The following forms are required to be completed prior to move in. Please contact us at (310) 422 – 5364 if you have any questions. Required download: Adobe Acrobat Reader

Please complete as best you can:

LIC601 ID & Emerg Info.pdf
LIC603A Resident Appraisal.pdf
LIC603 Pre Placement Appraisal.pdf
RR2 Resident ID & Emergency Info
Billing Information Sheet.pdf

Please review and sign:

LIC605A Release of Resident Medical Records
LIC613 Personal Rights.pdf
LIC621 Property Inventory.pdf
LIC627C Consent for Medical Treatment
LIC622 Centrally Stored Medication.pdf
LIC405 Cash Records.pdf
LIC9158 Telecommunications Device Form.pdf
Your Right to Make Decisions

Please sign and then give to doctor to complete:

LIC602A Physician Report.pdf

Completed forms can be faxed to (310) 868 – 2803 or given directly to an Americare Administrator.

valerie@visualeyezstudio.comDownloadable Forms