LIC 9112 - Facility Compliance Plan
Form LIC 9112 is used to develop a facility compliance plan for licensed facilities in California. The form assists facility operators in creating a comprehensive plan to address identified deficiencies, violations, or areas of non-compliance with licensing regulations.
LIC 9106A - Short-Term Residential Therapeutic Program
Form LIC 9106A is specific to short-term residential therapeutic programs (STRTPs) in California. The form provides instructions for completing the program statement required for STRTP licensure.
LIC 9119 Facility Inspection Checklist Group Homes
Form LIC 9119 is an inspection checklist specific to group homes in California.
LIC 622B - Psychotropic Medication Administration Record
Form LIC 622B is a specialized medication administration record used for psychotropic medications in licensed facilities in California. The form is completed by authorized staff members who administer psychotropic medications to residents or participants.
LIC 622A - Medication Administration Record
Form LIC 622A is a medication administration record used in licensed facilities in California. The form is completed by authorized staff members responsible for administering medications to residents or participants.
LIC 9221 - Parent Consent For Administration Of Medications And Medication Chart
Form LIC 9221 is used in child care facilities in California to obtain parental consent for the administration of medications to children while in their care. The form collects information about the child, the medication to be administered, dosages, frequency, and any specific instructions.
LIC 9151 - Property Owner/Landlord Notification Family Child Care Home
Form LIC 9151 is used to notify property owners or landlords about the operation of a family child care home in California.
LIC 9142A - Roster of Participants
Form LIC 9142A is used to maintain a roster of participants in training courses within the Administrator Certification Program in California. Course providers complete this form to document participant information, including names, contact details, course dates, and other relevant data.
LIC 9141 - Vendor Application/Renewal - Administrator Certification Program
Form LIC 9141 is utilized by vendors who provide goods and services related to the Administrator Certification Program in California. This form allows vendors to apply for initial registration or renew their existing registration.
LIC 9140A - Request to Add or Replace Instructor
Form LIC 9140A is used to request the addition or replacement of an instructor within the Administrator Certification Program in California. This form allows course providers to submit relevant details about the instructor, such as qualifications, experience, and expertise in the subject matter.