Lic 604 2025

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CALIFORNIA DEPARTMENT OF SOCIAL SERVICES. PERSONNEL REPORT. INSTRUCTIONS: This form is intended for keeping a current roster of all the facility personnel, other adults and licensees residing in the facility, including backup persons, volunteers and licensee if administrator/director.
If a persons medical condition does not change, a completed Form 602a is good for six months to one year. This range exists because certain tests may only be valid for six months , while others like chest X-rays remain valid for a full year.
Form 602 is issued by the California Department of Social Services. The form was established as a way to help senior communities better understand the needs of potential residents in terms of medical assistance, nutritional needs, mental and physical capabilities and other care requirements.
Form 602 is a specific type of physicians report that must be completed by all seniors living in elderly residential care facilities in California, regardless of whether they are residents of the state or moving in from another state.
A Physicians Report Form 602 is a required document for every state licensed senior care facility in California. It is to be completed by a physician who will confirm a diagnosis, give TB clearance, and certify other healthcare needs and/or issues.
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These will likely include: Legal certificates. Costs and care information. Physicians orders these are not necessarily required for admission, but simply confirming that the doctor approves of the care. Patient consent for care forms.
References are to be completed on the Reference Request-Exemption form (LIC 301E).

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