LIC 622 — Centrally Stored Medication and Destruction Record
LIC 622 is the centrally stored medication and destruction record. It tracks medications the facility stores centrally and documents how and when medications were destroyed.
Official PDF
The current LIC 622 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 622 on cdss.ca.govWho completes it and when
Staff authorized to handle centrally stored medications, with a witness for destruction.
Ongoing — maintained for the life of each medication order.
How to complete LIC 622
- 1Log each centrally stored medication with resident name, drug, strength, quantity, and the date received.
- 2Record administration or removal entries as they happen — not at the end of the week.
- 3When medication is discontinued, expired, or the resident leaves, complete the destruction section.
- 4Have destruction witnessed and signed by the required parties, with the method and quantity documented.
- 5Keep the record with the medication file so the count on paper matches the count in the cabinet.
Mistakes evaluators flag
- Paper counts that do not reconcile with what is physically in the medication cart.
- Destruction entries with only one signature.
- Backfilled entries written in a single handwriting and ink after the fact.
Questions about LIC 622
Does every medication need to be on LIC 622?
The record covers medications the facility stores centrally, including the eventual destruction of those medications.
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.