Alamedasocialservices.org
|Notice Date: | |
|Case Name: | |
|Case Number: | |
|Social Worker Name: | |
|Social Worker Number: | |
|Telephone Number: | |
|Fax Number: | |
Addressee:
Home Appointment Notice
We have received a request for In-Home Supportive Services stating that you require assistance to remain safely in your home. In order to determine your eligibility for In-Home Supportive Services, a home visit is required in order to assess your needs.
In order to continue to receive In-Home Supportive Services, an annual home visit is required to reassess your needs.
Attached is a Health Care Certification Form which must be completed by your Licensed Health Care Practitioner.
|Your home visit has been scheduled for : |Day: | |
| |Date: | |
| |Time: |AM PM |
Please contact the Social Worker immediately at the phone number listed above if you have a new address or need to reschedule the visit.
Important Notes:
• Please have all of your current medications and the names, addresses, & phone/fax numbers of all the doctors you have seen in the past 12 months available.
• If you do not speak English and you do not have anybody to assist you with translation, please contact the Social Worker immediately to arrange for an interpreter.
• If you have pets, please put them in another room during this visit.
• If you have locked gates or screen doors, please unlock them so the Social Worker can knock at your door upon arrival.
• If you fail to complete the home visit, your In-Home Supportive Services application may be denied or if you are currently receiving In-Home Supportive Services, your case may be discontinued.
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