Fill Out Your Lic 602A Form

What is the purpose of the Lic 602A form?

The Lic 602A form is a Physician's Report used for Residential Care Facilities for the Elderly (RCFE) in California. It helps determine if a resident or prospective resident is suitable for non-medical care at these facilities. The information provided by the physician is essential for evaluating the individual’s medical condition and care needs.

Who needs to complete the Lic 602A form?

The form must be completed by different parties. The licensee or their designee fills out the facility information. The resident or their responsible person provides their information. Finally, the resident's physician will complete the medical evaluation section. This collaborative effort ensures that all necessary details are collected properly.

What kind of medical information does the Lic 602A form require?

The form asks for a variety of medical details. It includes the resident's primary and secondary diagnoses, medication management, and any allergies. It also inquires about the patient’s physical and mental conditions, including their capacity for self-care. This comprehensive approach ensures that the facility can meet each resident's specific needs.

Is a tuberculosis (TB) test required on the Lic 602A form?

Yes, the form includes a section dedicated to tuberculosis screening. Physicians need to document the type of TB test given and its results. If a test indicates positive results, the physician must report on any actions taken, ensuring the safety of all residents in the facility.

What happens if the resident has conditions that require special care?

The Lic 602A form allows physicians to specify conditions that may necessitate additional care or supervision. If a resident cannot manage their treatment or medication, the physician should indicate the type of medical supervision needed. This information is crucial for the facility to provide an appropriate level of care.

How confidential is the information on the Lic 602A form?

The Lic 602A form is labeled as confidential. It includes personal medical information about the resident, which must be handled carefully. The authorization for the release of medical information must be signed by the resident or their legal representative, ensuring that confidentiality is maintained throughout the process.

Filling out the Lic 602A form can be a daunting task, and small errors can lead to delays or issues with processing. Here are six common mistakes to avoid.

One frequent mistake is missing or incomplete facility information. The facility name, licensee’s name, and address must all be clearly stated. If any of this information is omitted, it creates confusion and may result in delays. Always double-check that all sections in the facilities information part of the form are complete and accurate.

Another pitfall occurs in the resident/patient section. Often, individuals provide incorrect or outdated information regarding the date of birth or age. This section is critical for identifying the resident and verifying eligibility, so ensure that this information is correct. Also, don’t forget to confirm that the name matches the spelling on official documents.

In the authorization section, signatures can pose a problem. Sometimes, the signature of the resident or legal representative is missing or improperly dated. Double-check that the signature is present and valid. This step is crucial, as the release of medical information depends on a completed authorization.

When it comes to the physician's diagnosis section, many people overlook providing complete treatment details. Missing information, such as the type and dosage of medications, can hinder the evaluation of care needs. Be thorough when detailing treatment plans, as this section greatly influences the resident's placement in the facility.

Additionally, the section on medications often mixes up whether the patient can manage their medications. Some mistakenly check "Yes" when the reality is different. If the resident needs assistance, this must be noted clearly to ensure proper care arrangements are made.

Lastly, individuals can fail to specify the physical or mental condition of the resident correctly. This includes areas like mobility status or any cognitive impairments. Not providing sufficient detail can lead to inadequate care planning. It's crucial to take the time to fill out these sections accurately for the safety and well-being of the resident.

When dealing with the LIC 602A form, there are several other documents that often accompany it to ensure a comprehensive understanding of a resident's health needs and care requirements. Each of these documents serves a unique purpose in the context of residential care for the elderly. Here is a list of additional forms that are frequently used alongside the LIC 602A.

• LIC 500 - Application for a License to Operate a Residential Care Facility for the Elderly: This form is essential for those looking to operate a residential care facility. It includes details about the facility, ownership, and operational plans.
• LIC 610 - Emergency Disaster Plan: This document outlines the procedures a facility must follow in case of an emergency, ensuring both staff and residents can respond appropriately to protect everyone’s safety.
• LIC 9166 - Record of Personnel Qualifications: This form provides information about the qualifications and training of the staff working at the facility, helping to reinforce the level of care available for residents.
• LIC 601 - Application to Operate a Residential Care Facility for the Elderly: Similar to the LIC 500, this form is utilized to apply for facility licensing and includes details about staff, services provided, and overall mission.
• LIC 9020 - Resident Personal Property Inventory: This form is crucial for documenting the belongings of residents upon their admission to the facility, protecting both the resident’s property and the facility’s liability.
• LIC 627 - Verification of Personal Rights: This document affirms that residents have been made aware of their rights while living at the facility, covering aspects like privacy, dignity, and the ability to make choices.
• LIC 602 - Physician's Report for Residential Care Facilities for the Elderly: Similar in name to the LIC 602A, this document details the medical evaluation and health record of the resident, providing necessary medical background information.
• LIC 9141 - Plan of Operation: This plan outlines the daily operations of the facility, including schedules and routines, helping to establish consistency and reliability in care practices.
• LIC 128 - Adult Day Program Application: If the facility also provides adult day care services, this form outlines the application for those services, detailing the specific programs available.

In summary, each of these documents plays a crucial role in the overall management and operation of residential care facilities for the elderly. Together, they help ensure that residents receive appropriate care tailored to their individual needs.

• LIC 602: This form is also used to gather a resident's medical history and current health status for admission to residential care facilities. Similar to LIC 602A, it requires details regarding the patient's diagnosis and capacity for self-care.
• LIC 601: This document focuses on the applicant's medical assessment and includes comprehensive questions about current health conditions. Like the LIC 602A, it aims to ensure that the individual's needs can be met in a residential setting.
• LIC 626: This is a Personal Rights form. Similar to the LIC 602A, it ensures that the resident understands their rights within the care facility, reinforcing the necessity for proper communication about health needs.
• LIC 9102: The Emergency Disaster Plan requires information about residents' abilities to evacuate in case of an emergency. The data gathering is akin to the LIC 602A in that it assesses each individual's capacities and limitations.
• PH-27: This is a report form for identifying resident health conditions and care needs. It mirrors the LIC 602A as it collects essential medical information necessary for proper care and supervision in an elderly facility.
• LIC 9280: This form records staff qualifications and training related to resident care. Like the LIC 602A, it emphasizes the importance of understanding residents' medical and emotional needs to provide appropriate assistance.

When filling out the Lic 602A form, it's essential to be careful and accurate. Here are ten important dos and don'ts:

• Do use clear and legible handwriting when completing the form.
• Do ensure all necessary sections are filled out completely, especially contact details.
• Do double-check the resident's name and birth date for accuracy.
• Do attach any additional pages if there is not enough space for your responses.
• Do provide the date and signature of the resident or legal representative.
• Don't leave any required fields blank, as this can delay processing.
• Don't use abbreviations or acronyms that might not be understood by others.
• Don't forget to include the facility license number when applicable.
• Don't skip questions regarding the patient's medical history or conditions.
• Don't submit the form without reviewing it for any mistakes or omissions.

• Misconception 1: The LIC 602A form is unnecessary for entry into residential care facilities.

  This form is crucial. It ensures that the facility has the right information about the resident's health status. Without it, the facility cannot make informed decisions about care needs.

• Misconception 2: Only current residents need to complete the LIC 602A form.

  In fact, prospective residents must also have this form filled out. The document assists in assessing if the individual is suitable for the facility based on their health condition.

• Misconception 3: The physician's diagnosis part of the LIC 602A is optional.

  It is not optional. The physician’s diagnosis is mandatory. This section helps the facility understand the medical needs of the resident, ensuring appropriate care is provided.

• Misconception 4: The LIC 602A form is only about medical conditions.

  While medical conditions are important, the form also addresses cognitive abilities, capacity for self-care, and various health statuses. A holistic view of the resident's needs is vital for proper care.

• Misconception 5: Completing the LIC 602A is a quick and easy process.

  This process may take time. It involves gathering accurate health information and collaborating between the resident, their family, and medical professionals. Rushing through can lead to incomplete or incorrect information.

• The Lic 602A form is essential for documenting medical information for residents in residential care facilities for the elderly.
• Complete all sections thoroughly to ensure that the facility can provide appropriate care.
• Authorization for the release of medical information is mandatory and must be signed by the resident or their legal representative.
• The physician must provide detailed information about the resident's diagnosis, treatments, and any special needs.
• Inaccurate or incomplete information may delay the admission process to the facility.
• Regular updates and reevaluations of the resident's health status can help maintain appropriate care and support.