LIC 602A — Medical Assessment for Residential Care Facilities for the Elderly
LIC 602A is the physician-completed medical assessment for admission to a Residential Care Facility for the Elderly. It documents the resident's diagnoses, functional status, medications, and whether any condition would place them outside what an RCFE may accept.
Official PDF
The current LIC 602A 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 602A on cdss.ca.govWho completes it and when
The resident's physician completes and signs it; the facility supplies the form and keeps the signed original.
Signed by the resident's physician within 30 days prior to admission.
How to complete LIC 602A
- 1Give the blank LIC 602A to the resident or family early, along with the physician's contact information you have on file.
- 2Ask the physician to complete every section, including ambulatory status, communicable disease screening, and the current medication list.
- 3Confirm the assessment is signed and dated by the physician within the window required before admission.
- 4Read the form before accepting the resident, checking for conditions your license and staffing cannot support.
- 5File the signed original and carry its findings into the resident appraisal and Needs and Services Plan.
Mistakes evaluators flag
- An assessment dated too far before the admission date to be current.
- Medication sections left blank or replaced with 'see attached' without the attachment in the file.
- Accepting a resident whose documented condition is outside the facility's approved level of care.
Questions about LIC 602A
What is the difference between LIC 602 and LIC 602A?
LIC 602 is the physician's report for community care facilities generally. LIC 602A is the medical assessment specific to Residential Care Facilities for the Elderly, so RCFEs use 602A.
Can the facility fill out LIC 602A?
No. The clinical sections are completed by the resident's physician. The facility supplies the form, tracks its return, and files the signed original.
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 medical 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.