Printable blank LIC 603A Resident Appraisal

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What is LIC 603A?

LIC 603A is a Resident Appraisal report form issued by the Social Services. It is to be filled out by prospective residents of residential care facilities for elderly people or their representatives in California.

What do I need the LIC 603A for?

  • Potential residents of senior health facilities offering long-term care located in California are required to fill out a LIC 603A appraisal blank on admission. In this form, the prospective resident or their responsible person provides information on the prospective resident’s state of health and medical conditions.
  • Note that the form does not substitute a physician report (LIC 602).

You don’t need LIC 603A if:

  • The care facility is not in California.

How to fill out LIC 603A?

To complete the Resident Appraisal form, download a free printable PDF version of the blank. If you prefer to fill it out electronically, make sure that it contains fillable data fields. 

  • Enter the resident’s name and age.
  • In Health, describe their overall health condition, mentioning any dietary restraints.
  • Proceed to enumerate physical disabilities, if any, describe the resident’s mental health and health history.
  • Under Social Factors, describe the person’s social preferences.
  • Proceed to tick fitting answers related to specific needs below.
  • If there is any additional information you need to add, use an additional sheet.
  • Add your signature and date at the bottom of Page 2.

Organizations that work with LIC 603A

  • Residential senior care facilities, California

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