votes
Size: 68 KB
2 pages

Download this form, which is a medical certification submitted by a licensed health care professional to sanction the disabled, blind, or elderly access for services from the In-Home Supportive Services (IHSS) program.

Form LIC 602 Physician's Report for Community Care Facilities - California

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4.4(4.4 / 5) 69 votes
Size: 109 KB
3 pages

File this form if you are the physician of the applicant for admission to a Community Care Facility and have a thorough knowledge of the patient's medical issues. The goal of this document is to check if the patient can continue their residential treatment at the facility.

Form LIC 500 Personnel Report - California

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4.4(4.4 / 5) 52 votes
Size: 194 KB
2 pages

This is form issued by the California Department of Social Services (CDSS). It is filed to keep a current list of the staff (including backup persons, volunteers, etc.) employed and residing on the facility.

Form LIC 622a Medication Administration Record (MAR) - California

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4.7(4.7 / 5) 33 votes
Size: 180 KB
4 pages

Use this form if you are health care professional to keep track of non-psychotropic medications prescribed to a child. This four-page record sheet is often referred to as a drug chart.

Form LIC 9182 Criminal Background Clearance Transfer Request - California

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4.3(4.3 / 5) 59 votes
Size: 41 KB
2 pages

File this document if you are an employee of a licensed community care facility or home care organization, and wish to apply for a transfer of your active criminal record from one state licensed facility to another.

Form LIC 602A Physician's Report for Residential Care Facilities for the Elderly (Rcfe) - California

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4.3(4.3 / 5) 42 votes
Size: 174 KB
6 pages

Download this document to inform your residential care facility of care needs, diagnosis, and mental condition of an elderly person.

Form SAR 7 Eligibility Status Report - California

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4.6(4.6 / 5) 62 votes
Size: 1 MB
2 pages
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Form SR 1 Group Home Program Rate Application - California

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4.8(4.8 / 5) 65 votes
Size: 70 KB
3 pages
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California Legal Forms

Form SR 2 Program Classification Report - California

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4.5(4.5 / 5) 63 votes
Size: 88 KB
2 pages
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California Legal Forms

Form CW 52 Child Support Payment Opt-In Form - California

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4.3(4.3 / 5) 52 votes
Size: 1 MB
2 pages
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