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 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 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 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 421A - Civil Penalty Assessment
Form LIC 421A is used for the assessment of civil penalties against licensed facilities in California.
LIC 420 - Budget Information
Form LIC 420 is used to provide budget information for licensed facilities in California. The form is completed by the facility operator or licensee and includes details of projected income and expenses, anticipated cash flow, and other financial aspects related to the facility's operation.
LIC 406 - Client/Resident Cash Sheet
Form LIC 406 is used to document and track cash transactions related to clients or residents in licensed facilities in California. The form is completed by facility staff and captures details of cash received, disbursed, or held on behalf of clients or residents.
LIC 309 - Administrative Organization
Form LIC 309 is used to provide detailed information about the administrative organization and structure of a licensed facility in California.