Form 3106, Comprehensive Rehabilitation Services Referral

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Effective Date: 2/2022


Updated: 3/2019


The Comprehensive Rehabilitation Services (CRS) program assists people who have sustained a traumatic brain injury (TBI), a traumatic spinal cord injury (TSCI), or both, with rehabilitation and recovery, helping them to live more independently in their home and community by improving their mobility, self-care and communication skills. CRS provides personalized treatment plans based on a person’s specific needs and can pay for rehabilitation services, within certain limitations. Individuals must first use all available comparable medical benefits, such as medical insurance, Medicare or Medicaid, before they may use CRS program funding to pay for services.

CRS participants must meet all of the following criteria to be eligible for the program:

  • Have a TBI, a TSCI or both, that is caused by an external physical force. The TBI or TSCI significantly affects the person’s ability to perform daily activities.
  • Be at least 15 years of age.
  • Be a U.S. citizen or lawful permanent resident and a Texas resident.
  • Be willing to participate in services.
  • Be medically stable enough to participate in rehabilitation activities.


HHSC CRS provider website can be found here

  • Go to Manuals, Forms and Brochures 
  • Select the hyperlink to CRS Referral
  • It will take you to Form 3106. 

When completing Form 3106, attach all necessary supporting documentation. This will expedite the application process for people applying to the program. If you do not have access to one or more of the necessary documents, make note that these documents will need to be received before the program application is considered complete.

Items that will assist in expediting the referral process include the following unexpired documents. Some original documents will need to be seen at the initial appointment. However, a copy will suffice for obtaining the initial referral.

  • Texas driver's license or photo identification card issued by a governmental entity;
  • document to prove Texas residency, such as a residential lease agreement, unexpired Texas voter registration card, Texas motor vehicle registration, or utility bill with a Texas address;
  • document to prove U.S. citizenship, such as a birth certificate, U.S. passport, certificate of citizenship or naturalization certificate;
  • copy of insurance card (private insurance, Medicaid, Medicare, other charity, etc.);
  • Social Security card;
  • financial documents (pay stub, bank statement, Supplemental Security Income (SSI)/Social Security Disability Income (SSDI), tax return, etc.);
  • facility face sheet or admissions page;
  • medical documentation of TBI or TSCI; or
  • copy of Rancho Los Amigos or Glasgow Coma scores.


After completing Form 3106, submit it to CRS:
Email: with Referral in the subject line.
eFax: 512-206-3981