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Forms

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HHS forms are used every day to perform tasks such as applying for benefits, contracting to provide goods or services, reporting incidents, declaring end of life wishes, and conducting other business.

Search for Forms

ES = Spanish version available.

Title Last updated
Form 4121, Home and Community-based Services/Texas Home Living Community First Choice Personal Assistance Services/Habilitation ES May 27, 2022
Form H1038, Medical Facility Referral May 26, 2022
Form 1739, Service Provider Agreement ES May 26, 2022
Form 1123, Review of Assisted Living Facility Type C May 26, 2022
Form H0920, Notice from the Community Organization Helping You ES May 26, 2022
Form H0901, HHSC Enhanced Data Gathering Worksheet May 26, 2022
Form 2463, Emergency Dental Services May 26, 2022
Form H1225, Restitution ES May 26, 2022
Form H1350, Opportunity to Register to Vote May 26, 2022
Form 2333, Nursing Facility Risk Criteria Scoring Form May 26, 2022
Form 5605, Life Safety Code Overview Worksheet May 26, 2022
Form 8619, State Long-Term Care Ombudsman Program Case Record May 26, 2022
Form 1572, Nursing Tasks Screening Tool ES May 26, 2022
Form 3619, Medicare/Skilled Nursing Facility Patient Transaction Notice May 26, 2022
Form 3618, Resident Transaction Notice May 26, 2022

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