GETTING STARTED · CALIFORNIA LIC 602A
Download the 602
physician assessment.
The medical assessment is an important part of preparing for assisted living or a residential care home. Give the medical office time to complete it so paperwork doesn’t hold up the next step.
California LIC 602A
Medical Assessment for Residential Care Facilities for the Elderly
Revision 4/26 · PDF · 9 pages · Blank form
How to get it completed
- Start early. Contact the medical office about its process, turnaround time and whether an appointment is needed. Print all nine pages.
- Confirm the receiving community. Section I is completed by the facility’s licensee or designee. Before signing the release in Section III, confirm the receiving facility details; the authorization refers to the facility named on the form.
- Complete the family’s sections. The resident or legal representative completes Section II (resident information) and Section III (authorization).
- Arrange the clinical assessment. A licensed medical professional completes Section IV and signs Section V. Your loved one’s physician is a good place to start; coordinate any additional requirements with the receiving community.
You can start the conversation now.
You can explore options and arrange tours while the assessment is being completed. The receiving community confirms the documents and timing needed for admission. This form is intended for residential care facilities for the elderly; it is not a universal first step for independent living or in-home caregiving.
Keep completed forms private.
This page provides a blank download only. Please do not send completed forms or medical records through our website or a general inquiry email. Ask the medical office and authorized receiving community to arrange secure delivery.
Source: California Department of Social Services · LIC 602A (4/26). The download is the original form, without changes. Confirm the required version with the receiving community.
Check the official CDSS form source ↗
Looking for benefits applications instead? →
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Need help with the next step?
Rick can help you understand the placement process and connect with the receiving community about paperwork.
Rick Polanco · Care Navigator
(661) 755-5284
rick@