ES = Spanish version available.

1019Opportunity to Register to Vote/DeclinationES
1025Request for Information Medicare Advantage Coordination 
1027Caregiver Status QuestionnaireES
1031Case Record Transfer 
1032Residential Care Copayment Worksheet 
1131Individually Identifiable Health Information Fax Transmittal 
1581Consumer Directed Services Option OverviewES
1581-SROService Responsibility Option (SRO) OverviewES
1582Consumer Directed Services ResponsibilitiesES
1582-SROService Responsibility Option Roles and ResponsibilitiesES
1583Employee Qualification RequirementsES
1584Consumer Participation ChoiceES
1586Acknowledgement of Information Regarding Support Consultation Services in the Consumer Directed Services (CDS) OptionES
1589Consumer Directed Services Revision Worksheet 
1590Request for a Fair Hearing Exception 
1596Consumer Directed Services Agreement for Community Attendant Services Annual ReauthorizationES
1741Corrective Action PlanES
2058Case Activity Record 
2059Summary of Client's Need for Service 
2059-WSummary of Individual's Need for Services Worksheet 
2060Needs Assessment Questionnaire and Task/Hour Guide 
2060-BNeeds Assessment AddendumES
2064Eligibility Worksheet 
2065-ANotification of Community Care Services 
2067Case Information 
2068Application, Redetermination, or Monitoring for Community Care Services 
2076Authorization to Release Medical InformationES
2084Risk Management Team Meeting Summary 
2097Provider Contract Assignment Notification 
2101Authorization for Community Care Services 
2110Community Care Intake 
2111Interest List Notification 
2113Community Services Interest List Registration and Follow-Up 
2115Conflict of Interest Notification 
2119Residential Care, Adult Foster Care or Assisted Living Contribution AcknowledgementES
2247Interest List Contact Notification 
2307Rights and ResponsibilitiesES
2314Satisfaction and Service Monitoring 
2314-CConsumer Satisfaction Interview Consumer Directed Services Addendum 
2327Individual/Member and Provider Agreement 
2327-ARoom and Board Amendment to the Individual and Provider Agreement 
2330Assessment and Service Plan Approval for Adult Foster Care 
2423Request for Medical EvidenceES
3050DAHS Health Assessment/Individual Service Plan 
3052Practitioner's Statement of Medical Need 
3054Primary Home Care Service Delivery RecordES
3055Physician's Orders (DAHS) 
3062DAHS Utilization Review Report 
3070Day Activity and Health Services Notification of Critical Omissions 
3070-APHC Notification of Critical Omissions/Errors in Required Documentation 
4100Money Receipt 
4116Authorization for Expenditures 
8001Medicaid Estate Recovery Program Receipt AcknowledgementES
H0003Agreement to Release Your Facts 
H0005Policy Clarification Request 
H0025HHSC Application for Voter RegistrationES
H1026Verification of Railroad Retirement Benefits 
H1026-FTIVerification of Railroad Retirement Benefits - FTI 
H1027-AMedicaid Eligibility Verification 
H1200Application for Assistance - Your Texas Benefits 
H1200-EZApplication for Assistance - Aged and Disabled (Large Print) 
H1232Notification of IneligibilityES
H1235Notice of Appointment or Delay 
H1239Request for Verification of Bank Accounts 
H1240Request for Information from Bureau of Veterans Affairs and Client's Authorization 
H1240-FTIRequest for Information from Bureau of Veterans Affairs and Client's Authorization - FTI 
H1243Verification of Civil Services Benefits 
H1243-FTIVerification of Civil Services Benefits - FTI 
H1270Data Integrity SAVERR Notification 
H1746-AMEPD Referral Cover Sheet 
H1746-BBatch Cover Sheet 
H1826Case Information ReleaseES
H1297Request for Information from Teacher Retirement System of Texas 
H3034Disability Determination Socio-Economic ReportES
H3035Medical Information Release/Disability DeterminationES
H4800Fair Hearing Request Summary 
H4800-AFair Hearing Request Summary (Addendum) 
H4807Action Taken on Hearing Decision 
H4808Notice of Change in Applied Income/Notice of Denial of Medical Assistance