Lic 603 2026

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4.8 out of 5

165 votes

The document is a preplacement appraisal form used by the California Department of Social Services for assessing applicants seeking admission to residential care facilities. It collects detailed information about the applicant's health, physical and mental conditions, social factors, ambulatory status, functional capabilities, and services needed. The form aims to assist in determining the suitability of the applicant for admission and requires signatures from both the applicant or their representative and the facility's licensee.

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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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