Form LIC 602, Physician's Report for Community Care Facilities is a document completed by a health care professional (physician) to determine whether the resident or the applicant for admission to a Community Care Facility is appropriate for continued care in this facility or admission. Community Care Facilities are licensed to provide round-the-clock non-medical residential care to adults and children in need of assistance. In California, it is possible to apply for residential care to receive personal services, supervision, rehabilitative therapy, medication and more. This document is completed by the patient's primary physician or the attending physician. Most health care professionals are familiar with this document; however, it is recommended to have the form filled out by the primary care physician who possesses in-depth knowledge of the potential resident. A comprehensive physician's report is the most important part of the resident assessment process that must be updated should any significant change in the patient's condition take place.
The latest version of the Form 602 LIC was issued by the California Department of Social Services in July 2011 with all previous editions obsolete. A fillable version of the form is available for download below.
Form LIC 602A, Physician's Report for Residential Care Facilities for the Elderly (RCFE) is a related form used specifically to obtain residential care for the elderly residents or prospective residents of care facilities. Just like LIC Form 602, it needs to contain patient's information, authorization for release of medical information, and patient's diagnosis (primary and secondary diagnosis, description of known diseases, allergies, and other conditions, physical health and mental condition status, ambulatory status, etc.) certified by the health care professional.