Form LIC 601. Identification And Emergency Information
Form LIC 601 is a mandatory document required by the California Department of Social Services, Health and Human Services Agency's Community Care Licensing Division. The primary purpose of this form is to gather identification and emergency information on every person admitted to a community care facility in California.
The form consists of several sections that require personal details such as name, address, phone number, date of birth, gender, marital status, and emergency contact information. Additionally, the form requires information on the applicant's current health condition, any medications they are taking, and their medical history. Along with this, the form also contains questions about criminal records, abuse and neglect history, and citizenship or immigration status.
It is essential to note that all information provided in the form must be accurate and kept up to date. The form highlights that the information is readily available to the person in charge of the community care facility but is not accessible to unauthorized individuals.
There are no specific documents that need to be attached while submitting Form LIC 601. However, it is recommended to attach valid identification documents like driver's license, passport, or social security card to verify the applicant's identity.
The form is typically required when an individual is admitted to any community care facility in California, including residential facilities for children, to ensure the safety and security of the residents.
Strengths of the form include its comprehensive nature, which ensures that all necessary information is gathered upfront. Weaknesses may include the potential for errors or omissions on the part of the applicant, which could lead to incorrect data being used during emergency situations. Opportunities include the potential for improved data collection and analysis, while threats may include data breaches or unauthorized access to stored information.
Alternative forms that may be related to LIC 601 include medical history forms, emergency contact forms, and consent forms. However, these forms do not cover all the information required under California law for community care facilities.
The completion of Form LIC 601 can have a significant impact on the future of both the applicant and the community care facility. Accurate information provided on this form can help ensure that prompt and appropriate medical attention is provided during emergencies, and the safety of all residents is maintained.
The completed form can be submitted either online or in-person to the concerned authority. The information provided in the form is stored securely by the California Department of Social Services and is accessible only to authorized personnel.