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Get Ca Soc 873 2011
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How to fill out the CA SOC 873 online
This guide provides comprehensive instructions on how to complete the CA SOC 873, the medical certification form for the In-Home Supportive Services program. It is designed to support all users, regardless of their previous legal or documentation experience.
Follow the steps to effectively complete the CA SOC 873 online.
- Click ‘Get Form’ button to obtain the CA SOC 873 and open it for editing.
- In section A, the county must complete the applicant or recipient information. This includes filling in the applicant/recipient name, date of birth, address, IHSS case number, county of residence, and details of the assigned IHSS worker, including their name, phone number, and fax number.
- Proceed to section B where the applicant or recipient authorizes the release of medical information. The individual must clearly print their name, provide their signature or the signature of a legal guardian/conservator, and include the date. If necessary, a witness must sign and date the form as well.
- Section C must be completed by a licensed health care professional. They should describe the nature of services they provide, the duration of service, and the frequency of contact with the individual. Additionally, they need to indicate the date of last service provided.
- In section C, the health care professional must answer whether the individual is unable to perform daily living activities (question 5) and whether one or more IHSS services are recommended to prevent the need for out-of-home care (question 6). If both questions are answered yes, questions 7 and 8 must be completed.
- For questions 7 and 8, provide detailed descriptions of any physical or mental conditions or functional limitations, and indicate whether these conditions are expected to last more than 12 consecutive months.
- Finally, in section D, the licensed health care professional must certify the information by providing their name, title, address, contact information, license number, and signature. The form must then be returned to the listed social worker.
- Once all sections are complete, users can save their changes, print, or download the form for submission.
Complete the CA SOC 873 online today to ensure timely processing of your In-Home Supportive Services application.
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