Download the LIC 602 Form (Physician’s Report for RCFE Placement)

At Senior Living Concierge Placement, we understand how overwhelming the transition to assisted living or residential care can be for families. That’s why we’ve created this helpful resource page to explain the LIC 602 Form, also known as the Physician’s Report, and how it fits into the process of moving into a licensed Residential Care Facility for the Elderly (RCFE) in California.

What Is the LIC 602 Form?

The LIC 602A Form is a mandatory California Department of Social Services (CDSS) document required for admission to any licensed RCFE in the state. It must be completed and signed by a licensed physician or medical professional to verify that a senior is medically appropriate for community-based residential care.

Download the LIC 602 Form

We’ve provided a downloadable PDF of the current LIC 602A – Physician’s Report for Community Care Facilities for your convenience:

When Is the LIC 602 Form Required?

The LIC 602 form is required before a senior can move into a licensed care home, including:

• Assisted Living Facilities

• Memory Care Communities

• Board and Care Homes (6-bed homes)

• Residential Care Facilities for the Elderly (RCFEs)

The LIC 602 form is required before a senior can move into a licensed care home, including:

How to Complete the LIC 602 Form

  1. Schedule an appointment with the senior’s primary care physician or licensed health provider.

  2. Bring a printed copy of the LIC 602 Form to the appointment.

  3. The physician will assess:

    • Medical history

    • Cognitive functioning

    • Ability to perform daily activities

    • Need for assistance with medication or care

  4. Ensure all sections are complete, signed, and dated.

    Some facilities may request additional documents such as a TB test or medication list, so check with the care home as well.

• Assisted Living Facilities

• Memory Care Communities

• Board and Care Homes (6-bed homes)

• Residential Care Facilities for the Elderly (RCFEs)

Tips for Families


• Don’t wait until the last minute. Some physicians may require extra time or testing.


• Ask your doctor’s office to fax or email the form directly to the care home if requested.


• If the senior has memory loss or dementia, ask the physician to clearly indicate this under the cognitive assessment section.