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  • FORM SOC 873 - California Dept. of Social Services
    The IHSS worker has the responsibility for authorizing services and service hours The information provided in this form will be considered as one factor of the need for services, and all relevant documentation will be considered in making the IHSS determination
  • IN-HOME SUPPORTIVE SERVICES (IHSS) PROGRAM
    IN-HOME SUPPORTIVE SERVICES (IHSS) PROGRAM HEALTH CARE CERTIFICATION FORM S ic ow ta 8 Indicate the date you last provided services to this individual: ____ ____ ____ NOTE: THE IHSS WORKER MAY CONTACT YOU FOR ADDITIONAL INFORMATION OR TO CLARIFY THE RESPONSES YOU PROVIDED ABOVE
  • Recipient Forms - Department of Public Social Services
    If you need assistance completing any of these forms, please contact the IHSS Helpline at (888) 822-9622 You have the right to interpreter services provided by the County at no cost to you
  • Form SOC873 In-home Supportive Services (Ihss) Program Health Care . . .
    The latest version of the form was issued by the California Department of Social Services on February 1, 2023 , with all previous editions obsolete Form SOC 873 fillable version is available for download below
  • Become an IHSS Recipient - SFHSA. org
    Provide health care certification Form SOC 873, completed by a licensed health care professional, showing your need for services NOTE: The completed Form SOC 873 must be returned within 45 days of your application
  • In-Home Supportive Services (IHSS) Program Health Care . . . - Formalu
    Download In-Home Supportive Services (IHSS) Program Health Care Certification Form (SOC 873) – Department of Social Services (California) form
  • SOC873. pdf - San Mateo County Health
    The IHSS worker has the responsibility for authorizing services and service hours The information provided in this form will be considered as one factor of the need for services, and all relevant documentation will be considered in making the IHSS determination
  • In Home Supportive Services
    You must submit a completed Health Care Certification form A county social worker will interview you at your home to determine your eligibility and need for IHSS
  • IHSS - sjchsa. org
    Anyone who recognizes a person is in need of in-home assistance may make a referral to IHSS You can complete the application process by downloading, completing and submitting the forms below or you can call 209-468-1119 and we can assist you with the application process





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