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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
    ion will be considered in making the IHSS determination 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
  • 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
  • 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 Call (415) 355-6700 Fax or mail the completed IHSS Referral Form
  • 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
  • SOC 873 (Rev 10-2016) EN - pascla. org
    1, authorize the release of health care information related to my physical and or mental condition to the In-Home Supportive Services program as it (PRINT NAME) pertains to my need for domestic related and personal care services
  • IHSS qualified medical providers | LSNC Regulation Summaries
    County officials may now accept modified SOC 873 forms submitted through electronic medical record systems Examples include discharge papers and other medical documentation that can substantiate a recipient’s need for the IHSS program
  • 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 If denied, you will be notified of the reason for the denial
  • Health Care Certification - Santa Cruz Human Services
    State law (Senate Bill SB 72) requires that all In-Home Supportive Services have an IHSS Program Health Care Certification Form SOC 873 completed by a licensed health care professional Services cannot be authorized prior to the receipt of a completed medical certification form
  • 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





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