Fillable FORM SOC 873


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What is SOC 873 Form?

IHSS SOC 873 is known as In-Home Supportive Services Program Health Care Certification Form. This document can be used by the person who needs services from the IHSS program. The form has to prove to the state of California that the person that requires the services of health care can’t perform specific activities independently and needs the help of a professional health care employee.

The services have to be provided by professionals certified by the state. The person must have a license to do it. The health care certification SOC 873 has the intention to prove that without the health care requested by the citizen from the IHSS program, this person would risk getting placed in out of home care.

The worker from IHSS has to evaluate this individual who applied for the services and agreed on the condition. This form usually comes attached to other documents required by IHSS that proves the health situation of the applicant and the need to use the IHSS program. There must be proof that without this help the person will be in out-of-home care.

Form SOC 873 on PDFLiner

What I need the SOC 873 Form for?

  • An IHSS health care certification form SOC 873 is widely used by people who can’t take care of themselves and require extra help from healthcare workers. This form is a request to the IHSS of California to provide care of a person who needs help from the outside;
  • Professional health workers can use SOC 873 medical certification form to justify their actions and the need to take care of the applicant. If they need to take part in the IHSS program health care workers have to make sure that the applicant matches basic demands of this program;
  • The Health and Human Services Agency needs the form to check the applicant and make sure that there is no other way in the situation.

How to Fill Out SOC 873 Form?

You will find SOC 873 form here on PDFLiner. You can get it free of charge. The form is available to download, but you can always fill it out online and send it to the other party via email. The form is two pages long. It contains a detailed description from the State of California Health and Human Services Agency.

You have to read the information before you begin to fill in anything. Once you complete it, send it to the respondent. You can print the form and hand it in if you want. Here is what you need to include in IHSS form SOC 873:

  1. Provide detailed information on the applicant, including the name, address, date of birth, country, name of the IHSS worker, phone, number of the case, and fax;
  2. Write down your name, put the signature, and the date in the authorization to release health care information section. Ask the witness to put the signature and the current date near your signature;
  3. Leave the section on health care information to be filled by a licensed healthcare professional.

Organizations that work with SOC 873 Form

  • State of California Health and Human Services Agency.

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Fillable online FORM SOC 873
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