California LIC forms
LIC 622: the centrally stored medication and destruction record
Short answer
The LIC 622 Centrally Stored Medication and Destruction Record is the CDSS form a California facility uses to log medications it stores centrally for a resident, and to document the destruction of prescription drugs that are not taken with the resident when services end.
Its own printed instructions carry three rules worth memorising: centrally stored medications must be kept safe and locked away from anyone but authorized people; destruction happens in the facility, performed by the administrator or a designated representative and witnessed by one other adult who is not a resident; and an RCFE keeps its destruction records for at least three years, longer than the one year that applies to other facility types.
What the form actually is
The LIC 622 is published by the California Department of Social Services, Community Care Licensing. It is divided into two numbered parts, and facilities routinely fill in one and forget the other.
Part I — Centrally stored medication
A running log of the medications the facility holds centrally for a resident. The header identifies the resident and the facility — resident name, admission date, attending physician, administrator, facility name and facility number — and each medication gets a row.
Part II — Medication destruction record
The record of prescription drugs destroyed rather than sent with the resident. This is the half that gets skipped, because it only comes up when a resident leaves or a prescription is discontinued — which is exactly when a facility is busy with something else.
What the form's own instructions say
These are the instructions printed on the form itself, which is the most reliable place to read them:
Centrally stored medications shall be kept in a safe and locked place that is not accessible to any person(s) except authorized individuals. Medication records on each client/resident shall be maintained for at least one year.
Prescription drugs not taken with the client/resident upon termination of services or otherwise disposed of shall be destroyed in the facility by the Administrator or Designated Representative and witnessed by one other adult who is not a client/resident. All facilities except Residential Care Facilities for the Elderly (RCFEs) shall retain destruction records for at least one year. RCFEs shall retain records for at least three years.
Two different retention periods, on one form
Read that second instruction carefully, because it trips people up. The one-year retention in Part I applies to medication records generally. The three-year retention in Part II applies to destruction records and applies specifically to RCFEs — every other facility type keeps them one year.
If you run an RCFE and you purge on a one-year cycle, you are destroying destruction records two years early. Retention is a floor, never a ceiling: keeping records longer than required is never the finding.
Every column, and what goes in it
Each medication row on the LIC 622 asks for the same set of facts. In practice these come straight off the pharmacy label, which is why a photo of the label is usually enough to complete a row:
- Medication name
- Strength and quantity
- Instructions
- Control / custody
- Expiration date
- Date filled
- Date started
- Prescribing physician
- Prescription number
- Number of refills
- Name of pharmacy
The destruction half repeats the medication identification and adds the disposal date, the signature of the administrator or designated representative, and the signature of the adult witness who is not a resident.
Who signs, and when
The destruction entry needs two signatures, and they are not interchangeable. The administrator or their designated representative performs and signs for the destruction. A second adult — someone who is not a resident of the facility — witnesses it and signs as the witness.
The most common version of this mistake is a destruction entry signed only by the administrator, or witnessed by a resident because they happened to be in the room. Both leave you with an incomplete record of a controlled event, which is the kind of finding that invites a closer look at everything else.
What CCLD tends to find
- A destruction record with no witness signature, or a witness who is a resident.
- Medications logged in Part I that are no longer in the facility and were never carried through to Part II.
- Rows missing the prescription number, pharmacy, or prescribing physician — the fields that make a medication traceable.
- A centrally stored medication log that doesn't match what is physically in the locked storage.
- Destruction records purged at one year by an RCFE that owed three.
- A LIC 622 that disagrees with the resident's medication administration record about what the resident was actually taking.
Notice that every one of these is a documentation failure rather than a care failure. That is the recurring shape of medication findings in residential care: the medication handling was fine and the paperwork could not prove it.
Where to get the current form
Always download the LIC 622 from CDSS rather than reusing a photocopy of a photocopy — the revision stamp in the form's bottom corner is how you know which version you are holding, and a superseded form is a finding of its own. CDSS publishes the current LIC forms in its forms library.
How CareMAR handles the LIC 622
CareMAR generates the LIC 622 from the resident and medication records already in the system, so the header, the medication rows, and the prescribing details are not retyped — which is where transcription errors come from. The destruction entries and signatures are captured against the same resident record, and the printed output matches the state form.
The form is also protected from casual deletion, because a destruction record you can quietly remove is not much of a record.
Common questions
What is the LIC 622 form used for?
The LIC 622 Centrally Stored Medication and Destruction Record is the CDSS form a California facility uses for two related jobs: logging the medications it stores centrally for a resident, and documenting the destruction of prescription drugs that are not taken with the resident when services end. Both halves are printed on the same form, and facilities commonly complete the first and forget the second.
Who has to witness medication destruction in an RCFE?
The form's own instructions state that prescription drugs are destroyed in the facility by the administrator or a designated representative, witnessed by one other adult who is not a client or resident. That means two signatures on the destruction entry, and the witness cannot be one of your residents.
How long does an RCFE keep the LIC 622?
The form carries two different periods. Its instructions state that medication records on each client or resident are maintained for at least one year, and that all facilities except residential care facilities for the elderly retain destruction records for at least one year — while RCFEs retain those records for at least three years. If you run an RCFE and purge annually, you are destroying destruction records two years early.
What information does each LIC 622 row need?
Each medication row asks for the medication name, strength and quantity, instructions, control or custody, expiration date, date filled, date started, prescribing physician, prescription number, number of refills, and the name of the pharmacy. Most of that is on the pharmacy label. The destruction half repeats the medication identification and adds the disposal date and the two signatures.
Where do I download the current LIC 622?
From the CDSS forms library rather than from a photocopy or a third-party site. The revision stamp printed in the corner of the form tells you which version you are holding, and filing a superseded version is an avoidable finding.
Official sources
Regulations change and this page is a plain-English summary, not the law. Before you act on anything here, read the current text at the agency that issued it.