Form LIC 858. Client/Resident Records Review - California

Form LIC 858 is used in California by authorized individuals or agencies to request and conduct a review of client or resident records maintained by licensed facilities or programs. The main purpose of this form is to facilitate the review of records to ensure compliance with regulations, gather information for assessments or investigations, or provide appropriate services or oversight.

The form consists of sections where the individual or agency requesting the record review provides their contact information, identifies the specific clients or residents, and specifies the purpose for which the review is being conducted. It may also include sections for documenting the findings of the record review.

Important fields on this form include accurately providing the requester's information, clearly identifying the clients or residents whose records are to be reviewed, and specifying the purpose for the review. It is crucial for the authorized individuals or agencies to handle and protect the confidentiality and privacy of the reviewed records in accordance with applicable laws and regulations.

Application Example: A state regulatory agency responsible for overseeing assisted living facilities in California uses Form LIC 858 to request and conduct routine client records reviews. The agency specifies the facility and the clients' records to be reviewed, aiming to ensure compliance with regulations, assess the quality of care, and identify any potential concerns or areas for improvement. This form helps streamline the record review process and supports the agency's oversight responsibilities.