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PROGRAMS (Elderly Facility)

The forms below are requirements by Community Care Licensing for an Elderly Facility.  They are grouped based on Administration, Consumer, and Staff records needed to be sustained by a facility.

Administrative Records

LIC402-Surety Bond
LIC500-Personnel Report
LIC508-Personnel Record Statement
LIC610E-Emergency Disaster Plan Elde
LIC9059-Personal Property Procedures
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Client Records

LIC601-Identification and Emergency
LIC602A-Physician Report Elderly
LIC603A-Resident Appraisal
LIC604A-Admission Agreement Guide El
LIC613C-Personal Rights of Residents
LIC621-Client Personal Property and
LIC622-Centrally Stored Medication a
LIC624-Unusual Incident Injury Repor
LIC624A-Death Report
LIC625-Appraisal Needs and Service P
LIC9020-Register of Facility Clients
LIC9060-Resident Theft and Loss Reco
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Records to be Maintained at the Facility

LIC311F-Records to be Maintained at
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Personal Records

LIC402-Surety Bond
LIC500-Personnel Report
LIC508-Personnel Record Statement
LIC610E-Emergency Disaster Plan Elde
LIC9059-Personal Property Procedures
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