Form 0702, Fax Cover Sheet for TxHmL and HCS |
Form 1572, Nursing Tasks Screening ToolES |
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 1592, RN Delegation Checklist |
Form 1740, Service Backup PlanES |
Form 1741, Corrective Action PlanES |
Form 1742, Service Backup Plan for HCS, TxHmL and CFC Services |
Form 1744, TxHmL/CFC Entrance Conference |
Form 2124, Supported Home Living or Community Support Transportation LogES |
Form 3598, Individual Transportation Plan |
Form 3610, Informal Review Request |
Form 3611, Involuntary Termination of Consumer Directed Services IPC Cover Sheet |
Form 3615, Request to Continue Suspension of Waiver Program Services |
Form 3616, Request for Termination of Services Provided by HCS/TxHmL Waiver Provider |
Form 3617, Request for Transfer of Waiver Program Services |
Form 4116-Dental, Dental Summary Sheet |
Form 4116-MHM-AA, Minor Home Modification and Adaptive Aids Summary Sheet |
Form 4117, Supported Employment/Employment Assistance Service Delivery Log |
Form 4118, Respite Service Delivery Log |
Form 5842, TxHmL Financial Eligibility Information |
Form 8401, Employment First Discovery Tool |
Form 8492, Random Sample Review of Nursing On-Call Required Submission of Documentation |
Form 8493, Notification Regarding a Death in HCS, TxHmL and DBMD Programs |
Form 8494, Notification Regarding an Investigation of Abuse, Neglect or Exploitation |
Form 8509, Unlicensed Personnel Tracking of Delegated Tasks |
Form 8510, HCS/TxHmL CFC PAS/HAB Assessment |
Form 8511, Understanding Program Eligibility and ServicesES |
Form 8572, TxHmL Individual Profile Information |
Form 8574, Administration of Medications by Unlicensed Personnel |
Form 8575, Notification of Local Authority (LA) Reassignment |
Form 8578, Intellectual Disability/Related Condition Assessment |
Form 8580, Request for Variance of Supported Employment – Employer Requirements |
Form 8582, TxHmL-CFC Individual Plan of Care |
Form 8583, HCS and TxHmL Program Contact Information ES |
Form 8584, Nursing Comprehensive AssessmentES |
Form 8586, TxHmL Service Coordination Notification |
Form 8599, Individual Plan of Care (IPC) Cover Sheet |
Form 8601, Verification of Freedom of Choice |
Form 8608, Sample Appeal Letter |
Form 8627, Request for Review of Individual Plan of Care (IPC) Cost Over Maximum Cost Ceiling Cover Sheet |
Form 8662, Related Conditions Eligibility Screening Instrument |