Soc873 2025

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The document is a Health Care Certification Form for the In-Home Supportive Services (IHSS) program in California. It requires information from both the applicant/recipient and a licensed health care professional to assess eligibility for IHSS services, which assist aged, blind, and disabled individuals in performing daily living activities to prevent out-of-home care placement. The form includes sections for personal information, authorization to release health care information, and specific health care questions that must be answered by a licensed professional.

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Click ‘Get Form’ to open the soc873 in the editor.
Begin by filling out Section A, which includes your name, date of birth, address, IHSS case number, county of residence, and contact details for your IHSS worker.
In Section B, authorize the release of your health care information by printing your name and signing the form. If applicable, a witness should also sign.
Section C must be completed by a licensed health care professional. They will answer questions regarding your ability to perform daily living activities and provide necessary health care information.
Finally, ensure that the licensed health care professional completes their certification in Section D by providing their details and signature before submitting the form back to your IHSS worker.

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Versions	Form popularity	Fillable & printable
2016	4.8 Satisfied (62 Votes)
2011	3.8 Satisfied (30 Votes)
2011	4.3 Satisfied (48 Votes)

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Where do I send my w4 for IHSS Los Angeles County?

IHSS Application 2707 S. Grand Ave. Los Angeles, CA 90007.

What is soc873?

What Is Form SOC 873? 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.

Can my wife be my IHSS provider?

About 22% of IHSS workers are parent or spouse providers, almost exclusively mothers and wives, providing long-term care to spouses or disabled children.

soc 873 form

SOC 873 Spanish Printable IHSS forms for doctor IHSS forms SOC 426A SOC 295 IHSS application for Provider IHSS application form pdf download SOC 874 IHSS SOC 821

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How do I register with IHSS?

How to Become an IHSS Provider Go to an IHSS Provider Orientation given by the county. ... Complete, sign and return the IHSS Program Provider Enrollment Form (SOC 426) directly to the County IHSS Office or IHSS Public Authority. ... Complete and sign the IHSS Provider Enrollment Agreement (SOC 846) .

What is soc426?

A felony offense for fraud against a public social services program, as defined in W&IC sections 10980(c)(2)* and (g)(2)*. A complete listing of Tier 2 crimes is available upon request from the County IHSS Office or IHSS Public Authority. *See attached form SOC 426C for the text of these PC and W&IC sections.

Where do I send my Soc 426?

WHERE DO I RETURN THE SOC 426? After you have completed and signed the SOC 426, you must return it IN PERSON to the county IHSS office or county Public Authority. You will have to show identification (ID) when you return the SOC 426.

Can a family member do IHSS?

Yes. You can hire relatives, friends, neighbors, and other caregivers to provide you with IHSS.

What is a SOC 839 form?

\u2022 This form allows the IHSS applicant/recipient or his/her legal representative to. choose an Authorized Representative for the IHSS program and identifies the functions the Authorized Representative may perform on his/her behalf.

Soc873 2025

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How to use or fill out soc873 with our platform

See more soc873 versions

Complete this form in 5 minutes or less

Got questions?

What is the optimum way to electronically sign my [KEY]?

How do you edit [KEY] from Google Drive?

Where do I send my w4 for IHSS Los Angeles County?

What is soc873?

Can my wife be my IHSS provider?

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How do I register with IHSS?

What is soc426?

Where do I send my Soc 426?

Can a family member do IHSS?

What is a SOC 839 form?

ihss form soc 873

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