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Eligibility Form
To start services for our Homebound Critically Ill Program:
San Francisco residents:
Please call the Client Services Hotline at (800) 551-6325 to schedule an intake appointment with a case worker. You must bring with you a valid California photo identification with a San Francisco address (or other proof of San Francisco residency) and the eligibility form provided below, signed by your physician. Your intake appointment will be at 730 Polk Street (between Ellis and Eddy).
Alameda County residents:
Please call Client Services at (510) 622-0221 to schedule an intake appointment with a case worker. You must bring with you a valid California photo identification and the eligibility form provided below, signed by your physician. Your intake appointment will be at 1921 San Pablo Avenue in Oakland.
Certification for Services
Please print this form (for patients other than breast cancer patients) and have your doctor fill it out. Breast cancer patients please print this form. Bring it with you when you come to Project Open Hand for intake. This form is in PDF format and requires Adobe Acrobat Reader. Click here to download the reader for free if you do not already have it installed on your computer.
If a client is unable, due to health reasons, to come to Project Open Hand, a home visit can be arranged by calling (800) 551-MEAL (6325) between 9:00 AM and 4:00 PM Monday through Friday.
