The LIC 602 form and its role in the ALF

One of the most important elements of admitting a new resident is the initial physical examination by a physician. This process will determine if you are able to provide the services that this resident will require, ultimately deciding if you can move forward with admitting this resident. Unfortunately, your facility is not equipped to handle every person who walks through its doors and it is better to know this at the beginning rather than 3 weeks after the resident moves into your community. In order to ensure communities are providing due diligence before admitting residents, the CCLD has regulated this process, check it out below:


(a) Prior to a person’s acceptance as a resident, the licensee shall obtain and keep on file, documentation of a medical assessment, signed by a physician, made within the last year. The licensee shall be permitted to use the form LIC 602 (Rev. 9/89), Physician’s Report, to obtain the medical assessment.

(b) The medical assessment shall include, but not be limited to:

(1) A physical examination of the resident indicating the physician’s primary diagnosis and secondary diagnosis if any, and results of an examination for communicable tuberculosis, other contagious/infectious diseases, or other medical conditions which would preclude care of the person by the facility.

(2) Documentation of prior medical services and history and current medical status including, but not limited to height, weight, and blood pressure.

(3) A record of currently prescribed medications, and an indication of whether the medication should be centrally stored, pursuant to Section 87465(h)(1).

(4) Identification of physical limitations of the person to determine his/her capability to participate in the programs provided by the licensee, including any medically necessary diet limitations.

(5) The determination of whether the person is ambulatory or nonambulatory as defined in Section 87101(a) or (n), or bedridden as defined in Section 87455(d). The assessment shall indicate whether the nonambulatory status is based upon the resident’s physical condition, mental condition, or both.

(6) Information is applicable to the pre-admission appraisal specified in Section 87457, Preadmission Appraisal.

(c) The licensee shall obtain an updated medical assessment when required by the Department

Top Takeaways:

  • You better believe the CCLD will be taking a long, hard look at your resident’s LIC 602 form, especially for those residents who are teetering on the line of being ALF appropriate.