LIC 503 — Health Screening Report — Facility Personnel
LIC 503 is the health screening report for facility personnel, including tuberculosis screening. It documents that staff were cleared before working with residents.
Official PDF
The current LIC 503 is published by the California Department of Social Services. We link to the live source rather than hosting a copy, so you always get the latest revision.
Open LIC 503 on cdss.ca.govWho completes it and when
A licensed health professional completes the clinical portion; the facility files it in the personnel record.
At hire and on the CCL-required renewal cadence.
How to complete LIC 503
- 1Send the blank form with the new hire to their screening appointment before their first shift with residents.
- 2Confirm the TB result and signature are complete when the form comes back.
- 3File it in the personnel record and log the renewal due date.
- 4Track renewals on the cadence required for your staff, and re-screen after any qualifying exposure.
Mistakes evaluators flag
- Staff working shifts while the screening is still 'pending'.
- Renewal dates tracked nowhere, so expirations are discovered during an inspection.
- Form filed without the health professional's signature.
Questions about LIC 503
Does LIC 503 need to be renewed?
Yes. Health screening is renewed on the cadence Community Care Licensing requires for facility personnel, and the facility keeps the current report in the personnel file.
Fill this form from data you already have
- Resident, staff, and facility details populate the form fields automatically.
- Track which forms are on file, which are missing, and which are about to expire.
- Incident reports draft the LIC 624 narrative and finalize an immutable PDF.
Related personnel forms
RCFE OS is not affiliated with the California Department of Social Services. This guide is operational information for licensees, not legal advice. Always follow the current form instructions and guidance from your licensing analyst.