California Department of Social Services

The LIC 9239 CCH form is an entrance checklist specifically designed for Community Crisis Homes (CCHs) within the California Department of Social Services. This checklist is utilized when individuals or families apply for admission to a CCH or when a new resident is admitted. It ensures that all required procedures and criteria are followed during the entrance process. The checklist covers areas such as intake assessments, crisis intervention plans, safety protocols, consent forms, and initial orientation.

The LIC 9239 CN form serves as an entrance checklist specifically tailored for Crisis Nurseries in California. This checklist is used during the admission process for children entering a Crisis Nursery. It ensures that all necessary steps and requirements are met to provide a safe and supportive environment for children in crisis situations. The checklist covers areas such as intake assessments, emergency contact information, medical evaluations, consent forms, and initial care plans.

The LIC 700 form, Identification And Emergency Information Child Care Centers/Family Child Care Homes, serves as a comprehensive record that collects vital identification and emergency contact details of children enrolled in child care centers or family child care homes. This includes essential information like the child's full name, date of birth, address, parent/guardian contact information, and emergency contacts. The form aids in ensuring accurate and updated records on file for each child.

The LIC 9239 CTF form is an entrance checklist employed by Community Treatment Facilities (CTFs) in California. This checklist is used when individuals or families apply for admission to a CTF or when a new resident is admitted. It ensures that all required procedures and criteria are followed during the entrance process. The checklist covers areas such as intake assessments, treatment plans, consent forms, safety protocols, and initial orientation.

The LIC 627B form, Consent For Emergency Medical Treatment - Children's Residential Facilities, is designed to secure permission from parents or authorized representatives for emergency medical treatment for children residing in residential facilities. It ensures that appropriate medical care can be provided promptly in case of an emergency situation where immediate treatment is necessary to safeguard the health and well-being of the child.

The LIC 9239 EBSH form is an entrance checklist specifically designed for Enhanced Behavioral Supports Homes (EBSHs) within the California Department of Social Services. This checklist is utilized when individuals or families apply for admission to an EBSH or when a new resident is admitted. It ensures that all required procedures and criteria are followed during the entrance process. The checklist covers areas such as intake assessments, behavior support plans, safety protocols, consent forms, and initial orientation.

The LIC 9239 TrSCF form is an entrance checklist used by Transitional Shelter Care Facilities (TrSCFs) in California. This checklist is employed during the admission process for individuals or families seeking entry into a TrSCF. It ensures that all necessary steps and requirements are met to provide a safe and supportive environment for temporary shelter and care. The checklist covers areas such as intake assessments, emergency contact information, consent forms, medical evaluations, and initial care plans.

The LIC 701A form, Gastrostomy - Tube Care: Physician's Checklist, is used by physicians to provide guidance and instructions for the care and management of children with gastrostomy tubes. It includes a checklist of necessary actions, procedures, and precautions related to the care, cleaning, and maintenance of the gastrostomy tube, ensuring that child care providers have clear guidelines to follow to ensure the child's well-being.

The LIC 627A form, Consent To A Medical Examination, is utilized to obtain parental or authorized representative consent for a child to undergo a medical examination. It ensures that parents or legal guardians are aware of and agree to their child receiving necessary medical care, including physical examinations, diagnostic tests, or other medical procedures.

Form LIC 9151 is used to notify property owners or landlords about the operation of a family child care home in California. Family child care providers complete this form and provide it to their property owner or landlord to inform them that they will be operating a licensed child care business on the premises. The form includes information about the provider, the address of the child care home, and contact information.