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San Francisco Department of Disability and Aging Services fax number
(415) 355-2463
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In-Home Supportive Services (IHSS) – Department of Disability and Aging Services (DAS), San Francisco Human Services Agency (SFHSA)
Used for: Submit IHSS Referral Form (Form 3012) for DAS intake; ensure Health Certification Form (SOC 873) is completed; health certification can be faxed to 415-355-2463; for questions call (415) 355-6700 ext. 3
Fax destination details
- Department
- In-Home Supportive Services (IHSS) – Department of Disability and Aging Services (DAS), San Francisco Human Services Agency (SFHSA)
- Purpose
- Submit IHSS Referral Form (Form 3012) for DAS intake; ensure Health Certification Form (SOC 873) is completed; health certification can be faxed to 415-355-2463; for questions call (415) 355-6700 ext. 3
- Form
- Form 3012 — In-Home Supportive Services Referral Form
- Address
- P.O. Box 7988, San Francisco, CA 94120
- Voice phone
- (415) 355-6700
- Website
- Visit organization website
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Complete IHSS Referral Form 3012, provide consent for release of information, and attach Health Certification Form SOC 873. Fax SOC 873 to 415-355-2463. For questions, call (415) 355-6700 ext 3.
Official form instructions are published as a downloadable file on the organization's website.
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