[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-1-en-105":3,"doc-seo-382300-105":53,"doc-detail-382300-en":127},{"code":4,"msg":5,"data":6},0,"success",[7,14,19,24,29,34,39,44,49],{"id":8,"doc_module":9,"doc_module_name":10,"category_name":11,"show_sort_weight":12,"slug":13},11,1,"Template","Presentations",90,"presentations",{"id":15,"doc_module":9,"doc_module_name":10,"category_name":16,"show_sort_weight":17,"slug":18},12,"Resumes",80,"resumes",{"id":20,"doc_module":9,"doc_module_name":10,"category_name":21,"show_sort_weight":22,"slug":23},14,"Invoices",70,"invoices",{"id":25,"doc_module":9,"doc_module_name":10,"category_name":26,"show_sort_weight":27,"slug":28},15,"Posters",60,"posters",{"id":30,"doc_module":9,"doc_module_name":10,"category_name":31,"show_sort_weight":32,"slug":33},16,"Social Media",50,"social-media",{"id":35,"doc_module":9,"doc_module_name":10,"category_name":36,"show_sort_weight":37,"slug":38},17,"Forms",40,"forms",{"id":40,"doc_module":9,"doc_module_name":10,"category_name":41,"show_sort_weight":42,"slug":43},18,"Letters",30,"letters",{"id":45,"doc_module":9,"doc_module_name":10,"category_name":46,"show_sort_weight":47,"slug":48},21,"Paper Templates",5,"papers-templates",{"id":50,"doc_module":9,"doc_module_name":10,"category_name":51,"show_sort_weight":4,"slug":52},158,"General","general-158",{"code":4,"msg":54,"data":55},"ok",{"site_id":56,"language":57,"slug":58,"title":59,"keywords":60,"description":61,"schema_data":62,"social_meta":120,"head_meta":122,"extra_data":124,"updated_unix":126},105,"en","lic-601-identification-and-emergency-information","LIC 601 - Identification and Emergency Information","","Identification and Emergency Information form required for individuals admitted to a California community care facility. It mandates current, accessible-to-charge-holder details while restricting access for unauthorized persons. The form collects client and facility resident identification data, responsible persons and legal guardians, emergency contacts, and a hospitalization plan. It also includes medical, dental, ambulatory status, religious preference, visit or custody-related details for children’s residential facilities, and required signatures and dates.",{"@graph":63,"@context":119},[64,80,102],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":36,"@type":70,"position":76},"https://docshare.wps.com/template/forms/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/lic-601-identification-and-emergency-information/382300/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/lic-601-identification-and-emergency-information/382300.png","ImageObject",442,249,{"name":88,"@type":89},"Jordan Avery","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-19","2026-09-24",true,{"@type":98,"interactionType":99,"userInteractionCount":101},"InteractionCounter",{"@type":100},"ViewAction",7,{"@type":103,"mainEntity":104},"FAQPage",[105,111,115],{"name":106,"@type":107,"acceptedAnswer":108},"Who is LIC 601 required for in California community care facilities?","Question",{"text":109,"@type":110},"It is required for every person admitted to a community care facility, with information to be readily available to the person in charge and kept current.","Answer",{"name":112,"@type":107,"acceptedAnswer":113},"What information does LIC 601 collect for emergency situations?",{"text":114,"@type":110},"It records emergency contacts, an emergency hospitalization plan, and relevant medical and dental plan information, along with other required details and comments.",{"name":116,"@type":107,"acceptedAnswer":117},"What additional sections are included for residential facilities for children?",{"text":118,"@type":110},"It adds child-specific information such as names and contacts, court status and living arrangements, visitation restrictions, authorized persons to remove the child, telephone access rules, and related comments.","https://schema.org",{"og:url":78,"og:type":121,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":123,"canonical":78},"index,follow",{"doc_id":125,"site_id":56},382300,1791238758,{"code":4,"msg":5,"data":128},{"doc_id":125,"user_id":129,"nickname":88,"user_avatar":130,"doc_module":9,"category_id":35,"category_name":36,"doc_title":59,"doc_description":61,"doc_content":131,"file_id":132,"file_url":133,"file_type":134,"file_size":135,"view_count":101,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":73,"language":136,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":137,"faqs":138,"seo_title":139,"seo_description":61,"update_tm":140,"read_time":9},1099523882367,"https://ap-avatar.wpscdn.com/davatar_9964176cb1d06d4a9deccf72a44ae3dc","STATE OF CALIFORNIA CALIFORNIA DEPARTMENT OF SOCIAL SERVICES  \nHEALTH AND HUMAN SERVICES AGENCY COMMUNITY CARE LICENSING DIVISION  \nIDENTIFICATION AND  \nEMERGENCY INFORMATION  \nThis information is required under the H & S Code and the regulations of the Department to be maintained on every person admitted to a community care facility, to be readily available to the person in charge, but not accessible to unauthorized persons. All information must be kept current. See other side for additional information required for residential facilities for children.  \nA. ALL FACILITIES [EXCEPT CHILD CARE CENTER/FAMILY CHILD CARE HOME COMPLETES LIC 700]  \n\n| 1. NAME OF CLIENT OR CHILD |  | SOCIAL SECURITY NUMBER (OPTIONAL) | DATE OF BIRTH | AGE | SEX |\n| --- | --- | --- | --- | --- | --- |\n| 2. RESPONSIBLE PERSON OR PLACEMENT AGENCY |  | ADDRESS |  | TELEPHONE\u003Cbr>( ) |  |\n| 3. NAME OF NEAREST RELATIVE (OPTIONAL) | RELATIONSHIP | ADDRESS |  | TELEPHONE\u003Cbr>( ) |  |\n| 4. DATE ADMITTED TO FACILITY | ADDRESS PRIOR TO ADMISSION |  |  |  |  |\n| 5. DATE LEFT | FORWARDING ADDRESS |  |  |  |  |\n\n6. REASONS FOR LEAVING FACILITY  \n7. PERSON(S) RESPONSIBLE FOR FINANCIAL AFFAIRS, PAYMENT FOR CARE, LEGAL GUARDIAN, IF ANY  \n\n| NAME | ADDRESS | TELEPHONE |\n| --- | --- | --- |\n|  |  | ( ) |\n|  |  | ( ) |\n|  |  | ( ) |\n\n8. OTHER PERSONS TO BE NOTIFIED IN EMERGENCY  \n\n| NAME | ADDRESS | TELEPHONE |\n| --- | --- | --- |\n| a. PHYSICIAN |  | ( ) |\n| b. MENTAL HEALTH PROVIDER, IF ANY |  | ( ) |\n| c. DENTIST |  | ( ) |\n| d. RELATIVE(S) |  | ( ) |\n| e. FRIEND(S) |  | ( ) |\n\n9. EMERGENCY HOSPITALIZATION PLAN  \n\n| NAME OF HOSPITAL TO BE TAKEN IN AN EMERGENCY | ADDRESS OF HOSPITAL TO BE TAKEN IN AN EMERGENCY |\n| --- | --- |\n| MEDICAL PLAN | MEDICAL PLAN IDENTIFICATION NUMBER |\n| NAME OF DENTAL PLAN (IF ANY) | DENTAL PLAN NUMBER (IF ANY) |\n\n10.  \nOTHER REQUIRED INFORMATION  \na. AMBULATORY STATUS  \n\n| b. RELIGIOUS PREFERENCE | NAME AND ADDRESS OF CLERGYMAN OR RELIGIOUS ADVISOR, IF ANY | TELEPHONE\u003Cbr>( ) |\n| --- | --- | --- |\n\n11. COMMENTS  \n\n| SIGNATURE OF RESIDENT | SIGNATURE OF PERSON COMPLETING FORM | TITLE | DATE |\n| --- | --- | --- | --- |\n\nLIC 601 (8/08) Personal Page 1 of 2  \nB. RESIDENTIAL FACILITIES FOR CHILDREN  \n (Additional information is required by regulation for residential facilities for children.)   \n1. NAME OF CHILD  \n\n| 2. NAME AND ADDRESS OF PERSON TO CONTACT, IF AUTHORIZED REPRESENTATIVE IS NOT AVAILABLE | SPECIFY RELATIONSHIP | TELEPHONE NUMBER ( ) |\n| --- | --- | --- |\n| 3. NAME AND ADDRESS OF PARENT(S)/PARENT’S DOMESTIC PARTNER, IF KNOWN |  | TELEPHONE NUMBER ( ) |\n\n4. CHILD’S COURT STATUS (ATTACH CUSTODY ORDERSAND AGREEMENTS WITH PARENT(S), OR PERSON(S) HAVING LEGAL CUSTODY. NOTE: OPTIONAL FOR SMALL FAMILY AND FOSTER FAMILY HOMES)  \n5. PERSON(S) WITH WHOM CHILD HAS BEEN LIVING (IF KNOWN)  \n\n| NAME AND RELATIONSHIP | ADDRESS | TELEPHONE |\n| --- | --- | --- |\n|  |  | ( ) |\n|  |  | ( ) |\n|  |  | ( ) |\n\n6. VISITATION RESTRICTIONS (BY COURT ORDER OR AUTHORIZED REPRESENTATIVE)  \n\n| PERSON(S) NOT AUTHORIZED TO VISIT CHILD |  | PERSON(S) NOT AUTHORIZED TO VISIT CHILD |  |\n| --- | --- | --- | --- |\n| NAME | RELATIONSHIP | NAME | RELATIONSHIP |\n|  |  |  |  |\n|  |  |  |  |\n|  |  |  |  |\n|  |  |  |  |\n|  |  |  |  |\n\n7.  \nFAMILY RESIDENCE VISITATION RESTRICTIONS  \nSPECIFY, IF ANY  \n8. ALL PERSONS AUTHORIZED TO REMOVE CHILD FROM HOME  \n\n| NAME | RELATIONSHIP | SPECIFY CONDITIONS |\n| --- | --- | --- |\n|  |  |  |\n|  |  |  |\n|  |  |  |\n|  |  |  |\n\n9. TELEPHONE ACCESS  \n\n| MAKE AND RECEIVE CONFIDENTIAL CALLS\u003Cbr>■ YES ■ NO (BY COURT ORDER) | IF NO, SPECIFY RESTRICTIONS |\n| --- | --- |\n|  |  |\n|  |  |\n|  |  |\n\n10. COMMENTS","cbCaicI25KLkVOgF","https://ap.wps.com/l/cbCaicI25KLkVOgF","pdf",74224,"English","# Identification and Emergency Information\n## A. All Facilities (Except Child Care Center/Family Child Care Home completing LIC 700)\n## B. Residential Facilities for Children (Additional required information)","[{\"question\":\"Who is LIC 601 required for in California community care facilities?\",\"answer\":\"It is required for every person admitted to a community care facility, with information to be readily available to the person in charge and kept current.\"},{\"question\":\"What information does LIC 601 collect for emergency situations?\",\"answer\":\"It records emergency contacts, an emergency hospitalization plan, and relevant medical and dental plan information, along with other required details and comments.\"},{\"question\":\"What additional sections are included for residential facilities for children?\",\"answer\":\"It adds child-specific information such as names and contacts, court status and living arrangements, visitation restrictions, authorized persons to remove the child, telephone access rules, and related comments.\"}]","LIC 601 - Identification and Emergency Information | PDF",1790249934]