Ihss dangerous behavior log 2025

Get Form
ihss protective supervision examples Preview on Page 1

Here's how it works

01. Edit your ihss protective supervision examples online
Type text, add images, blackout confidential details, add comments, highlights and more.
02. Sign it in a few clicks
Draw your signature, type it, upload its image, or use your mobile device as a signature pad.
03. Share your form with others
Send ihss protective supervision form via email, link, or fax. You can also download it, export it or print it out.

How to use or fill out ihss dangerous behavior log with our platform

Form edit decoration
9.5
Ease of Setup
DocHub User Ratings on G2
9.0
Ease of Use
DocHub User Ratings on G2
  1. Click ‘Get Form’ to open the ihss dangerous behavior log in the editor.
  2. Begin by entering the name of the IHSS recipient/applicant and their case number at the top of the form.
  3. Review the list of risky behaviors. For each activity, indicate whether it could occur without supervision by selecting 'Yes' or 'No'.
  4. In the 'Dates of Occurrence' section, provide specific dates if any of these behaviors have been observed.
  5. Add any additional comments that may help clarify the situation or provide context for the behaviors noted.
  6. Complete the declaration section by filling in your county, state, and signing as a declarant. Ensure all personal information is accurate.
  7. If applicable, have a physician complete their certification section, including their signature and medical specialty.

Start using our platform today to easily fill out your ihss dangerous behavior log for free!

See more ihss dangerous behavior log versions

We've got more versions of the ihss dangerous behavior log form. Select the right ihss dangerous behavior log version from the list and start editing it straight away!
Versions Form popularity Fillable & printable
2018 4.6 Satisfied (55 Votes)
be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.
Contact us
The IHSS social worker will request the form SOC 821 Assessment of Need. for Protective Supervision for In-Home Supportive Services Program be. completed by the recipients physician or other appropriate medical professional. to docHub the need for Protective Supervision and returned to the county.
After you submit your application for protective supervision, your county IHSS office will contact you to schedule an assessment. Generally, the county must process your application and mail you a notice of action within 30 days from when you completed the application.
Non-self-direction is defined as an inability, due to a mental impairment/mental illness, for individuals to assess danger and the risk of harm, and therefore, the individuals would most likely engage in potentially dangerous activities that may cause self-harm.
Examples of self-directed supports include, but are not limited to: information regarding how a self-directed care program works; individual rights and responsibilities; and available resources; counseling; training; assistance, such as the use of a supports broker/consultant and financial management services (FMS);
Self-directed behavior strategies are those that students use to monitor and regulate their own behavior. The teacher plays a role in guiding students in selecting and establishing appropriate self-directed strategies, but it is the students themselves who actually implement the strategies.

People also ask

This can include anything beyond a verbalization or thought, such as assembling a method (e.g., buying a gun, collecting pills) or preparing for ones death by suicide (e.g., writing a suicide note, giving things away).

ihss protective supervision form pdf