LIC 601 — Identification and Emergency Information
LIC 601 is the resident's identification and emergency information record. It is the first page an evaluator or paramedic looks for, because it holds the resident's identity, physician, responsible party, and emergency contacts in one place.
Official PDF
The current LIC 601 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 601 on cdss.ca.govWho completes it and when
The facility completes it with the resident or the resident's responsible party at admission.
Completed at admission; updated whenever contact info changes.
How to complete LIC 601
- 1Collect the resident's full legal name, date of birth, and prior address before admission day.
- 2Record the responsible party and at least one alternate emergency contact, each with a phone number that is answered after hours.
- 3List the resident's physician and dentist, including phone numbers, and the health plan or Medi-Cal/Medicare identifiers.
- 4Note ambulance or hospital preference if the resident or family has one.
- 5Have the resident or responsible party sign and date, then file the form in the resident record and re-verify contacts whenever they change.
Mistakes evaluators flag
- Emergency contact numbers that were never updated after a family member moved or changed carriers.
- Blank physician information because intake happened before the medical assessment came back.
- A signature line left unsigned when a responsible party signed remotely.
Questions about LIC 601
When does LIC 601 have to be completed?
It is completed as part of admission and kept current in the resident's file. Update it any time contact, physician, or responsible-party information changes.
Who signs LIC 601?
The resident or the resident's responsible party signs, and the facility keeps the signed original in the resident record.
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 admission 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.