LIC 613C — Personal Rights of Residents in Publicly Operated Residential Care Facilities for the Elderly
LIC 613C is the California CDSS form titled "Personal Rights of Residents in Publicly Operated Residential Care Facilities for the Elderly". Gives residents of publicly operated RCFEs their statutory personal rights.
Official PDF
The current LIC 613C 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 613C on cdss.ca.govWho completes it and when
The facility prepares this form and files the completed original in the appropriate record.
Provided and signed at admission in publicly operated facilities.
How to complete LIC 613C
- 1Download the current revision of the form directly from CDSS so you are not working from an outdated copy.
- 2Fill in facility and resident identifying information exactly as it appears in your licensing and resident records.
- 3Complete every section — evaluators read blanks as missing documentation.
- 4Obtain the required signatures and dates before filing.
- 5File the completed form in the resident or facility record. Provided and signed at admission in publicly operated facilities.
Mistakes evaluators flag
- Using an old revision of the form after CDSS published an update.
- Sections left blank with no explanation.
- Signature or date lines missed on the final page.
Questions about LIC 613C
When is LIC 613C used?
Provided and signed at admission in publicly operated facilities.
Is LIC 613C required for an RCFE?
LIC 613C is not required for every RCFE resident or facility. It applies in the situations described in the form instructions.
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.