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These sections will make up the PDF document that you will be filling out:
Complete the Name of Facility and License Number, Administrator of Facility, Street Address, City, State, Zip Code, Telephone Number, Alternate Telephone Number Cell, EMERGENCY NAMES AND TELEPHONE, Emergency Contact Name, AmbulanceParamedics, Fire Department, Poison Control, PoliceSheriff, and Office of Emergency Services fields with any information that are requested by the system.
The system will ask you for details to conveniently submit the area Adult Protective Services, County Mental Health, Note Emergency numbers must be, ASSIGNMENTS DURING AN EMERGENCY OR, Facility Staff Members Responsible, Name, Title, Assignment, Accessing emergency supplies, Utility shutoff and if applicable, Provide transportation, and Direct evacuation assembly of.
The LIC E, and Page of section could be used to indicate the rights and responsibilities of both parties.
Check the sections Information, Location, Roster of residents with date of, Appraisal of resident needs and, Medication list for residents with, Contact information for the, Note This information must be, Utility, ShutOff Location, Instructions for ShutOff, UTILITY SHUTOFF, Electricity, Gas, Sewer, and Water and next complete them.
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