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Adult Day Care Program Forms and Documents This section provides forms necessary to maintain and adult day care program including: Flu Consent Form, Vehicle Inspection Form, Care Plan Meeting Form, Mandatory Inservice Form, Nutritional Care Policy, Day Care Test and Answers, and more. Product Compare (0). Apr 01,  · Adult Day Care Forms. Adult Day Care Certified Employee Medical Statement per rule doc. Adult Day Care Certified Employee Medical Statement.

1. Client or responsible party should fill out the forms completely. 2. Please feel free to ask for assistance. Call 3. After completing the forms, return the packet to the Director of More to Life. 4. Pay the admission/processing fee. 5. Get a physical examination and submit the report. Form is included in this packet. hentai-x.xyz Size: KB. Admission Form for Adult Day Care Center By Jim Probasco Senior Lifestyle Expert If you operate or are in the process of opening an adult day care center, you have likely already dealt with a number of tasks, including finding and setting up a physical facility, obtaining proper licensure, and conducting background checks to name a few.

CACFP - Adult Day Care: Daily Meal Count and Attendance Record (Centers and Emergency Shelters) H CACFP - Child Care Center: Daily Meal Count, Attendance, and Meal Production Record (H) H CACFP - Day Care Home: Daily Meal Production Record - Adult Day Care H Adult Day Care Centers. Forms; Informational Charts and Guides (All Brochures, Forms, Informational Charts, and Sample Menus are available below in PDF Format or may be requested by contacting the Child and Adult Care Food Program at our Toll Free Number: ).

LIC C (4/05) - Records To Be Maintained At The Facility - Adult Residential LIC D (3/07) - Forms/Records To Keep In Your Family Child Care Home LIC E (4/05) - Records To Be Maintained At The Facility - Small Family Home And Foster Family Home. *Note: This page contains materials in the Portable Document Format (PDF). The free Adobe Reader may be required to view these files. Licensing Agency. The Agency for Health Care Administration (), Rule 58A Breaking News. Due to recent changes in the Agency for Health Care Administration’s (AHCA) Rule 58A-6, Florida Administrative Code, the food service activities for Adult Day Care.

Below are links to some commonly-used forms. Feel free to copy these forms as needed. If you have a question about a form in particular, please contact your licensing representative. Forms for Children in Licensed Care: CFS Application/Record of Child Information; CFS Consents to Day Care Providers; CFS Certificate of Child Health Exam. Application for a License or Certification to Operate a Child Day Care Facility Child Care Licensing Governing Body/Director Designation Request for a Registration Permit: ES: Admission Information: ES: Child Care Licensing Waiver/Variance Request Request for an Administrative Review: ES: Child Care Operation.