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FORM SOC 873
This health care certification form must be completed and returned to the. IHSS worker listed above. The IHSS worker will use the information provided to
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I-9, Employment Eligibility Verification
Apr 2, 2025 Note that this form view is NOT fillable. Select the Upload button, then choose a PDF filler application on your device to open a fillable form.
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Santa Clara Family Health Plan Medi-Cal Member Handbook
For routine or preventive health care, you would need to use the SCFHP regular network of providers located in the head of the households county of residence.
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