Form Lic 627A PDF Details

The Lic 627A form plays a crucial role within the framework of the State of California's Health and Human Services Agency, particularly under the jurisdiction of the California Department of Social Services. This document serves as a written consent from a client, resident, parent, or authorized representative for a physical examination to be conducted by a physician appointed by the aforementioned department. Its primary purpose is to facilitate investigations into potential abuse or neglect of the client or resident in question. The form not only covers the consent to the physical examination itself but also extends to any laboratory tests that may be deemed necessary as part of the investigation. By ensuring that a formal consent is obtained before any medical examination or testing is carried out, the Lic 627A form upholds the rights and dignity of individuals, safeguarding their well-being while under the care of health and human services. The importance of such documentation cannot be overstated, as it stands at the intersection of health care, legal compliance, and human rights, ensuring that investigations into abuse and neglect are conducted ethically and responsibly.

QuestionAnswer
Form NameForm Lic 627A
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesCALIFORNIA, LIC, authorized representative, AUTHORIZING

Form Preview Example

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES

CONSENT TO A MEDICAL EXAMINATION

I ,

 

d o h e r e b y c o n s e n t

 

 

(CLIENT/RESIDENT, PARENT OR AUTHORIZED REPRESENTATIVE)

t o a p hy s i c a l ex a m i n a t i o n o f

(CLIENT/RESIDENT)

by a physician designated by the California Depar tment of Social Services and

also consent to any laboratory tests associated with the medical examination for

the purpose of investigating the possible abuse or neglect of

(CLIENT/RESIDENT)

DATE

(SIGNATURE OF AUTHORIZING PERSON)

(RELATIONSHIP TO CLIENT/RESIDENT—IF OTHER THAN CLIENT/RESIDENT)

(ADDRESS)

(CITY/STATE/ZIP CODE)

LIC 627A (9/08)

How to Edit Form Lic 627A Online for Free

neglect can be completed online without any problem. Just try FormsPal PDF editor to get the job done quickly. To keep our editor on the leading edge of convenience, we aim to integrate user-driven features and improvements regularly. We are routinely grateful for any feedback - assist us with remolding PDF editing. In case you are looking to begin, this is what it's going to take:

Step 1: Just hit the "Get Form Button" in the top section of this page to see our pdf file editor. This way, you'll find all that is necessary to work with your document.

Step 2: With the help of our state-of-the-art PDF file editor, you could do more than just fill out forms. Try all of the features and make your forms appear faultless with custom text put in, or adjust the file's original input to perfection - all backed up by the capability to insert any images and sign the document off.

This PDF doc will require some specific information; in order to guarantee accuracy and reliability, don't hesitate to adhere to the following guidelines:

1. It is critical to fill out the neglect accurately, therefore take care while filling out the parts that contain all these blank fields:

The right way to complete authorized representative form part 1

2. Right after performing the last part, go to the subsequent stage and fill in the essential particulars in all these blanks - CLIENTRESIDENT, DATE, SIGNATURE OF AUTHORIZING PERSON, RELATIONSHIP TO CLIENTRESIDENTIF, ADDRESS, and CITYSTATEZIP CODE.

authorized representative form completion process described (portion 2)

You can easily make an error while filling in your RELATIONSHIP TO CLIENTRESIDENTIF, and so make sure you take another look prior to deciding to submit it.

Step 3: Confirm that the information is accurate and click "Done" to finish the task. Join FormsPal now and instantly gain access to neglect, all set for download. All modifications you make are preserved , making it possible to modify the pdf at a later stage anytime. FormsPal offers protected document editing with no personal information recording or sharing. Feel at ease knowing that your information is in good hands with us!

Form Lic 627A isn’t the one you’re looking for?

Related Documents