The LIC 625 form, issued by the State of California’s Health and Human Services Agency through the Department of Social Services Community Care Licensing, serves an essential function in the landscape of community care and residential facilities. This form is a critical document for ensuring that individuals entering these facilities receive care tailored to their unique needs. It encompasses a comprehensive appraisal and needs and service plan, detailing the client or resident’s personal information, including name, date of birth, sex, and other essential data, along with the facility's details. It is meticulously designed to capture a wide spectrum of information including, but not limited to, emotional, behavioral, and physical problems; functional limitations; likes and dislikes; as well as the client's or resident's capacities in handling personal finances and performing basic homemaking tasks. The process of completing this form is collaborative, requiring inputs from multiple stakeholders including the client or resident, their authorized representative, and professionals like physicians and social workers. This ensures the development of a highly personalized service plan aiming to address the individual’s specific needs. Moreover, this form acts as a medium for the referral agency or person to inform the facility of any potential risks associated with the client’s or resident's tendencies. While not initially required at admission in residential care facilities for the elderly, its completion becomes necessary if it's determined that an elderly resident's needs are unmet, highlighting the form's adaptability and importance in continuous care assessment.
| Question | Answer |
|---|---|
| Form Name | Lic 625 |
| Form Length | 4 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 1 min |
| Other names | lic 625 appraisal, california 625, needs services plan, lic625 ccld |
