Forms and documents
LIC 603A - Resident Appraisal
Form LIC 603A is an appraisal form used to evaluate residents in licensed facilities in California.
LIC 603 - Preplacement Appraisal Information
Form LIC 603 is used to gather preplacement appraisal information for individuals considering placement in a licensed facility in California.
LIC 602A - Physician's Report For Residential Care Facilities For The Elderly
Form LIC 602A is a physician's report used specifically for Residential Care Facilities for the Elderly (RCFE) in California.
LIC 508B - Criminal Record Statement - Long-Term Care Ombudsman Program
Form LIC 508B is a criminal record statement used by participants in the Long-Term Care Ombudsman Program in California. The form is completed by the program participant and includes questions regarding criminal history, convictions, and any pertinent legal matters.
LIC 508D - Out-Of-State Disclosure And Criminal Record Statement
Form LIC 508D is a combined form used for both out-of-state disclosures and criminal record statements in licensed facilities in California.
LIC 508 O-O-S - Out-Of-State Disclosure
Form LIC 508 O-O-S (Out-Of-State Disclosure) is a standalone form used to disclose out-of-state criminal records for individuals seeking employment or serving in positions where background checks are required in licensed facilities in California.
LIC 508A - Criminal Record Statement - Adoption Facilitator
Form LIC 508A is a criminal record statement used by adoption facilitators in California. The form is completed by the adoption facilitator and includes questions related to criminal history, convictions, and any relevant legal issues.
LIC 508 - Criminal Record Statement & Out-Of-State Disclosure
Form LIC 508 is a combined form used for both criminal record statements and out-of-state disclosures in licensed facilities in California. The form is completed by individuals seeking employment or serving in positions where background checks are required.
LIC 507 - Facilities Staff Work Schedule
Form LIC 507 is a work schedule form that records the staffing schedule for facilities in California. The form includes details such as staff names, assigned shifts, days off, and any additional notes or adjustments to the schedule.
LIC 501 - CCL/Personnel Record
Form LIC 501 is a record used to document and maintain personnel information for Community Care Licensing (CCL) purposes in licensed facilities in California.