Forms

The following required state forms:

  1. Consent for Medical Treatment (LIC 627)
  2. ID & Emergency Info (LIC 700)
  3. Notification of Parent’s Rights (LIC 995A)
  4. Consumer Awareness Info (LIC 9212)
  5. Caregiver Background Check (LIC 995E)
  6. Personal Right (LIC 613)
  7. Unusual Incident/Injury Report( LIC 624B)
  8. Child’s Preadmission Health History-Parent (LIC 9150)
  9. Affidavit Regarding Liability Insurance (LIC 282)
  10. Immunization Record