Key takeaways
Fill, sign, and submit Medical Treatment Authorization and Consent Form from any browser — or have AI generate a custom version in seconds. No installs, no printing, no back-and-forth.
- Identification and Emergency Information (LIC 700) collects essential contact and medical details for children in licensed California child care facilities.
- Parents or legal guardians must sign this form to authorize emergency medical treatment and routine care for their children.
- The document requires child identification, parent contact details, emergency contacts, physician information, and a list of known allergies or medications.
- A completed and signed copy must be on file at the child care facility before the child's initial attendance.
- This form enables facilities to respond to emergencies and provides consent for disaster preparedness measures and medical transportation.
- Facilities must update these records regularly to comply with California licensing regulations and avoid potential citations or fines.
What is Medical Treatment Authorization and Consent Form?
Identification and Emergency Information Child Care Centers/Family Child Care Homes (Medical Treatment Authorization and Consent Form) is a mandatory document used to collect vital identification and emergency contact details for children enrolled in licensed California child care facilities. The primary purpose of this medical treatment authorization form is to provide child care centers and family homes with the necessary information and legal permission to seek professional medical or dental care when a parent or guardian cannot be reached immediately. It ensures that critical care is not delayed during urgent health situations or accidents.
This document records a wide range of information, starting with the child's basic identifying details and the contact information for their parents or legal guardians. It also lists authorized emergency contacts, the child's primary physician, and their dentist. Crucially, the form includes a section for medical history, highlighting known allergies, current medications, and any special medical treatments required. By including consent for routine care and disaster preparedness, the form serves as a comprehensive safety record that remains on file at the facility for daily reference and emergency response.
California Department of Social Services (CDSS), Community Care Licensing Division (CCLD)
Who needs the Medical Treatment Authorization and Consent Form — and who doesn't
Not everyone files Medical Treatment Authorization and Consent Form. The checklist below tells you whether it applies to your situation — and points you to the right alternative if it doesn't.
You need this Medical Treatment Authorization and Consent Form if…
- your child is being enrolled in a licensed Child Care Center or Family Child Care Home within the state of California
- you must provide a licensed facility with a child's identifying information, emergency contacts, and physician details before attendance begins
- you want to grant written authorization for a care provider to arrange emergency medical or dental treatment if you cannot be reached immediately
- you need to document a child's known allergies, current medications, and routine medical care requirements for their care provider
You do not need this Medical Treatment Authorization and Consent Form if…
- the child is not attending a licensed care facility regulated by the California Department of Social Services
- you are seeking child care services in a state other than California
Why you need the Medical Treatment Authorization and Consent Form
Why people fill out Medical Treatment Authorization and Consent Form, and what tends to go wrong when they don't.
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Ensure Regulatory Compliance California law requires licensed child care facilities to keep this form on file for every child. Completing it ensures the provider remains compliant and avoids potential citations or licensing fines.
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Facilitate Immediate Care This document grants explicit parental consent for emergency medical or dental treatment. It allows providers to act quickly if a child needs urgent help and a guardian cannot be reached immediately.
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Share Critical Information The form records essential health details, including known allergies and current medications. This data helps caregivers and medical professionals provide safe, appropriate treatment during routine care or unexpected medical emergencies.
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Secure Digital Management Use pdfFiller to fill, sign, and store this form in secure, encrypted storage. The platform allows you to easily update contact information or medical details and share the finished PDF.
Medical Treatment Authorization and Consent Form vs. similar documents
Medical Treatment Authorization and Consent Form gets mixed up with similar documents more than most. Here's how to tell them apart, and what filing the wrong one actually costs.
| Comparison criteria | Medical Treatment Authorization and Consent Form | Personal Rights - Child Care Centers |
|---|---|---|
| Purpose | Collect identification and emergency medical consent. | Outline personal rights of children in care. |
| When to use | Prior to the child's initial attendance. | Companion to enrollment and emergency information. |
| Signatures required | Parent or legal guardian. | Parent acknowledgment of receipt. |
| Filing | On file at the licensed facility. | Not specified. |
| Governing reference | Health and Safety Code Section 1596.791. | Not specified. |
What each section of Medical Treatment Authorization and Consent Form means
Every section explained — what it's asking, the records you'll need on hand, and the mistakes that most often cause a rejection or follow-up request.
| Child Identification Details | Provide the child's full legal name, current home address, date of birth, and the specific date they are scheduled to begin attending the child care facility. |
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| Parent Guardian Contact Info | Enter names, home and work addresses, multiple phone numbers, and email addresses for the child's parents or legal guardians to ensure they can be reached. |
| Authorized Emergency Contacts | List the names, addresses, and telephone numbers of reliable individuals authorized to act on your behalf if you cannot be reached during an emergency situation. |
| Healthcare Provider Information | Record the names, office addresses, and primary contact numbers for the child's regular physician and dentist to facilitate quick communication for medical or dental needs. |
| Essential Medical History | Detail any known allergies, current medications, special medical treatments required, or other health-related information that facility staff must know to handle emergencies safely and effectively. |
| Emergency Treatment Authorization | Provide written consent for the child care facility to arrange for necessary emergency medical or dental care if parents or guardians are unavailable during a crisis. |
| Routine Care and Disaster Consent | Grant permission for the facility to administer minor first aid, provide transportation during disasters, and perform other routine care tasks as required for the child's safety. |
How to fill out Medical Treatment Authorization and Consent Form using pdfFiller
A walkthrough from the first field to the signature line. With your records in front of you, most people finish in under ten minutes.
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Open the Form Click Get Form to open Medical Treatment Authorization and Consent Form in the pdfFiller editor to start filling out the document using the platform's intuitive online tools.
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Enter Child Details Click the designated text fields to type the child's full name, address, and birthdate, ensuring all identifying information is accurate for the facility's records.
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Provide Guardian Contact Use the editor to input names and phone numbers for parents or guardians, including work and cell contacts, to ensure you are reachable at all times.
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List Emergency Contacts Click the fields for secondary contacts to provide names and addresses of authorized individuals who can be reached if the primary parents or guardians are unavailable.
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Record Medical Providers Navigate to the physician and dentist section to type in the names and phone numbers of the healthcare professionals responsible for the child's routine care.
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Document Health History Fill in the medical information section by detailing allergies and current medications to assist in minor medical treatment authorization and emergency care scenarios.
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Authorize Medical Treatment Complete the consent sections by providing written authorization for emergency medical or dental care and routine disaster preparedness measures within the fillable document.
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Sign and Share Apply a legally binding eSignature and share the document via link or email; pdfFiller ensures your sensitive data is protected with secure encrypted storage and SOC 2 compliance.
Deadlines, key dates & penalties for Medical Treatment Authorization and Consent Form
When Medical Treatment Authorization and Consent Form is due, what late filing actually costs, and how to request more time if you need it.
| Submission Deadline | The Identification and Emergency Information Child Care Centers/Family Child Care Homes (LIC 700) must be completed, signed, and on file at the licensed child care facility before the child's initial attendance. It is mandatory to update the document whenever contact or medical information changes to ensure records remain current. |
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| Penalties for Non-Compliance | Licensed child care facilities that fail to maintain a current LIC 700 for every child are in violation of licensing regulations and may be subject to citations, fines, or other enforcement actions by the Community Care Licensing Division. For the child, failing to provide this form may result in a denial of admission to the facility and could cause dangerous delays in receiving critical emergency medical care. |
State variations of Medical Treatment Authorization and Consent Form
The Identification and Emergency Information (LIC 700) form is a state-specific document issued by the California Department of Social Services. It is mandatory for children enrolled in licensed child care centers and family child care homes to comply with the California Code of Regulations, Title 22.
Recent changes to Medical Treatment Authorization and Consent Form
The California Department of Social Services issued the current version of the Identification and Emergency Information Child Care Centers/Family Child Care Homes in September 2019. This revision, identified as LIC 700 (9/19), is the standard form for documenting a child's contact details and medical history in licensed care settings. To meet regulatory requirements, a parent or legal guardian must sign the form to provide essential consent for emergency medical treatment and routine care.
Licensed child care centers and family child care homes must keep a completed and signed copy of this 2019 revision on file for every enrolled child. Using the most recent version ensures the facility stays compliant with the California Health and Safety Code and Title 22 regulations, helping to avoid potential citations or enforcement actions during licensing inspections.
Pointer: A parent or legal guardian must sign the form before the child's first day of attendance to ensure compliance with state licensing rules.
Related content
The forms, guides, and worksheets most filers reach for alongside Medical Treatment Authorization and Consent Form.
Key terms used in Medical Treatment Authorization and Consent Form
A one-sentence glossary of the Medical Treatment Authorization and Consent Form terms and concepts you'll see throughout this guide.
- Identifying Information
- Essential data including the child's full name, address, birthdate, and the date of admission to the child care facility.
- Emergency Contacts (other than parents)
- Individuals authorized to be contacted in an emergency if the child's parents or guardians cannot be reached.
- Physician and Dentist Information
- Records the names, addresses, and phone numbers of the child's physician and dentist.
- Medical Information
- Details regarding known allergies, medications, special medical treatments, and other information necessary during an emergency.
- Consent for Emergency Medical Treatment
- Written parental authorization for the facility to arrange medical or dental care when parents cannot be contacted immediately.
- Consent for Routine Medical Care/Disaster Preparedness
- Includes parental authorization for minor first aid, emergency disaster transportation, and other routine care as needed.
Frequently asked questions about Medical Treatment Authorization and Consent Form
Quick answers to the questions we hear most often about completing the Medical Treatment Authorization and Consent Form.
The Medical Treatment Authorization and Consent Form (Identification and Emergency Information Child Care Centers/Family Child Care Homes) is used to collect essential identification details and emergency contact information for children in licensed California child care. It also serves as a formal emergency medical consent, allowing providers to arrange for necessary medical or dental care if a parent or guardian cannot be reached immediately.
The LIC 700 form must be completed, signed, and on file at the licensed child care facility before the child's first day of attendance. Maintaining an updated version of this form is critical for compliance with California licensing regulations. Failure to have a current copy on file may result in citations or fines for the facility and could delay care for the child.
A parent or legal guardian must sign the Identification and Emergency Information form to authorize emergency medical treatment and routine care. While the form itself does not explicitly require a witness signature for the medical consent section, individual child care centers may have their own internal policies. You can sign and share this document securely using pdfFiller.
No, the LIC 700 form does not require notarization under California Department of Social Services regulations. The signature of a parent or legal guardian is sufficient to authorize emergency medical treatment and provide the necessary identification information. Using pdfFiller, you can easily add a legally binding e-signature to the document from your browser without needing a notary.
This form records known allergies, current medications, required special medical treatments, and contact information for the child's physician and dentist. It also includes sections for routine medical care consent and disaster preparedness measures, such as emergency transportation. This comprehensive data ensures that child care providers are prepared to act quickly during medical emergencies or natural disasters.
You can fill out, edit, sign, and manage the LIC 700 form online using the pdfFiller platform. pdfFiller allows parents and providers to store completed forms in a secure, encrypted environment that is compliant with GDPR, HIPAA, and SOC 2 standards. This ensures that sensitive child identification and medical information is protected while remaining easily accessible for regular updates.
