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Downloadable Forms

The following forms are required to be completed prior to move in.
Please contact (310) 422 – 5364 if you have any questions.

Please complete as best you can:

LIC601 ID & Emerg Info

LIC603A Resident Appraisal

LIC603 Pre Placement Appraisal

RR2 Resident ID & Emergency Info

Billing Information Sheet

Please review and sign:

LIC605A Release of Resident Medical Records

LIC613 Personal Rights

LIC621 Property Inventory

LIC627C Consent for Medical Treatment

LIC622 Centrally Stored Medication

LIC405 Cash Records

LIC9158 Telecommunications Device Form

Your Right to Make Decisions

Please give to the resident’s doctor to complete:

LIC602A Physician Report