LIC 602A: Medical Assessment for Residential Care Facilities for the Elderly

What Is LIC 602A?

LIC 602A, Medical Assessment for Residential Care Facilities for the Elderly, is a medical assessment used for a prospective resident or resident of an RCFE.

The form provides the facility with important information about the resident's medical conditions, medications, cognitive and mental health, physical abilities, behavioral needs, and level of assistance required. It also addresses areas such as allergies, communicable diseases, medication management, and ambulatory status.

The assessment is completed by a licensed medical professional, while the facility and the prospective resident or their legal representative complete their respective sections.

The form states that this information is required to help determine whether the prospective resident or resident is appropriate for care in an RCFE, which provides primarily non-medical care and supervision and cannot provide skilled nursing care.

Official LIC 602A Form

The current LIC 602A is published by the California Department of Social Services (CDSS). RCFE Connect links directly to the official source rather than hosting a copy, so you can access the form from CDSS.

[Open LIC 602A on CDSS]

Who Completes LIC 602A and When?

LIC 602A has sections completed by the facility, the prospective resident/resident or their legal representative, and a licensed medical professional.

The licensee or designee completes the facility information. The prospective resident/resident or their legal representative provides the resident information and authorization for release of medical information. The licensed medical professional completes the medical assessment and signs the form.

The form is intended to provide medical information that assists in determining whether the prospective resident/resident is appropriate for care in an RCFE.

What Information Is Included on LIC 602A?

LIC 602A covers several areas of the resident's medical condition, functional abilities, and care needs, including:

• Resident's basic information

• Authorization for release of medical information

• Date of medical examination

• Diagnosis or diagnoses

• Treatment, medication, and equipment

• Cognitive conditions

• Communicable tuberculosis (TB) screening

• Infectious and contagious diseases

• Allergies

• Overall physical health

• Physical health conditions and limitations

• Capacity for self-care

• Overall mental health

• Behavioral expressions

• Safety risks involving certain items and environments

• Medication management abilities

• Ambulatory status

• Bedridden status, when applicable

• Hospice care

• Licensed medical professional information and signature

How to Complete LIC 602A

1. Complete the facility information

The licensee or designee completes the facility section with the facility's name, contact person, phone number, email address, and address.

2. Complete the resident information and authorization

The prospective resident/resident or their legal representative provides the requested personal information and completes the authorization for release of medical information.

The form includes a signature and date for this authorization.

3. Have the licensed medical professional complete the medical assessment

The licensed medical professional documents the resident's medical information, including:

• Diagnoses

• Treatments

• Medications and dosages

• Equipment

• Cognitive conditions

• Disease and TB information

• Allergies

• Physical and mental health conditions

The form also asks whether the resident can independently manage their treatment, medication, or equipment and, when they cannot, what assistance is needed.

4. Review functional abilities and safety needs

The assessment covers more than diagnoses.

It also evaluates the resident's ability to perform activities such as bathing, dressing, feeding, toileting, communicating, following directions, and managing cash resources.

It also addresses behavioral expressions, access to potentially dangerous items, supervision around certain equipment or bodies of water, and medication management.

5. Complete the ambulatory and bedridden information

The form specifically documents whether the resident is:

• Ambulatory

• Nonambulatory

• Bedridden

For fire-clearance purposes, the form provides specific definitions for nonambulatory and bedridden status. If the resident is bedridden, the form also asks about the underlying illness, surgery, or other cause and the expected duration.

6. Review, sign, and date the assessment

Before filing the completed form, confirm that the licensed medical professional's information, signature, and date are complete.

The final section includes the professional's name and address, phone number, email address, length of time providing care to the resident, signature, and date.

Common LIC 602A Mistakes to Avoid

A medical assessment is only useful when it provides complete and current information about the resident.

Watch for:

• Incomplete medical information — Diagnoses, treatments, medications, or equipment may be missing.

• Unclear assistance requirements — The form asks whether the resident can manage their own treatment, medication, or equipment and what assistance is needed when they cannot.

• Overlooking functional abilities — The assessment covers bathing, dressing, feeding, toileting, communication, following directions, and other daily functions—not just medical diagnoses.

• Missing behavioral or safety information — Conditions such as unsafe wandering, elopement, lack of hazard awareness, and other behavioral expressions are specifically addressed.

• Incomplete medication management information — The form separately evaluates the resident's ability to administer medications, injections, glucose testing, PRN medications, oxygen, and medication storage.

• Missing ambulatory status — The form requires specific consideration of ambulatory, nonambulatory, and bedridden status, including fire-clearance classifications.

• Missing signatures or dates — Review the authorization and licensed medical professional signature sections before filing.

LIC 602A Quick Check

Before filing or reviewing a LIC 602A, check that:

☐ Facility information is complete

☐ Resident information is complete

☐ Medical information release is authorized and signed

☐ Diagnoses are documented

☐ Treatment, medications, and equipment are documented

☐ Cognitive conditions have been addressed

☐ TB information is complete

☐ Infectious and contagious diseases have been addressed

☐ Allergies are documented

☐ Physical health and self-care abilities have been assessed

☐ Mental health and behavioral conditions have been addressed

☐ Safety and supervision needs have been considered

☐ Medication management abilities are documented

☐ Ambulatory status is documented

☐ Bedridden information is completed when applicable

☐ Hospice status is addressed

☐ Licensed medical professional information is complete

☐ Required signatures and dates are completed

Frequently Asked Questions

What is the difference between LIC 602 and LIC 602A?

LIC 602A is specifically titled Medical Assessment for Residential Care Facilities for the Elderly and is designed for prospective residents/residents of RCFEs.

The LIC 602A itself identifies the RCFE as a non-medical facility and states that RCFEs cannot provide skilled nursing care.

Can the facility complete the medical portion of LIC 602A?

The medical assessment section is designated for completion by a licensed medical professional. The facility has its own designated section for facility information, while the resident or legal representative completes the resident information and medical-information release authorization.

Does LIC 602A include medication information?

Yes. The form asks for treatment, medication type and dosage, equipment, and whether the resident can manage their own treatment, medication, or equipment.

It also has a separate Medication Management section covering prescription medications, injections, glucose testing, PRN medications, oxygen, and medication storage.

Does LIC 602A assess the resident's ability to perform daily activities?

Yes. The form assesses capacity for self-care, including bathing, dressing and grooming, feeding, toileting, managing cash resources, communication, following directions, and leaving the facility unsupervised.

Does LIC 602A address dementia or cognitive conditions?

Yes. LIC 602A contains a specific Cognitive Conditions section and includes definitions for Mild Cognitive Impairment and Major Neurocognitive Disorder.

Does LIC 602A determine whether a resident is ambulatory?

It documents the resident's ambulatory status and, for purposes of fire clearance, identifies whether the resident is ambulatory, nonambulatory, or bedridden.

Is LIC 602A confidential?

Yes. The form is explicitly marked “CONFIDENTIAL.”

More California RCFE LIC Forms

LIC 602A is one of many forms used in California's residential care system.

RCFE Connect is building a practical library to help facility owners understand what different LIC forms are for, when they are used, and what to check when completing them.

More LIC form guides coming soon.