WebCopies of the last two facility Licensing Reports . A sample monthly meal plan, including snacks . A sample activity schedule . A list of course topics used in staff training . Evacuation Plan – CDSS LIC 610 E. Copy of CDSS Facility License. Assisted Living Waiver Program Provider Agreement (See ALW . Provider Enrollment. webpage). WebDownload Physician's Report For Community Care Facilities (LIC 602) – Department of Social Services (California) form. Formalu Locations. United States. Browse By State Alabama AL ... The purpose of the LIC 602 form is to collect information about an individual seeking admission or continued care in a residential care facility.
Form LIC602A Download Fillable PDF or Fill Online Physician
WebSIGNATURE OF RESIDENT AND/OR RESIDENT'S LEGAL REPRESENTATIVE. 2. ADDRESS 3. DATE. IV. PATIENT'S DIAGNOSIS (To be completed by the physician) NOTE TO … WebJun 4, 2024 · the physician's report for residential care facilities for the ... (rcfe) i. f a cility informa tion (t o be completed by the licensee/designee) 1. name of f a cility . 2. telephone … bitsight australia
Fillable PHYSICIAN
WebCollects the necessary paperwork e.g. 602 RCFE Physician’s report, medication list etc. Ensures the loved one has had a TB and COVID test; Follows up the during the week after move in & one month later; Provides other resources (e.g. move manager, geriatric care manager, estate planner etc.) Webreport instructions : notify licensing agency, placement agency and responsible persons, if any, by next working day. submit written report within 7 days of occurrence. retain copy of report in client’s file. name of facility facility file number city, state, zip WebSep 10, 2024 · Residential Care Facilities for the Elderly (RCFEs) — sometimes called “Assisted Living” (e.g., 16+ beds) or “Board and Care” (e.g., 4 to 6 beds) — are non–medical facilities that provide room, meals, housekeeping, supervision, storage and distribution of medication, and personal care assistance with basic activities like hygiene ... bitsight cambridge