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A collection of some of the most requested and important special needs forms, waivers, and applications for the State of California.
Health Insurance and Medi-Cal
APPLICATION FOR HEALTH INSURANCE
MEDICAID WAIVER CONSUMER CHOICE OF SERVICES/LIVING ARRANGEMENT STATEMENT
DHCS Forms
WAIVER PERSONAL CARE SERVICES WORKWEEK EXEMPTION FOR WPCS CARE PROVIDERS
APPLICATION TO DETERMINE CCS PROGRAM ELIGIBILITY
REQUEST TO ACCESS PROTECTED HEALTH INFORMATION BY PARENT OR GUARDIAN
IHSS Forms
APPLICATION FOR SOCIAL SERVICES
REQUEST FOR ORDER AND CONSENT - PARAMEDICAL SERVICES FOR IHSS
IN-HOME SUPPORTIVE SERVICES (IHSS) PROGRAM PROVIDER ENROLLMENT FORM
IN-HOME SUPPORTIVE SERVICES (IHSS) PROGRAM RECIPIENT DESIGNATION OF PROVIDER
IHSS VOLUNTARY SERVICES CERTIFICATION
ASSESSMENT OF NEED FOR PROTECTIVE SUPERVISION FOR IHSS PROGRAM
PROTECTIVE SUPERVISION 24-HOURS-A-DAY COVERAGE PLAN
IN-HOME SUPPORTIVE SERVICES (IHSS) PROGRAM PROVIDER OR RECIPIENT CHANGE OF ADDRESS AND/OR TELEPHONE
IHSS PROGRAM PROVIDER ENROLLMENT AGREEMENT
IHSS PROGRAM HEALTH CARE CERTIFICATION FORM
IHSS PROGRAM PROVIDER WORKWEEK & TRAVEL TIME AGREEMENT
IHSS SERVICES PROGRAM RECIPIENT AND PROVIDER WORKWEEK AGREEMENT
IHSS PROGRAM LIVE-IN FAMILY CARE PROVIDER OVERTIME EXEMPTION
IHSS PROGRAM PROVIDER NOTIFICATION OF RECIPIENT AUTHORIZED HOURS AND SERVICES AND MAXIMUM WEEKLY HOURS
IHSS PROGRAM RECIPIENT NOTICE OF MAXIMUM WEEKLY HOURS
OTHER FORMS
AUTHORIZED REPRESENTATIVE FORM FOR CDHS / IHSS