LIC 9186 — Client Death Report
LIC 9186 is the California CDSS form titled "Client Death Report". Reports client deaths to CCL when required.
Official PDF
The current LIC 9186 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 9186 on cdss.ca.govWho completes it and when
The facility prepares this form and files the completed original in the appropriate record.
As specified by CCL reporting requirements.
How to complete LIC 9186
- 1Download the current revision of the form directly from CDSS so you are not working from an outdated copy.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. As specified by CCL reporting requirements.
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 9186
When is LIC 9186 used?
As specified by CCL reporting requirements.
Is LIC 9186 required for an RCFE?
LIC 9186 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 incident & reporting 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.