Forms and documents
LIC 421D - Civil Penalty Assessment Death/Serious Injury/Physical Abuse
The LIC 421D form is used by the California Department of Social Services to assess civil penalties in cases involving death, serious injury, or physical abuse.
LIC 421D - Civil Penalty Assessment Death/Serious Bodily Injury/Physical Abuse
Form LIC 421D is a civil penalty assessment form used by the California Department of Social Services (CDSS) in cases involving death, serious bodily injury, or physical abuse in licensed facilities.
LIC 421CC - Civil Penalty Assessment Child Care
Form LIC 421CC is a civil penalty assessment form specific to child care facilities in California.
LIC 421BG - Civil Penalty Assessment Caregiver Background Check
Form LIC 421BG is a specific civil penalty assessment form related to caregiver background checks in licensed facilities in California.
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 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 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 606 - Residential Care Facility For The Elderly Disclosure Worksheet
Form LIC 606 is a disclosure worksheet specific to Residential Care Facilities for the Elderly (RCFE) in California. The form is completed by facility operators and serves as a checklist to ensure compliance with disclosure requirements mandated by licensing regulations.
LIC 605A - Release Of Client/Resident Medical Information
Form LIC 605A is a release form used to obtain consent for the release of client or resident medical information in licensed facilities in California.
LIC 604 - Admission Agreement Guide For Residential Facilities
Form LIC 604 is an admission agreement guide designed for residential facilities in California.