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Resident Forms

 
The forms are listed to the right under Related Content. Forms marked with a (* ) are required and must be used unless prior written approval for a specific substitute form has been granted. All other forms on this page are intended to assist the licensee in demonstrating compliance with the record keeping requirements specified in the Adult Foster Care Licensing Rules.

You may request multiple copies of the AFC publications by using the Request for AFC Forms and Publications order form.

It is the responsibility of the licensee to copy and distribute each form as specified by statute.



Related Documents
AFC Forms Order Request - 117549 bytes PDF icon
Related Content
 •  AFC Forms Request PDF icon
 •  AFC Sample Starter Packet PDF icon
 •  Worksheet for Calculating Evacuation Difficulty Score  PDF icon
 •  Worksheet for Rating Residents  PDF icon
 •  Finding the Staff Shift Score  PDF icon
 •  Original License Application Packet
 •  Resident Register - BCAL-0535 PDF icon
 •  Adult Foster Care License Limited Liability Company Governmental Organization and Corporate Application - BCAL-569-C PDF icon
 •  Adult Foster Care License Individual Application - BCAL-569-I PDF icon
 •  Homes for the Aged Application for Licensure - BCAL-1600 PDF icon
 •  Homes for the Aged, Certificate of Appointment for Authorized Representative - BCAL-1603  PDF icon
 •  HFA Administrator Appointment - BCAL-1606 PDF icon
 •  Certification of Specialized Programs Application - BCAL-1609 PDF icon
 •  Appointment of Home for the Aged Resident Authorized Representative - BCAL-1610 PDF icon
 •  Resident Funds Record Part 1(*) - BCAL-2318 PDF icon
 •  Resident Funds Record Part II(*) - BCAL-2319 PDF icon
 •  Assessment Plan for AFC Residents - BCAL-3265
 •  Resident Care Agreement(*) - BCAL-3266 PDF icon
 •  AFC Resident Medication Record - BCAL-3267 PDF icon
 •  Appointment of Designated Representative - BCAL-3268 PDF icon

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