Get Ca Pasc Homecare Registry Application Form For Consumers 2018-2026

Filling out the CA PASC Homecare Registry Application Form is an essential step for users seeking homecare services through the registry. This guide will walk you through each section of the form, ensuring you have the information needed to complete it accurately and confidently.

Follow the steps to successfully fill out the application form.

1. Press the ‘Get Form’ button to retrieve the application form and open it in your browser.
2. Begin by entering your first name, last name, and middle initial in their respective fields. Provide your IHSS case number, social worker's name, and contact information including home phone, cell phone, and email address.
3. Supply your home address, including any apartment number, city, state, and ZIP code. Indicate your gender by selecting the appropriate option.
4. Optionally, you can provide your date of birth and race/ethnic group for statistical purposes. List any languages you speak, including sign language if applicable.
5. List emergency contacts by providing their names and phone numbers. This information is critical for health-related emergencies.
6. Indicate if you are authorized to receive paramedical services. If yes, ensure your IHSS provider is trained to assist you with these services.
7. Specify your preferences regarding the gender of potential caregivers and whether you require assistance with lifting. Mention if you have a Hoyer Lift.
8. Select your preference regarding the sharing of your information with applicants for referrals and indicate whether you require fragrance-free providers.
9. State whether you have pets at home and if you live near public transportation. Indicate if you maintain a smoke-free environment.
10. If you are seeking a provider immediately, select 'Yes' or 'No.' If 'No,' your application will be held for future needs. Confirm the truthfulness of your application by signing and dating where indicated.
11. If someone assisted you in completing the form, provide their name and phone number.
12. Save your changes, download, print, or share the completed form as needed.

Take the next step in obtaining your homecare services by completing the application form online today.