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- FORM SOC 873 - California Dept. of Social Services
IHSS is a program intended to enable aged, blind, and disabled individuals who are most at risk of being placed in out-of-home care to remain safely in their own home by providing domestic related and personal care services
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D LICENSED HEALTH CARE PROFESSIONAL CERTIFICATION By signing this form, I certify that I am licensed in the State of California and all information provided above is correct SOC 873 (10 16) PLEASE RETURN THIS FORM TO THE IHSS WORKER LISTED ON PAGE 1 PAGE 2 OF 2
- IHSS Recipients - Department of Public Social Services
Applicants may provide the SOC 873 - In-Home Supportive Services Program Health Care Certification Form to certify their need for IHSS
- Form SOC873 In-home Supportive Services (Ihss) Program Health Care . . .
Form SOC 873, In-Home Supportive Services (IHSS) Program Health Care Certification Form , is a medical certification form filled out by a licensed health care professional to enable disabled, blind, or elderly individuals to receive services from the In-Home Supportive Services (IHSS) program
- 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
- SOC 873 - In-Home Supportive Services Program Health Care . . . - Formalu
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- SOC 873 (Rev 10-2016) EN - pascla. org
Services (IHSS) program State law requires that in order for IHSS services to be authorized or continued a licensed health care professional must provide a health care certification declaring the individual above is unable to perform some activity of daily living independently and without IHSS the individual would be at risk of place
- In Home Supportive Services
A completed Health Care Certification (SOC 873) must be received by the county prior to authorization of services You will be notified if IHSS has been approved or denied
- Recipient Forms - Department of Public Social Services
You have the right to interpreter services provided by the County at no cost to you
- In-Home Supportive Services | Solano County, California
Applicants who meet residency requirements and have qualifying Medi-Cal eligibility will be mailed a Health Care Certification (SOC 873) form to take to his her licensed health care provider for completion
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