Form LIC 601, Identification and Emergency Information, is a legal document that contains the personal details of every individual admitted to a community care facility. It is typically filled out when an individual is admitted to a facility to establish all of the necessary details about the resident and a contact person that may be reached if the resident gets involved in an emergency situation. The information stated in the form must be kept current and made available to community care facility employees. Make copies for relatives, caretakers, physicians - anyone who is periodically responsible for the child.
This form was released by the California Department of Social Services (CDSS), a component of the California Health and Human Services Agency (CHHS). The latest version of the form was issued on August 1, 2008, with all previous editions obsolete. You can download a fillable LIC 601 Form through the link below.
Form LIC 601 (SP), Identificación e Información de Emergencia (the Spanish version of LIC 601 Form) can also be found on our website. If an individual is submitting to a child care center or family child care home, complete Form LIC 700, Identification and Emergency Information (Child Care Centers/Family Child Care Homes).
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