Designation receiver form 2025

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The document outlines the process for a victim to designate a health care provider or HIV counseling and testing site to receive and disclose the results of a court-ordered HIV/AIDS test performed on a child. It includes instructions for both the victim and the court clerk, consent for information release, and the option for the victim to withdraw consent at any time. The document emphasizes confidentiality protections and potential costs associated with obtaining test results.

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Versions	Form popularity	Fillable & printable
2010	4.8 Satisfied (143 Votes)

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What is a SOC 839 form?

This form allows you, as the IHSS applicant/recipient or their legal representative, to choose an Authorized Representative for the IHSS program. An Authorized Representative is responsible for acting on the behalf of the IHSS recipient for purposes of the IHSS program. This form is only for the IHSS program.

What disqualifies you from being an IHSS provider?

Under the law, you are ineligible to work in the IHSS program ONLY if you have been convicted within the last 10 years of: 1) fraud against a government health care or supportive services program; 2) child abuse; or 3) abuse of an elder or dependent adult.

What is an SOC 295 form for?

Fill out SOC 295 Application for In-Home Supportive Services. The form is available in three languages. Submit the application to your county IHSS office.

What is receivers designation in letter?

This information appears on the left margin below the senders address. It includes the name and mailing address of the intended recipient. It essentially tells the recipient that you know him/her, helping create a personalized connection. You should also include the title or degrees that the recipient holds.

Who fills out the IHSS form?

You (or your authorized representative) must complete PART A of this form to let the county know who you have chosen to provide your authorized services. If you have multiple providers, you must fill out a separate form for each person who will be providing authorized services for you.

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How do I get a SOC 426 form?

Get a blank copy of the SOC 426 from the County IHSS Office or Public Authority. Read the information carefully before you complete the form. Complete the SOC 426 form and answer all questions completely and truthfully.

Designation receiver form 2025

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What is a SOC 839 form?

What disqualifies you from being an IHSS provider?

What is an SOC 295 form for?

What is receivers designation in letter?

Who fills out the IHSS form?

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How do I get a SOC 426 form?

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