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Request for order and consent - California Department of Social - cdss ca 2026
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- Click ‘Get Form’ to open it in the editor.
- Begin by entering the patient's name and Medi-Cal identification number at the top of the form.
- In the section addressed to the doctor, clearly indicate what specific paramedical services are needed and describe the condition necessitating these services.
- Complete the fields for the licensed professional's information, including their name, title, office telephone number, and address if not listed above.
- Answer whether the patient has a medical condition requiring IHSS paramedical services by selecting 'YES' or 'NO'. If 'YES', list the conditions below.
- Detail the required paramedical services, including type of service, time required for each performance, frequency, and duration for which these services should be provided.
- Ensure that both the licensed professional and patient sign and date their respective sections to confirm informed consent.
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| Versions | Form popularity | Fillable & printable |
|---|---|---|
| 1999 | 4.5 Satisfied (59 Votes) |
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