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TO: Dear Doctor: This patient has applied for In-Home Supportive Services (IHSS) and stated that he/she needs certain paramedical services in order for him/her to remain at home. You are asked to indicate on this form what specific services are needed and what specific condition necessitates the services. In-Home Supportive Services is authorized to fund the provision of paramedical services, if you order them for this patient. For the purpose of this program, paramedical services are activiti.

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How to fill out the Soc 321 online

This guide provides detailed instructions on how to effectively complete the Soc 321 form online. The Soc 321 is a request for order and consent for paramedical services essential for individuals applying for In-Home Supportive Services.

Follow the steps to complete the Soc 321 form thoroughly.

  1. Click the ‘Get Form’ button to obtain the Soc 321 form and open it in the online editor.
  2. Fill in the patient's name and Medi-Cal identification number at the top of the form. Ensure that the information provided is accurate and clearly written.
  3. In the section addressed to the doctor, you may leave a message for the medical professional indicating what specific paramedical services are being requested.
  4. Check either 'YES' or 'NO' to indicate whether the patient has a medical condition that necessitates IHSS paramedical services. If 'YES', provide details of the conditions in the designated area.
  5. List the paramedical services needed by the patient. Fill in the type of service, the time required for each service, the frequency of service, and the time period for which these services should be provided.
  6. Certify the information by entering the name, title, and contact information of the licensed professional completing the form. Ensure accuracy and completeness in these details.
  7. Sign and date the form in the certification section to verify that the services ordered are necessary.
  8. Obtain the patient's informed consent by having them sign and date the specified section. Ensure they understand the risks associated with the provision of the services.
  9. Final review: Go over all filled-out sections to ensure that no information is missing, and all details are correct.
  10. Once completed, save changes to the form. You can also download, print, or share the completed Soc 321 form as needed.

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ELIGIBILITY & CASE MANAGEMENT The In-Home Supportive Services (IHSS) authorized representative process is intended to ensure that IHSS recipients with cognitive impairments have the assistance needed to secure services from the IHSS program, allowing them to remain safely in their own homes.

SOC 839 - In-Home Supportive Services Designation of Authorized Representative.

The In-Home Supportive Services (IHSS) is California's largest in-home care program. The IHSS program helps low-income individuals with disabilities, including older adults, remain safely in their own homes. IHSS does this by paying someone chosen by the individual with a disability to provide the needed help.

Currently, the application process can be confusing, and at present only 10% of eligible families get approved for IHSS. Of those who do get approved, it can take anywhere from two weeks to several months to finally receive benefits.

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.

Effective April 2023 – March 2024, the monthly income limit for the IHSS program for a single applicant is $1,677. When both spouses are applicants, there is a couple income limit of $2,269 / month.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Help Portal
Legal Resources
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232