The Role of Nurse and Physician Assistants in Completing LIC 602A
The LIC 602A form determines whether a person can safely move into a Residential Care Facility for the Elderly (RCFE). It reviews medical history, current diagnoses, medications, functional status, cognition, and safety considerations. Because this assessment is clinical in nature, the professional signing the form must be legally authorized to evaluate a patient’s health. Today, Nurse Practitioners (NPs) and Physician Assistants (PAs) play an essential and expanding role in this process.
Why LIC 602A Matters
LIC 602A protects both the resident and the facility. RCFEs provide non-medical care, meaning they help with daily living, mobility, grooming, supervision, and support—not skilled nursing services.
To ensure a resident’s needs match what the facility can legally provide, the evaluation must address:
Current diagnoses and treatment history
Functional status and mobility
Cognitive and behavioral health
Medication list and allergies
TB screening results
Any risks affecting safety and daily care
If the evaluation shows that a resident requires a level of medical support beyond RCFE limits, admission is not appropriate.
| Section of LIC 602A | What Must Be Documented |
|---|---|
| Medical History | Diagnoses, surgeries, chronic conditions, relevant past events. |
| Medications | Full list with dosages, timing, allergies, and medication management needs. |
| Functional Status | Mobility, transfers, ADLs, fall risk, assistance needs. |
| Cognitive & Behavioral Health | Orientation, memory, mood, behavior patterns, safety risks. |
| Tuberculosis Screening | Valid TB test results and required follow-up documentation. |
| Special Instructions | Diet, restrictions, equipment needs, monitoring requirements. |
Why NPs and PAs Are Permitted to Sign LIC 602A
Earlier versions of the form referenced only physicians. The latest version (4/25) now uses the broader term “Licensed Medical Professional,” which includes NPs and PAs. This update reflects modern clinical practice, where these clinicians routinely perform physical exams, assess health conditions, evaluate cognition, and manage medications.
NP Authority
NPs may complete and sign LIC 602A when they:
Work under Standardized Procedures that allow RCFE-related evaluations
Hold independent 104 NP status under AB 890
Both models permit NPs to perform all assessments required by the form.
PA Authority
PAs may sign LIC 602A when:
Their Practice Agreement includes authority to perform RCFE evaluations
A supervising physician is electronically available during the assessment
Their authority is directly tied to what is delegated within the agreement.
| Clinician Type | Authority to Sign LIC 602A |
|---|---|
| Physician (MD/DO) | Fully authorized to complete and sign the form without additional conditions. |
| NP (Non-Independent) | May sign if Standardized Procedures explicitly allow RCFE evaluations. |
| NP (Independent 104 NP) | May independently perform all assessments required for LIC 602A. |
| Physician Assistant | May sign if the Practice Agreement includes RCFE evaluations and supervising physician is electronically available. |
How the LIC 602A Form Aligns With NP and PA Competencies
The tasks required in LIC 602A align closely with primary care and geriatric practice, making NPs and PAs well-suited for this role.
Functional Status Assessment
Assessing functional status is central to determining whether a resident can safely live in an RCFE. NPs and PAs observe how a person moves, transfers, eats, dresses, and manages daily tasks. These observations reveal important details about fall risk, safety needs, and the level of support required. A clear and accurate functional evaluation ensures the resident receives the right assistance from day one.
Medical and Physical Evaluation
NPs and PAs routinely review medical histories, identify current diagnoses, conduct physical exams, and evaluate treatment plans. These skills directly match the clinical requirements of LIC 602A. By documenting conditions such as diabetes, heart disease, mobility disorders, or neurological issues, they help the facility understand the resident’s overall health and anticipate necessary care adjustments.
Cognitive and Behavioral Assessment
Cognitive changes can significantly impact safety, medication adherence, decision-making, and behavior. LIC 602A requires documentation of orientation, memory, behavioral symptoms, and mood. NPs and PAs regularly perform these assessments in primary care settings. Their evaluations help the facility plan for wandering risks, nighttime confusion, or support with daily routines, ensuring a safer environment for all residents.
Common Mistakes That Delay RCFE Admission
Even when a clinician is authorized to sign the form, errors can slow or prevent admission. This section helps families and facilities avoid common pitfalls.
Incomplete medication lists, missing dosages, or outdated TB tests are frequent issues. Sometimes cognitive changes or fall history are not fully documented, leaving the facility without key information needed to build a safe care plan. Conflicting data—such as marking a resident as “ambulatory” while also noting they need full assistance—can cause the form to be rejected. Ensuring every section is accurately filled protects the resident and speeds up placement.
When LIC 602A Must Be Updated
LIC 602A is not a one-time document. There are situations when an updated evaluation is required to keep care safe and compliant.
After a hospitalization or major health event, the resident’s needs may change. A new assessment helps confirm whether they can safely return to the RCFE. Reassessment is also necessary if there are new medications, behavioral changes, or significant mobility decline. Keeping the form current ensures the care plan reflects the resident’s true condition.
Practical Examples of NP and PA Involvement
Many families are surprised to learn that an NP or PA may be the one completing the evaluation. In practice, this is extremely common. For example, an NP might perform the evaluation in a clinic when a physician is unavailable. A PA may conduct an in-home assessment for a resident who cannot travel due to mobility issues. After a hospitalization, an NP may review the resident’s condition to determine whether they are ready to return to the facility.
These scenarios are not only common—they help prevent delays. Since NPs and PAs are trained to conduct full clinical evaluations, their involvement often results in faster placement and clearer documentation for the facility.
Family Checklist Before Submitting LIC 602A
Families often feel overwhelmed by the paperwork required for RCFE admission. Preparing in advance makes the process smoother.
It helps to bring a complete medication list with dosages and schedules, as well as TB test results. Notes about recent falls, mobility changes, and memory issues give the clinician a clearer picture of daily functioning. Past hospital discharge summaries, allergy lists, and contact information for treating clinicians can also speed up evaluation. Good preparation minimizes repeat visits and reduces delays in move-in.
The Importance of TB Screening
TB screening is mandatory for all RCFE admissions and one of the most commonly incomplete sections of the form. The clinician must provide results from an approved test, such as a PPD or Quantiferon. If the resident has previously tested positive, proper documentation and follow-up must be included.
TB screening protects residents in a shared living environment. Because TB risk affects the entire community, facilities cannot accept incomplete or estimated results. Ensuring this section is complete helps avoid compliance issues and protects everyone’s safety.
How NPs and PAs Coordinate With Physicians
Although NPs and PAs can sign the form, their collaboration models differ. Independent NPs perform evaluations autonomously within their certified population focus. NPs with Standardized Procedures collaborate with a supervising physician according to a defined clinical framework.
PAs always practice under a physician-supervised agreement. The supervising physician does not need to be physically present, but must be reachable. This structure allows PAs to function efficiently while maintaining the oversight required by California law.
Documents RCFEs Should Keep on File
Proper documentation ensures compliance during inspections or audits. Facilities should keep copies of the clinician’s license, confirmation of their scope of practice, and, if applicable, the NP’s Standardized Procedures or PA’s Practice Agreement.
A complete LIC 602A, TB results, and any supporting notes should also be stored in the resident’s file. These records help demonstrate that the RCFE made an informed and lawful placement decision.
What Can Happen If the Form Is Incorrect
An improperly signed or incomplete LIC 602A can lead to immediate delays. Families may need to schedule another evaluation or repeat testing. If a facility accepts an invalid form, it risks citations for improper placement.
Incorrect information also puts the resident at risk. Underreported mobility issues or cognitive changes may lead to falls or unsafe situations. Because LIC 602A forms the foundation of the care plan, accuracy is essential for safety and compliance.
Why Accurate Functional Assessment Matters
Functional assessments influence room assignments, staffing needs, and supervision levels. NPs and PAs are trained to evaluate gait, balance, transfers, and daily activity patterns. These observations reveal whether the resident needs reminders, standby support, or hands-on assistance.
Accurate documentation helps facilities prepare proper support and prevents situations where a resident receives too little or too much assistance. A clear picture of daily functioning is crucial for delivering consistent care.
Why Cognitive Assessment Is Essential for Safe Placement
Cognitive health affects everything from medication management to safety awareness. The LIC 602A requires clinicians to document orientation, memory, behavioral patterns, and signs of confusion. NPs and PAs routinely perform these assessments and can identify changes that may impact the resident’s well-being.
A thorough cognitive evaluation helps facilities implement proper supervision, nighttime monitoring, or structured activities. This information makes placement safer and helps prevent incidents related to confusion or wandering.
When Reassessment Helps Prevent Problems
A resident’s health can change quickly. After a fall, hospitalization, infection, or behavioral shift, reassessment ensures the care plan still reflects the resident’s needs. Regular updates also help families understand when additional support or a higher level of care may be necessary.
Reassessment protects both safety and compliance, reducing the risk of residents remaining in an environment that no longer fits their health needs.
Conclusion
Nurse Practitioners and Physician Assistants are fully recognized as licensed medical professionals who can complete and sign LIC 602A when acting within their legal scope. Their involvement speeds up admissions, reduces delays for families, and supports accurate, timely evaluations.
For facilities, confirming authorization, reviewing documentation, and keeping forms current ensures safe placement and regulatory compliance. With clear communication and complete evaluations, LIC 602A becomes a reliable foundation for safe, appropriate care in every RCFE.
References
California Department of Social Services (CDSS) — LIC 602A Medical Assessment Form (version 4/25)
California Code of Regulations, Title 22, Division 6 — Section 87458: Medical Assessment Requirements for RCFE
California Board of Registered Nursing (BRN) — Nurse Practitioner Scope of Practice Overview
California Business and Professions Code (BPC) — Sections 2725, 2837, 2837.103, 2837.104 (NP authority and independent practice)
Medical Board of California (MBC) — Physician Assistant Scope of Practice Standards
California Physician Assistant Board (PAB) — Practice Agreement Requirements for PAs
California Legislative Information — AB 890: Nurse Practitioner Independent Practice Act
California Legislative Information — AB 637: POLST Signature Authority for NPs and PAs
California Health & Human Services Agency — POLST (Physician Orders for Life-Sustaining Treatment) Guidelines
Centers for Disease Control and Prevention (CDC) — Tuberculosis Screening and Testing Guidance
CDSS Community Care Licensing Division (CCLD) — RCFE Admission Requirements and Regulatory Guidance
