ES = Spanish version available.

Form Title  
0003 Authorization to Furnish Information  
1579 Referral for Relocation Services  
1581 Consumer Directed Services Overview ES
1582 Consumer Directed Services Responsibilities ES
1582-SRO Service Responsibility Option Roles and Responsibilities ES
1583 Employee Qualification Requirements ES
1584 Consumer Participation Choice ES
1585 Acknowledgement of Responsibility for Exemption from Nursing Licensure for Certain Services Delivered through Consumer Directed Services ES
1586 Acknowledgment of Information Regarding Support Consultation Services in the Consumer Directed Services (CDS) Option ES
1740 Service Backup Plan ES
1741 Corrective Action Plan ES
1747 Acknowledgement of Nursing Requirements  
2406 Physician Recommendation for Length of Stay in a Nursing Facility ES
2416 Minor Home Modifications and Adaptive Aids Service Authorization  
2442 Notification of Interest List Release Closure ES
2601 Physician Certification ES
2602 Application Acknowledgment ES
2603 STAR Kids Individual Service Plan (ISP) Narrative ES
2604 STAR Kids Individual Service Plan - Service Tracking Tool ES
2605 Member SK-SAI MDCP Review Signature ES
3618 Resident Transaction Notice  
H1097 Affidavit for Citizenship/Identity ES
H1746-A MEPD Referral Cover Sheet  
H1826 Case Information Release  
H2053-B Health Plan Selection ES
H2065-D Notification of Managed Care Program Services ES
H2067-MC Managed Care Programs Communication  
H1200 Application for Assistance – Your Texas Benefits  
H3034 Disability Determination Socio-Economic Report ES
H3035 Medical Information Release/Disability Determination ES
H3676 Managed Care Pre-Enrollment Assessment Authorization  
H4800 Fair Hearing Request Summary  
H4800-A Fair Hearing Request Summary (Addendum)  
H4803 Notice of Hearing  
H4807 Action Taken on Hearing Decision