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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES IN-HOME SUPPORTIVE SERVICES (IHSS) PROGRAM NOTICE TO APPLICANT OF HEALTH CARE CERTIFICATION REQUIREMENT.

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How to fill out the Soc 874 online

Filling out the Soc 874 form is an essential step in applying for the In-Home Supportive Services (IHSS) program. This guide provides a clear and comprehensive approach to complete the form accurately and efficiently online.

Follow the steps to fill out the Soc 874 online.

  1. Click the ‘Get Form’ button to obtain the Soc 874 form and open it in your preferred online editor.
  2. Begin by entering your personal information in the designated fields. This may include your name, address, and contact information. Ensure that all details are accurate and up-to-date.
  3. Provide information regarding your licensed health care professional (LHCP). Fill out the fields related to their name, title, and contact details. This section is crucial, as the LHCP will need to complete the health care certification.
  4. Next, indicate your difficulties with activities of daily living (ADLs). Clearly state which ADLs you are unable to perform on your own, such as eating, bathing, dressing, or walking.
  5. If applicable, detail any additional conditions or circumstances that necessitate in-home supportive services. This information helps to provide a comprehensive picture of your needs.
  6. Review your completed form for accuracy. Check for any missing information or errors that could delay the application process.
  7. Once you are satisfied with your entries, save the changes to your form. You will have options to download, print, or share the Soc 874 as needed to submit it to the appropriate county office.

Take the next step in your IHSS application by completing the Soc 874 online today.

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Generally, misdemeanor crimes involving violence or threats of violence would disqualify a person from being an IHSS provider. Minor infractions, such as traffic violations, would not disqualify a person from being an IHSS provider. 10. WHAT HAPPENS IF I'M CONVICTED OF A CRIME AFTER I'M ENROLLED AS AN IHSS PROVIDER?

You must have a physician or other licensed health care professional fill out a Health Care Certification (SOC 873) form and you must return it to the county before care services can be authorized. You will be notified if your application for IHSS has been approved or denied.

To be eligible, you must be 65 year of age and over, or disabled, or blind. Disabled children are also potentially eligible for IHSS. IHSS is considered an alternative to out-of-home care, such as nursing homes or board and care facilities.

NOTICE TO APPLICANT OF HEALTH CARE CERTIFICATION REQUIREMENT.

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