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This book belongs to: Parent/Legal GuardianCounty of Los Angeles Department of Public Health Children's Medical Service sand: Child CCS number: Start/Annual Review Date: CCS Nurse Case Manager (NCM):
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How to fill out parentlegal guardian hild ccs
How to fill out parentlegal guardian hild ccs
01
Start by gathering all the necessary information about the child, such as their full name, date of birth, and social security number.
02
Next, provide the child's current address and contact information.
03
Fill out the relevant details about the child's parent or legal guardian, including their full name, contact information, and relationship to the child.
04
Indicate whether the child has any existing medical conditions or special needs that require attention.
05
Specify any specific instructions or restrictions regarding the child's health care, if applicable.
06
Sign and date the form as the parent or legal guardian, acknowledging that the information provided is accurate and complete.
07
Submit the filled-out form to the relevant authority or organization responsible for processing child care services applications.
Who needs parentlegal guardian hild ccs?
01
Parent or legal guardian of a child in need of child care services need to fill out parent/legal guardian child care services form (CCS).
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