DADS does not require providers to use the sample forms listed below.§ A provider can use these sample forms as they are, modify the forms to fit a facility's needs or elect to create its own forms.
- Form 1572 Nursing Tasks Screening Tool (English and Spanish)
- Form 1592 Waiver Survey and Certification HCS/TxHmL RN Delegation Checklist
- Form 1593 Waiver Survey and Certification Nursing Services Checklist
- Form 1591 Provider Advocate Committee Acting as the Client's Responsible Adult
- Form 8495 Exemption of Foster/Companion Care (FCC) Provider from the Board of Nursing (BON) Definition of Unlicensed Person
- Form 8584 Nursing Comprehensive Assessment
- Form 8585 RN Delegation Worksheet for 22 TAC §225
- Form 8587 Nursing Process Toolkit
- Form 8588 Nursing Supervision for Unlicensed Assistive Personnel (UAP)
- Form 8589 Nursing Special Needs: RN Delegation and Care Instructions for Assistive Personnel
DADS has created tools that can be used as a resource for HCS/TxHmL providers and for DADS staff. Use of these tools is optional.