Form LIC 606. Residential Care Facility For The Elderly Disclosure Worksheet - California

Form LIC 606 is used in California by residential care facilities for the elderly to provide a disclosure worksheet to prospective residents. The main purpose of this form is to inform individuals of the facility's services, policies, and fees before admission.

The form consists of sections that outline important information such as the facility's name, address, contact details, and licensing information. It includes details about the types of services provided, staffing levels, resident rights and responsibilities, medication administration policies, social and recreational activities, and fee structures. The form may also include spaces for the signature of the prospective resident or their representative and the date of disclosure.

Important fields on this form include accurately describing the facility's services and amenities, clearly stating the rights and responsibilities of residents, providing information on medication administration and care practices, and explaining the fee structure and payment arrangements. It is crucial for the residential care facility to ensure that the disclosure worksheet is comprehensive, transparent, and complies with applicable regulations to facilitate informed decision-making by prospective residents.

Application Example: A family is considering placing their elderly loved one in a residential care facility in California. Form LIC 606 would be provided to them by the facility as a disclosure worksheet. By reviewing the form, the family gains an understanding of the facility's offerings, policies, and fees, enabling them to make an informed decision about the best care option for their loved one.