IDENTIFICATION AND EMERGENCY INFORMATION
a. all facilities [except child care center/family child care home completes lic 700] 1. name of client or child . social security number (optional) date of birth age sex 2. responsible person or placement agency . address telephone () 3. name of nearest relative (optional) relationship . address telephone ( ) 4. date admitted to facility
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CONSENT FOR EMERGENCY MEDICAL TREATMENT-Child …
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cdss.ca.govRIGHTS, RESPONSIBILITIES AND OTHER IMPORTANT INFORMATION For the Cash Aid and CalFresh Programs, and/or Medi-Cal/34-County Medical Services Program (CMSP) These pages give you your rights and responsibilities and other important information. The county needs your facts to see if you are eligible for cash aid, CalFresh benefits, and/or Medi-Cal ...
CONFIDENTIAL REPORT - NOT SUBJECT TO PUBLIC …
cdss.ca.govJ. WRITTEN REPORT Enter information about the agencies receiving this report. If the abuse occurred in a LTC facility and resulted in Serious Bodily Injury*, please refer to “Reporting Responsibilities and Time Frames” in the General Instructions. Do not submit report to California Department of Social Services Adult Programs Division.
State and Federal Mandated Reporting Guidelines in Long ...
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Recertification for Calfresh Benefits
cdss.ca.govWithdraw your application at any time prior to the County determining eligibility. Ask for help to fill out your application for CalFresh and get an explanation of the rules. Ask for help to get proof that is needed. Be treated with courtesy, consideration and …
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cdss.ca.govCASE NAME. CASE NUMBER. WORKER NAME AND NUMBER. DATE RECEIVED. 1.Parent’s or Caretaker Relative’s Name. 2.Give us all the facts for this child. 4.Did the child get cash aid or CalFresh this month? If “YES”, complete below: 5.Does the child get or expect to get any income, such as: Earnings, Supplemental Security Income/State Supplementary
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cdss.ca.govPersonal Rights, See Section 101223 for waiver conditions applicable to Child Care Centers. (a) Child Care Centers. Each child receiving services from a Child Care Center shall have rights which include, but are not limited to, the following: (1) To be accorded dignity in his/her personal relationships with staff and other persons.
STATEMENT ACKNOWLEDGING REQUIREMENT TO REPORT …
cdss.ca.gov341, “Report of Suspected Dependent Adult/Elder Abuse” for each report of known or suspected instance of abuse (physical abuse, sexual abuse, financial abuse, abduction, neglect (self-neglect), isolation, and abandonment) involving an elder or dependent adult. Reporting shall be completed as follows:
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