Form SOC 873, In-Home Supportive Services (IHSS) Program Health Care Certification Form - also called Form SOC 873 (IHSS) or the IHSS certification form for short - is a medical certification form filled out by a licensed health care professional to enable disabled, blind, or elderly individuals to receive services from the In-Home Supportive Services (IHSS) program. The California IHSS program aids California residents who are at risk of being placed in out-of-home care such as assisted living, board and care facilities, or skilled nursing facilities. It allows people to remain in their homes by providing care services, including but not limited to meal preparation, laundry, shopping for necessities, cleaning, assistance with respiration and feeding, protective supervisions, and paramedical services. To qualify for these services, the Form SOC 873 must be signed by a health care professional and submitted to the IHSS prior to the authorization of services.
The latest version of the form was issued by the California Department of Social Services in October 2016 with all previous editions obsolete. Form SOC 873 fillable version is available for download below.