Get Lic 604a

The LIC 604a is a critical form required for admission agreements in residential facilities in California. This guide will assist you in navigating the online filling process of the LIC 604a, ensuring you accurately complete each section to meet regulatory requirements.

Follow the steps to fill out the LIC 604a online effectively.

1. Press the ‘Get Form’ button to access the LIC 604a document. This will allow you to view and interact with the form in an online format.
2. Begin by filling out the facility information section. You need to enter the name of the facility, the type of facility, and the complete address including city, state, and zip code. Also, include the facility's telephone number.
3. Next, provide the name of the client or resident for whom the admission agreement is being created. Include the client's or resident's social security number (optional) and birthdate.
4. In the basic services section, you will need to outline the accommodations provided, such as room type and meal services. Specify the monthly rate for these services, indicating whether payment is made in advance or arrears.
5. Proceed to optional services, detailing any additional services offered, their rates, and pay schedules. Total the monthly rate for optional services in the designated field.
6. Combine the rates from both the basic and optional services to complete the total monthly rate section.
7. Review the eviction procedures, visiting policy, and discharge/removal policies to ensure understanding and compliance.
8. Complete the refund policy and include the holding rate if applicable. Indicate the client's funding source and ensure all necessary parties sign the agreement alongside the respective dates.
9. After completing the form, save your changes. You may download, print, or share the LIC 604a form as required.

Start filling out your LIC 604a online today to streamline the admission process.