Form 1581, Consumer Directed Services (CDS) Option OverviewES |
Form 1582, Consumer Directed Services ResponsibilitiesES |
Form 1583, Employee Qualification RequirementsES |
Form 1584, Consumer Participation Choice |
Form 1586, Acknowledgement of Information Regarding Support Consultation Services in the Consumer Directed Services (CDS) OptionES |
Form 1740, Service Backup PlanES |
Form 2067, Case Information |
Form 2124, Supported Home Living or Community Support Transportation LogES |
Form 3594, Individual Plan of Care (IPC) Cover Sheet |
Form 3596, PAS/Habilitation Plan – CLASS/DBMD/CFC |
Form 3598, Individual Transportation Plan |
Form 3627, Specialized Nursing Certification |
Form 3628, Provider Agency Model Service Backup Plan |
Form 4800-D, Fair Hearing Request Summary |
Form 4800-DA, 4800-D Addendum |
Form 6500, DBMD and CFC – Individual Plan of Care (IPC) |
Form 6500-T, DBMD and CFC - IPC Service Delivery Transfer Worksheet |
Form 6501, Individual Program Plan |
Form 6502, Denial of Application for DB-MD |
Form 6503, DBMD and CFC Summary of Services Delivered |
Form 6504, Prior Authorization for Dental Services |
Form 6505, Daily Census Documentation |
Form 6507, Rationale for Adaptive Aids, Medical Supplies, and Minor Home Modifications |
Form 6508, Specifications for Minor Home Modifications |
Form 6509, CLASS/DBMD Coordination of Care |
Form 6510, Decline of Offer for DBMD Program Enrollment |
Form 6515, CLASS or DBMD Nursing Assessment |
Form 6517, Individual Program Plan (IPP) Service Review |
Form 6518, Record of Completion for Individual Specific Training, Instructions |
Form 8001, Medicaid Estate Recovery Program Receipt AcknowledgementES |
Form 8401, Employment First Discovery Tool |
Form 8493, Notification Regarding a Death in HCS, TxHmL and DBMD Programs |
Form 8507, Understanding Program Eligibility - CLASS/DBMDES |
Form 8557, CLASS/DBMD Corrective Action Plan |
Form 8578, Intellectual Disability/Related Condition Assessment |
Form 8598, Non-Waiver Services |
Form 8601, Verification of Freedom of Choice |
Form 8604, Transition Assistance Services (TAS) Assessment and Authorization |
Form 8605, Documentation of Completion of Purchase |
Form 8662, Related Conditions Eligibility Screening Instrument |
Form H1200, Application for Assistance – Your Texas BenefitsES |
Form H1200-EZ, Application for Assistance - Aged and DisabledES |
Form H1746-A, MEPD Referral Cover Sheet |
Form H1746-B, Batch Cover Sheet |
Form H3034, Disability Determination Socio-Economic ReportES |
Form H3035, Medical Information Release and Disability DeterminationES |