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- Click ‘Get Form’ to open the lic 603 in the editor.
- Begin by entering the applicant’s name and age in the designated fields. This information is crucial for identifying the individual.
- In the health section, describe the overall health condition, including any dietary limitations. Use clear and concise language to ensure accurate representation.
- Detail any physical disabilities, specifying limitations such as vision or hearing issues. This helps assess the applicant's needs effectively.
- Provide a comprehensive health history, listing prescribed medications and any major illnesses or surgeries from the last five years.
- Fill out social factors by describing likes, dislikes, interests, and activities that may influence care decisions.
- Indicate bed status by selecting one of the options provided. This helps facilities understand daily activity levels.
- Complete tuberculosis information by answering questions regarding family history and recent exposure. Include details if applicable.
- Assess ambulatory status and functional capabilities by checking appropriate boxes based on the applicant's abilities.
- Finally, review all sections for accuracy before signing and dating at the bottom of the form. Ensure that both the applicant (or representative) and licensee sign where required.
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| Versions | Form popularity | Fillable & printable |
|---|---|---|
| 1999 | 4.8 Satisfied (165 Votes) |
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