Form LIC 603. Preplacement Appraisal Information

The LIC 603 form, also known as Preplacement Appraisal Information, is a significant document regulated by the California Department of Social Services' Community Care Licensing. This form serves the purpose of collecting essential information to evaluate and assess potential placements for individuals in various care settings.

The LIC 603 form consists of multiple sections that are crucial for conducting a thorough appraisal. It includes fields such as applicant information, living environment assessment, personal history, medical conditions, behavioral concerns, and emergency contact details. Each field contributes to a comprehensive understanding of the individual's background and suitability for placement.

The parties involved in completing the LIC 603 form include the applicant or their authorized representative and the licensing agency responsible for evaluating the prospective placement. Both parties must provide accurate and complete information during the form filling process.

When filling out the LIC 603 form, several data points are required. This includes the applicant's personal information, employment history, criminal background, physical and mental health status, medication records, and any relevant supportive documentation. Additional documents that may need to be attached include identification documents, medical reports, references from previous employers or caregivers, and any legal paperwork related to the applicant.

Application examples and use cases for the LIC 603 form include:

1. Placement in Residential Care Facilities: The form is used when an individual is being considered for placement in various care settings such as adult residential facilities, group homes, or child care institutions. It helps assess the applicant's suitability for the intended placement.

2. Foster Care Placements: The LIC 603 form is utilized when considering individuals for foster care placements. It aids in evaluating the prospective foster home environment and ensures a proper match between the applicant and the foster family.

Related forms or alternative options to the LIC 603 form may include:

1. LIC 602. Physician's Report - Adult Residential Facilities (ARF): This form is specifically used for assessing the health condition and care needs of individuals seeking admission to adult residential facilities.

2. LIC 627. Child Placement Agency Application: This alternative form is employed when submitting an application to become a licensed child placement agency. It includes information about the agency's structure, policies, and procedures.

Once completed, the LIC 603 form is typically submitted directly to the licensing agency responsible for evaluating the potential placement. It is crucial to ensure accuracy and completeness when filling out the form. The licensing agency securely stores the completed form as part of their records, aiding in the assessment and decision-making process related to placements.

In summary, the LIC 603 form plays a vital role in evaluating and assessing potential placements in various care settings. By gathering comprehensive information, the form helps licensing agencies make informed decisions regarding the suitability of applicants for specific placements. Accurate completion and submission of the form are essential to ensure a thorough appraisal and proper match between the applicant and the intended care setting.