Form LIC 503. Health Screening Report for Facility Personnel

The LIC 503 (Health Screening Report for Facility Personnel) is the form used by California health care facilities to determine the health of personnel prior to employment or assignment. It consists of three parts: health history, immunizations and health screening.

For the health history, applicants are asked to list any past or current illnesses or chronic medical conditions, recent hospital stays or emergency room visits, surgeries, major illnesses or illnesses for which you are still under medical care, and allergies or allergies to medications. The immunizations section requires applicants to provide proof of immunization, e.g. tetanus or rabies, and the health screening section requires applicants to submit proof of health care professional's evaluation.

Another important part of the form is the information section, which includes detailed information about the applicant's name, birthdate, and address. All of these must be accurate and up-to-date. If any of this information is inaccurate, it could cause delays in the processing of the form.

The LIC 503 form is a document that must be submitted prior to employment or assignment in a California health care facility. It is just one of the steps involved in the comprehensive personnel screening process. The form is meant to safeguard the health of the individuals who work in these facilities as well as the individuals who are being cared for.

If a facility decides to hire or assign an individual, both the applicant and the facility must sign the form, and the signed copy must be kept in both the facility and the applicant's personnel file. The form must also be updated annually if the individual is still employed or assigned at the facility.

Overall, the LIC 503 is an important form for health care facilities in California. It is important for applicants to ensure that they complete it accurately and supply all documents required for processing. The form also important for the facilities, as it is meant to protect the health and safety of both the personnel and the patients.