Get Lic 602a Rcfe Form

Filling out the Lic 602a Rcfe Form is an essential step for documenting the medical information of individuals in residential care facilities for the elderly. This guide provides clear and detailed instructions to help users complete the form efficiently and accurately online.

Follow the steps to effectively complete the Lic 602a Rcfe Form online.

1. Click ‘Get Form’ button to obtain the form and open it in your editor.
2. Enter the facility information in Section I. Fill in the name of the facility, its address, telephone number, the licensee’s name, their telephone number, and the facility license number in the designated fields.
3. In Section II, provide resident/patient information. Input the name of the resident, their birth date, and age in the corresponding fields.
4. Complete Section III by authorizing the release of medical information. The resident or their legal representative should sign and provide their address and the date.
5. Section IV requires the physician to provide the patient's diagnosis. The physician must fill out the date of the exam, sex, height, weight, and TB test details, including the results, if applicable.
6. Complete the sections regarding primary and secondary diagnoses, treatment details, and if assistance is needed for managing medications or other equipment.
7. Answer the questions regarding physical and mental health status. The physician must indicate any impairments and provide necessary explanations.
8. Fill in ambulatory status and any other relevant health conditions or comments in the designated sections.
9. Provide the physician's name, address, and signature at the end of the form. Ensure the length of time the resident has been a patient and the date are also included.
10. Once all sections are filled out correctly, users can save changes, download, print, or share the form to complete the submission process.

Get started on completing your Lic 602a Rcfe Form online today!