| Form 1023, Request for Services Funded by General Revenue |
| Form 1025, Request for Information Medicare Advantage Coordination |
| Form 1027, Caregiver Status QuestionnaireES |
| Form 1131, Individually Identifiable Health Information Fax Transmittal |
| Form 1578, Qualified Income Trust (QIT) Copayment AgreementES |
| Form 1579, Referral for Relocation ServicesES |
| Form 1580, Texas Money Follows the Person Demonstration (MFPD) Project Informed Consent for ParticipationES |
| 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 1585, Acknowledgement of Responsibility for Exemption from Nursing Licensure for Certain Services Delivered through Consumer Directed ServicesES |
| Form 1586, Acknowledgement of Information Regarding Support Consultation Services in the Consumer Directed Services (CDS) OptionES |
| Form 1720, Appointment of a Designated RepresentativeES |
| Form 1721, Revocation of Appointment of Designated RepresentativeES |
| Form 1735, Employer and Financial Management Services Agency Service AgreementES |
| Form 1740, Service Backup PlanES |
| Form 1741, Corrective Action PlanES |
| Form 2059, Summary of Client's Need for Service |
| Form 2110, Community Care Intake |
| Form 2110-A, Community Care Intake Nursing Facility Diversion Slot Screening |
| Form 2115, Conflict of Interest Notification |
| Form 2119, Residential Care, Adult Foster Care or Assisted Living Contribution AcknowledgementES |
| Form 2327, Individual or Member and Provider AgreementES |
| Form 2327-A, Room and Board Amendment to the Individual or Member and Provider Agreement |
| Form 2330, Assessment and Service Plan Approval for Adult Foster Care |
| Form 2442, Notification of Interest List Release ClosureES |
| Form 2606, Managed Care Enrollment Processing DelayES |
| Form 3050, DAHS Health Assessment or Individual Service Plan |
| Form 3055, Physician's Orders (DAHS) |
| Form 3632, Withdrawal ConfirmationES |
| Form 4116, Authorization for Expenditures |
| Form 4800-D, Fair Hearing Request Summary |
| Form 4800-DA, 4800-D Addendum |
| Form 4801, State Fair Hearing Evidence Packet Cover PageES |
| Form 4807-D, Action Taken on Hearing Decision |
| Form 8001, Medicaid Estate Recovery Program Receipt AcknowledgementES |
| Form 8604, Transition Assistance Services (TAS) Assessment and Authorization |
| Form H0025, HHSC Application for Voter RegistrationES |
| Form H1027-A, Medicaid Eligibility Verification |
| Form H1097, Affidavit for Citizenship/IdentityES |
| Form H1200, Application for Assistance – Your Texas BenefitsES |
| Form H1200-A, Medical Assistance Only (MAO) RecertificationES |
| Form H1200-EZ, Application for Assistance - Aged and DisabledES |
| Form H1270, Data Integrity SAVERR Notification |
| Form H1350, Opportunity to Register to Vote |
| Form H1700-1, Individual Service PlanES |
| Form H1700-2, Individual Service Plan – AddendumES |
| Form H1700-3, Individual Service Plan – Signature PageES |
| Form H1700-A1, Certification of Completion/Delivery of STAR+PLUS HCBS Program Items/ServicesES |
| Form H1746-A, MEPD Referral Cover Sheet |
| Form H1746-B, Batch Cover Sheet |
| Form H1826, Case Information ReleaseES |
| Form H2053-B, Health Plan SelectionES |
| Form H2060, Needs Assessment Questionnaire and Task/Hour GuideES |
| Form H2060-A, Addendum to Form H2060ES |
| Form H2060-B, Needs Assessment AddendumES |
| Form H2062, STAR+PLUS Waiver Activity Record |
| Form H2064, Gap in Enrollment for Medicaid Managed Care Members |
| Form H2065-A, Notification of Community Care ServicesES |
| Form H2065-D, Notification of Managed Care Program ServicesES |
| Form H2067-MC, Managed Care Programs Communication |
| Form H2111, Interested List Notification – HCBSES |
| Form H2118, STAR+PLUS HCBS Program Interest List – Confirmation of Continued InterestES |
| Form H3034, Disability Determination Socio-Economic ReportES |
| Form H3035, Medical Information Release and Disability DeterminationES |
| Form H3675, Application AcknowledgementES |
| Form H3676, Managed Care Pre-Enrollment Assessment Authorization |
| Form H4800, Fair Hearing Request Summary |
| Form H4800-A, Fair Hearing Request Summary (Addendum) |
| Form H4803, Notice of HearingES |
| Form H4807, Action Taken on Hearing Decision |
| Form H6516, Community First Choice Assessment ES |
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