What You Need to Know About California’s Form 602a for Residential Care Facilities

If your senior loved one lives in California and need an assisted living facility — also called a residential care facility for the elderly (RCFE) — their physician must fill out Form 602a. This form includes health information and other data to help give the facility a full picture of your loved one’s needs. Residents of RCFEs are generally people who need help with their activities of daily living and other support as designated by their medical professionals. 

In California, a senior adult’s doctor fills out Form 602a, also known as the Physician’s Report for Community Care Facilities. It includes information on the care they need, their medical diagnosis and other pertinent data. It’s required for entry into an assisted living facility, or Residential Care Facility for the Elderly (RCFE). 

California’s 602a form contains facility, personal, and medical information, including:

• Facility information: This includes basic identifiers, such as the facility’s name, address, and phone number. A facility representative fills it out.
• Senior’s diagnostic information for any medical conditions: This includes a list of medical conditions, age, height, and weight.
• Tuberculosis information: Prior to admission, seniors must not have an active tuberculosis (TB) diagnosis. The physician must complete a TB skin test or chest X-ray to ensure there is no active infection.
• Medications and treatments: Information on treatments, medications, and prescription doses.
• Ambulatory status: Notes how mobile a senior is, including whether they can independently transfer to and from a bed and if they are considered nonambulatory or bedridden, for the purpose of a fire clearance.
• Physical health status: Information describing how a physician rates the senior’s general physical health, including evaluations of impairments and assistive devices required.
• Mental health status: This describes how a physician rates a senior’s mental health and whether they can communicate and follow directions, or if they present as confused or depressed.
• Capacity for self-care: This describes a senior’s ability to complete activities of daily living, including the ability to groom and feed themselves, leave the facility unassisted, or take and manage their own medications.  

Your loved one’s doctor fills out most of Form 602a — either their primary care physician (PCP) or an attending physician if they are in a hospital or nursing facility. After you fill in the personal identifying data, including name, date of birth and address, you may need to make an appointment with the appropriate medical professional to schedule time to fill out the rest of the form. You may want to be present to help your loved one answer any questions. Section I is completed by a facility representative.

If you are a caregiver or family member of a senior loved one, your primary role in this process is to be an advocate. Here are some ways to offer support:

• Schedule the appointment for your loved one with their primary care physician or attending physician if they are in a hospital or nursing facility.
• Attend the appointment with them.
• Talk to the physician if you have any concerns about your loved one’s health and wellness that may be relevant to the form. Your insight may prove valuable.
• Reiterate to the doctor, if necessary, that the form needs to be completed as thoroughly and accurately as possible.
• Once the form has been completed, you can review it to ensure it’s been filled out correctly.
• Later, touch base with the RCFE to ensure they have the form. If not, contact the doctor’s office to facilitate the completion of the form and transfer to the facility.

Whether your California-based loved one lives in an independent living residence or is currently in a hospital, memory care unit, or nursing home, their medical team may feel they would benefit from the care they would receive in an RCFE, or assisted living facility. If that’s the case, their attending physician or PCP will need to fill out Form 602a. You cannot fill out this form for them, but you can help by scheduling an appointment and attending it to ensure that the doctor has all pertinent information.

• Physician’s report for community care facilities. (n.d.). California Department of Social Services
• Tuberculosis (TB). (n.d.). U.S. Centers for Disease Control and Prevention