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Physician Attestation of Consumer CapacityThe following member is interested in participating in InHome Support Services (IHSS). To qualify for IHSS, the members primary care physician shall attest
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How to fill out ihss physician attestation of
How to fill out ihss physician attestation of
01
Obtain the IHSS Physician Attestation of Form from your IHSS social worker or county health department.
02
Fill out the patient's information including name, date of birth, and Medi-Cal ID number.
03
Have the physician fill out their information including name, address, phone number, and license number.
04
The physician must also provide their professional opinion on the patient's ability to perform Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs).
05
Make sure both the patient and physician sign and date the form before submitting it to the IHSS office.
Who needs ihss physician attestation of?
01
Individuals who are applying for or already receiving In-Home Supportive Services (IHSS) benefits.
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What is ihss physician attestation of?
IHSS physician attestation verifies the medical need for In-Home Supportive Services (IHSS) benefits.
Who is required to file ihss physician attestation of?
The IHSS recipient or their authorized representative is required to file the physician attestation.
How to fill out ihss physician attestation of?
The IHSS physician attestation form can be filled out by the recipient's physician, providing relevant medical information.
What is the purpose of ihss physician attestation of?
The purpose of the IHSS physician attestation is to verify the recipient's medical need for assistance with daily activities.
What information must be reported on ihss physician attestation of?
The physician must report the recipient's medical condition, functional limitations, and need for supportive services.
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