Form 752HH Physician/Clinician Statement of Necessary Patient Care For A Household Member
Owner:	Division of Family Assistance
Effective Date:	07/01/2009
Form 752HH - Physician/Clinician Statement of Necessary Patient Care For A Household Member - Used by the Division of Family Assistance to evaluate if you are unable to work or participate in New Hampshire Employment Program (NHEP) activities because you have to take care of a relative, assistance group member, or spouse who has a medical or psychological condition that is being treated by a doctor or psychologist and there is no other care available for that person.