602-A Physician Report Form

When a loved one is moving into an Assisted Living Facility, Board and Care, Memory Care or other Living Community, California requires the 602A Physician Report Form ( Medical Assessment For Residential Care Facilities For The Elderly).

This form documents medical history, diagnoses, medications, functional abilities, and special care needs. It helps facilities ensure your loved one receives safe, appropriate care. We understand the form is time sensitive and At Home Based Medicine, we make this process as simple and stress-free as possible for patients and families.

We provide telehealth (virtual video) appointments with a licensed physician who can complete the 602A form after meeting the patient and reviewing their medical history.

✓ Telehealth Convenience – Appointments via Zoom (approximately 20–40 minutes)

✓ Form Completion – The 602A is filled out during the visit and returned the same or the next day (once all required information is available)

✓ Payment Options

— Insurance – No additional fee for telehealth or form completion. We will establish care, review and reconcile medications, assess function and make additional recommendations and follow up based on the evaluation. Insurance may or may not cover the visit, in that case, the self-pay option is available.

 — Self-Pay Option (if not covered by insurance)– $299 flat fee includes the appointment and form completion.

✓ Medical Record Review – We can access most records once a chart is created, we may ask you for copies if we are unable to find electronic health records

✓ Fast Turnaround – Most families receive completed forms within hours after the appointment

Frequently Asked Questions

At Home Based Medicine, we understand how stressful care transitions can be. Our goal is to make the 602A process fast, reliable, and compassionate, so you can focus on what matters most—supporting your loved one.

💬 I need more details about how to get started

Paperwork Fill out the Telehealth Intake Forms online and send us any supporting documents.

Request Appointment: Call/text 650-360-9309 or email or request a telehealth appointment on line. 

Meet with our physician via Zoom. Your loved one should be present so the doctor can complete the exam portion and see the patient face to face.

💬 How fast can the form be completed?
Most forms are completed and returned within 24 hours of the appointment, provided all required information is available.

💬 What if the TB test is pending?
We can proceed with the appointment and complete most of the form. The TB section will be finalized once results are available.

If a Tuberculosis (TB) screening skin test is needed then we may need to schedule an in-person visit.

💬 Do you accept insurance?
Yes, we accept Medicare part B and most Commercial insurances. Call your insurance to find out if Telehealth is covered for you. If it is not covered or is denied, 602A form completion is a self-pay service ($299), and we accept insurance for ongoing primary care or palliative care services if patients choose to establish care.

MEDICAL ASSESSMENT FOR RESIDENTIAL CARE FACILITIES FOR THE ELDERLY

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