Lic 604 2026

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The document is a guide for creating admission agreements for residential care facilities in California, outlining the required components such as facility information, basic and optional services, payment terms, eviction procedures, visiting policies, discharge protocols, and refund policies. It emphasizes that this guide is not an official admission agreement but serves as a template to help facilities comply with state regulations.

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Click ‘Get Form’ to open the lic 604 document in the editor.
Begin by filling out the 'Facility Information' section. Enter the name, type, address, city, state, zip code, and telephone number of your facility.
In the 'Basic Services' section, specify the name of the client/resident and their optional Social Security number and birthdate. Check off the basic services provided such as lodging options and food services.
Indicate the monthly rate for basic services and whether it is paid in advance or arrears. Ensure to include any additional charges for optional services in the respective section.
Complete sections on eviction procedures, visiting policy, discharge/removal policies, and refund policy as applicable to your facility.
Finally, ensure all parties sign at the bottom of the form. This includes signatures from the client/resident or authorized representative and licensee/administrator.

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What is the lic 500 form?

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.

How long is a 602 good for?

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.

What is LIC 602?

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.

What is a lic 602?

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.

Who completes a 602 form?

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.

admission agreement arf

Lic 604 pdf LIC 605 LIC 603 LIC 601 LIC 613 Lic 613C Lic 605a LIC 602

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What paperwork is needed for assisted living?

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.

What is an admission agreement?

References are to be completed on the Reference Request-Exemption form (LIC 301E).