Type or print clearly.
Ambulatory Status: check appropriate box that indicates the client/resident mobility status. These definitions are for the purposes of a fire clearance.
Non-ambulatory: means a person who is unable to leave a building unassisted under emergency conditions.
Bedridden: means a person who is unable to independently turn or reposition in bed.
Restricted Health Conditions: applicable to facilities governed by California Code of Regulations, Title 22, Sections 80071(a)(1)(D) and 82071(a)(4) only.
Responsible Person: enter the name, address, and telephone number of the person responsible for the client/resident.
| Question | Answer |
|---|---|
| Form Name | LIC 9020 |
| Form Length | 2 pages |
| Fillable? | Yes |
| Fillable fields | 89 |
| Avg. time to fill out | 15 min |
| Edition | Rev 5/17 |
| Issuing agency | California Department of Social Services, Community Care Licensing Division |
| Who maintains it | The licensee |
| Matches the agency's file | Yes, checked October 2, 2026 |
| Other names | LIC 9020, LIC9020, Register of Facility Clients/Residents, facility register |
| Official source | LIC 9020 (Rev 5/17), California Department of Social Services |
Register Facility Clients Residents Form isn’t the one you’re looking for?