When Physician Recommendations Conflict with the LIC 602A Form

Understanding the LIC 602A Form	Explains the form’s purpose, use, and who completes it in California RCFEs.
Why Conflicts Occur	Discusses reasons for discrepancies between a doctor’s recommendation and the form.
How to Handle the Situation	Outlines practical steps for resolving conflicts and updating documentation.
When the Doctor’s View Prevails	Describes cases where the physician’s recommendation takes precedence under regulations.
Preventing Future Disputes	Shares proactive strategies to avoid conflicts through regular reassessment and communication.
Real-World Scenarios	Provides real examples of short-term recovery, cognitive decline, and temporary bedrest cases.
Key Takeaways & Next Steps	Summarizes main points and offers guidance for administrators on keeping LIC 602A forms current.

Conflicts between a doctor’s medical recommendation and a California LIC 602A form happen more often than many facilities expect. The form may show one reality, while a physician’s new exam shows another. When that happens, the updated medical judgment usually leads — but only if the facility’s license still fits the resident’s actual care level.

Understanding What the LIC 602A Is For

Purpose and Use

The LIC 602A, officially Medical Assessment for Residential Care Facilities for the Elderly, comes from the California Department of Social Services (CDSS). Each RCFE must use it to confirm that a resident’s needs fit within non-medical supervision.

Quick Fact: The LIC 602A is not a care plan. It’s an admission and retention tool that tells whether a facility is legally allowed to care for a person based on their current medical status.

Who Completes It

Only a licensed provider (MD, DO, NP, or PA) may fill out the form. They include diagnoses, medications, TB results, mobility, and cognitive findings. Everything recorded helps the facility decide whether it can keep or must transfer a resident.

Why Conflicts Occur

Timing and Change

Health changes quickly. A form completed months ago may no longer reflect reality. When the doctor writes a new recommendation, the older 602A can suddenly contradict it.

Different Priorities

Doctors want to maintain well-being. Facilities must follow licensing rules. Even with good intentions, their goals don’t always match.

Example of Conflict: A doctor recommends that Mrs. B. stay at her RCFE after a hospital visit, but her form still lists “nonambulatory.” Without proper fire clearance, the facility cannot legally retain her.

State Restrictions

Under Title 22, certain conditions fall outside RCFE authority:

• Bedridden for more than 14 days without a clear plan.

• Advanced pressure injuries (stage 3 or 4).

• Active tuberculosis or total dependence in ADLs.

These rules aren’t optional; they protect residents and staff.

How to Handle the Situation

Step 1 — Verify the Doctor’s Findings

Check how recent the recommendation is. Sometimes the form just needs updating.

Step 2 — Update the Form

If the resident’s condition changed, the physician should issue a new LIC 602A or an addendum. Keeping paperwork current avoids future confusion.

Step 3 — Check Facility Scope

Even if a doctor supports continued placement, the facility must confirm it can meet the resident’s needs without violating its license.

Step 4 — Document Everything

Write down the doctor’s opinion, family discussion, and final decision. Accurate notes prove that the RCFE acted in good faith and within the law.

When the Doctor’s View Prevails

Conditions for Acceptance

If the physician’s update is recent, specific, and the resident still fits RCFE criteria, the recommendation guides care. That is especially true after short-term rehabilitation or temporary illness.

When Regulations Override

When care needs shift to skilled nursing—such as IV therapy or constant medical monitoring—the law takes precedence. Facilities must follow licensing limits even if the doctor and family prefer otherwise.

Preventing Future Disputes

Routine Reviews

Most administrators schedule 602A updates every six months or after hospitalization. It keeps paperwork accurate and avoids surprises during inspections.

Staff Training

Employees should recognize red flags: new weakness, increased confusion, or dependence in ADLs. Reporting early allows timely re-evaluation.

Family Transparency

Early calls to families reduce tension. Explaining why the update is required builds trust and prevents appeals later.

Practical Tip for Administrators: Keep a simple spreadsheet listing each resident’s LIC 602A date, doctor’s name, and next review deadline. Color-code rows for quick visual tracking. It takes five minutes to update and saves hours during audits.

Comparison Table

Aspect	Description
LIC 602A Purpose	Determines whether a resident’s medical status fits the RCFE’s non-medical license.
Physician Recommendation	Reflects the doctor’s current evaluation and may override older form data if within scope.
Conflict Resolution	Update the form, verify facility capability, and document the decision process clearly.
Legal Limits	State laws override both facility and physician opinions when safety is at stake.

Real-World Scenarios

Short-Term Recovery

After a fall, Mr. R. needs help walking for two weeks. The doctor updates the form to note temporary assistance. The RCFE keeps him with extra monitoring.

Progressive Decline

Mrs. H. develops advanced dementia and needs help in every ADL. The updated 602A shows full dependency, so the facility coordinates transfer to memory care.

Temporary Bedrest

A resident recovers from infection and remains bedridden for 10 days. The physician documents this clearly and schedules review. Because it’s short-term, the resident can stay.

Key Takeaways

• The LIC 602A defines who qualifies for RCFE care.

• A doctor’s recent recommendation usually leads the plan if within license limits.

• State rules set the final boundary for safety and compliance.

• Updating the form and communicating openly prevents appeals and disputes.

Next Steps

Administrators should review every resident file this month. If any form is outdated or the resident’s health has changed, request a fresh evaluation immediately.

Timely updates keep records accurate and protect everyone involved — the resident, the doctor, and the facility.

Sources

• California Department of Social Services (CDSS) — Physician’s Report for Residential Care Facilities for the Elderly (LIC 602A)

• California Code of Regulations, Title 22 — Sections 87455–87458: Admission, Retention, and Termination Procedures for RCFEs

• California Department of Public Health (CDPH) — Tuberculosis Screening Guidelines for Assisted Living Residents

• Office of Administrative Hearings and Appeals (OAHA) — Transfer and Discharge Appeal Process for RCFE Residents

• Home-Based Medicine — What Is the 602A Form in California?

• Synkwise Regulatory Blog — California Assisted Living Compliance Guide

• New West Haven RCFE — Sample LIC 602A Medical Assessment Form