Get Lic 503 2020-2025

The Lic 503 form is an essential document required for personnel working in residential care facilities. This guide provides a comprehensive, step-by-step approach to filling out the Lic 503 online, ensuring clarity and ease of use for all individuals involved.

Follow the steps to effectively complete the Lic 503 form.

1. Press the ‘Get Form’ button to access the Lic 503 form and open it in your document editor.
2. Begin with entering the facility name in the appropriate field. Ensure that the name is spelled correctly to reflect the official title of the facility.
3. In the facility address section, provide the complete address, including street, city, state, and zip code.
4. Fill in the person's name where indicated, ensuring to use full legal names for accuracy.
5. Enter the age of the individual being screened, as this information is vital for health assessments.
6. Indicate the position title of the individual. This helps define the responsibilities and expectations of the role.
7. Select the type of facility in which the individual will be working by checking the appropriate box.
8. Complete the work days per week and work hours per day sections to outline the expected work schedule.
9. Provide a detailed duty statement for the individual's role to give context to the health screening.
10. Check all applicable types of persons served, ensuring to mark all relevant categories clearly.
11. Complete the authorization for the release of medical information to allow sharing necessary health data. Fill in the address and date, and provide the signature of the applicant, licensee, or employee.
12. The physician should fill in their evaluation of general health and the ability to perform the described duties, noting any health conditions that could pose hazards.
13. Ensure the physician's name, stamp, and original signature are included before finalizing the form.
14. After completing the form, you can choose to save changes, download, print, or share it as necessary.

Complete your Lic 503 form online today to ensure compliance with regulations and the wellbeing of all facility personnel.