This is an online form designed to allow for the swift and efficient registration of facility clients. It ensures that all relevant information about each resident is collected in a streamlined and secure manner. Providing vital personal data and address information, as well as project eligibility criteria, our approach allows every client's enrollment process to be completed with efficiency. Our Register Facility Clients Residents Form offers unparalleled convenience to ensure each resident's details are accurately and promptly registered. Moreover, by removing the need to confirm identity or paperwork during onboarding, the process is optimized and residents can rest assured knowing their identity remains secure throughout the entire registration process.

Successful facility management requires precise, efficient organization. Having a streamlined process for registering clients or residents is the cornerstone of any effective system of operation, and having the right registration forms in place can make all the difference. In this blog post, we will discuss why it’s important to have clearly defined registration forms for your facility, as well as offer advice on ways to improve and streamline your current form processes. With our tips, you'll be able to not only save time but also increase data accuracy and ensure that all necessary information is collected during customer registrations. Whether you're looking at revamping an existing form or creating one from scratch - let's dive into how exactly best to approach successfully building out an effective facility client registration form!

Question	Answer
Form Name	Register Facility Clients Residents Form
Form Length	2 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	30 sec
Other names	register of facility clients residents, lic 9020, register of facility clients residents form, lic 9020a 6 17

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STATE OF CALIFORNIA—HEALTH AND HUMAN SERVICES AGENCY	CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
	COMMUNITY CARE LICENSING DIVISION

FACILITY NAME:

FACILITY NUMBER:

LICENSEE NAME

DATE/UPDATE

ROOM	CLIENT/RESIDENT	AMBULATORY STATUS
IDENTIFIER	NAME	RESTRICTED CONDITION(S)				PHYSICIAN	RESPONSIBLE PERSON
(If applicable)		(If applicable)
		(If applicable)

					NAME:		NAME:
		AMBULATORY	■
		AMBULATORY	■		ADDRESS:		ADDRESS:
					ADDRESS:		ADDRESS:
		NON-AMBULATORY	■
		BEDRIDDEN	■
		BEDRIDDEN	■		PHONE:		PHONE:
				(		)	(	)

					NAME:		NAME:
		AMBULATORY	■
		AMBULATORY	■		ADDRESS:		ADDRESS:
					ADDRESS:		ADDRESS:
		NON-AMBULATORY	■
		BEDRIDDEN	■
		BEDRIDDEN	■		PHONE:		PHONE:
				(		)	(	)

					NAME:		NAME:
		AMBULATORY	■
		AMBULATORY	■		ADDRESS:		ADDRESS:
					ADDRESS:		ADDRESS:
		NON-AMBULATORY	■
		BEDRIDDEN	■
		BEDRIDDEN	■		PHONE:		PHONE:
				(		)	(	)

					NAME:		NAME:
		AMBULATORY	■
		AMBULATORY	■		ADDRESS:		ADDRESS:
					ADDRESS:		ADDRESS:
		NON-AMBULATORY	■
		BEDRIDDEN	■
		BEDRIDDEN	■		PHONE:		PHONE:
				(		)	(	)

					NAME:		NAME:
		AMBULATORY	■
		AMBULATORY	■		ADDRESS:		ADDRESS:
					ADDRESS:		ADDRESS:
		NON-AMBULATORY	■
		BEDRIDDEN	■
		BEDRIDDEN	■		PHONE:		PHONE:
				(		)	(	)

					NAME:		NAME:
		AMBULATORY	■
		AMBULATORY	■		ADDRESS:		ADDRESS:
					ADDRESS:		ADDRESS:
		NON-AMBULATORY	■
		BEDRIDDEN	■
		BEDRIDDEN	■		PHONE:		PHONE:
				(		)	(	)

LIC 9020 (8/11) (CONFIDENTIAL)

Page______ of ______

INSTRUCTIONS FOR REGISTER OF FACILITY CLIENT/RESIDENTS

Type or print clearly. the licensee shall ensure that a current register of all clients/residents in the facility is maintained.

1.Facility Name: Enter the name used by to designate the single facility under application.

2.Facility Number:

3.Licensee Name: Enter the name of the Licensee. “Licensee” means the individual, firm, partnership, corporation, association or county having the authority and responsibility for the operation of a licensed facility.

4.Date/Update: Enter the date information is being initially recorded or updated.

5.Room Identifier: Applicable to Residential Care for the Elderly only. Enter information that identifies the resident room, such as room number.

6.Client/Resident Name: Enter client/resident legal name.

7.Ambulatory Status: Check appropriate box that indicates the client/resident mobility status. These definitions are for the purposes of a fire clearance.

■Ambulatory: Means a person who is capable of demonstrating the mental competence and physical ability to leave a building without assistance of any other person or without the use of any mechanical aid in case of an emergency.

■Non-ambulatory: Means a person who is unable to leave a building unassisted under emergency conditions. It includes any person who is unable or likely to be unable, to physically and mentally respond to a sensory signal approved by the State Fire Marshal, or an oral instruction relating to fire danger, and person who depend upon mechanical aids such as crutches, walkers, and wheelchairs. A person who is unable to independently transfer to and from bed, but who does not need assistance to turn or reposition in bed, shall be considered non-ambulatory for fire safety requirements.

■Bedridden: Means a person who is unable to independently turn or reposition in bed.

Restricted Health Conditions means those conditions required by sections 80071(a)(1)(D) and 82071(a)(4), and only applies to facilities governed by these sections.

8.Physician: Enter the name, address, and telephone number of the client/resident attending physician.

9.Responsible Person: Enter the name, address, and telephone number of the person responsible for the client/resident. “Responsible Person” means that individual or individuals, including a relative, health care surrogate decision maker, or placement agency, who assists the resident in placement or assume varying degrees of responsibility for the resident’s well-being.

LIC 9020 (8/11) CONFIDENTIAL

Page ______ of ______

How to Edit Register Facility Clients Residents Form Online for Free

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9020 lic conclusion process outlined (portion 1)

2. The third part is usually to complete the next few blanks: PHONE, NAME, ADDRESS, PHONE, NAME, ADDRESS, PHONE, NAME, ADDRESS, NONAMBULATORY, BEDRIDDEN, PHONE, NAME, AMBULATORY, and ADDRESS.

3. Completing PHONE, NONAMBULATORY, BEDRIDDEN, PHONE, LIC CONFIDENTIAL, and Page of is essential for the next step, make sure to fill them out in their entirety. Don't miss any details!

9020 lic writing process shown (portion 3)

Concerning PHONE and BEDRIDDEN, ensure that you don't make any mistakes in this current part. These two could be the most important ones in the document.

4. Your next subsection requires your details in the following areas: Ambulatory Means a person who is, Nonambulatory Means a person who, Bedridden Means a person who is, Restricted Health Conditions means, Physician Enter the name address, physician, and Responsible Person Enter the name. Be sure to give all needed info to move onward.

Physician Enter the name address, Nonambulatory Means a person who, and Responsible Person Enter the name of 9020 lic

5. To finish your document, this particular segment requires several extra blank fields. Filling in LIC CONFIDENTIAL, and Page of will certainly conclude everything and you'll certainly be done very quickly!

The best ways to fill in 9020 lic portion 5

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Register Facility Clients Residents Form – Fill Out and Use This PDF

Register Facility Clients Residents Form PDF Details

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Register Facility Clients Residents Form – Fill Out and Use This PDF

Register Facility Clients Residents Form PDF Details

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