Get Lic 604

Filling out the Lic 604 form is essential for community care facilities in California to establish an admission agreement between the facility and its residents. This guide provides detailed, user-friendly instructions on completing the Lic 604 online, ensuring all necessary requirements are met.

Follow the steps to complete the Lic 604 online efficiently.

1. Press the ‘Get Form’ button to access the Lic 604 form and open it in your preferred online editor.
2. Begin with section 1, providing essential facility information. Fill in the name, type, address, city, state, zip code, and telephone number of your facility. Ensure accuracy, as this establishes your identity within the document.
3. In section 2, list the basic services provided to the resident. Start with the name of the client/resident and include services like lodging options and details about food, laundry, cleaning, transportation, and personal care services.
4. Complete the section on optional services by specifying what additional services might be available, along with their rates and pay schedule in section 3. Be clear about whether these services are paid in advance or in arrears.
5. Add the total monthly rate for both basic and optional services in section 4. Make sure this reflects the sum of the basic services and any optional services that may be chosen.
6. Read through sections 5 through 12, which outline important policies such as eviction procedures, discharge/removal conditions, and refund policies. Provide specific details applicable to your facility.
7. In section 13, ensure the responsible party acknowledges the payment agreement and conditions by checking the relevant boxes. This section requires explicit confirmation from the client/resident or their authorized representative.
8. Finalize the form by entering the signatures of the client/resident, licensee/administrator, and authorized representative, along with the dates, ensuring all parties understand their obligations and rights as outlined in the agreement.
9. Once all sections are filled out, you can save the changes, download the completed form, print it, or share it as necessary to complete the process.

Complete your Lic 604 form online today to ensure compliance and provide quality services to your residents.