Forms

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.

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ES = Spanish version available.

Title Last updated
Form 1327, Growth Hormone Agents Standard PA Addendum (CSHCN) October 18, 2022
Form 1356, Xyrem Standard PA Addendum (Medicaid) October 18, 2022
Form 1325, Synagis Prior Authorization Addendum (CSHCN) October 18, 2022
Form 3234, Council for Sex Offender Treatment (CSOT) Request for Criminal History Evaluation October 13, 2022
Form 3233, Licensed Chemical Dependency Counselor Program Request for Criminal History Evaluation October 13, 2022
Form 2442, Notification of Interest List Release Closure ES October 12, 2022
Form 3239, Initial Licensed Sex Offender Treatment Provider or Affiliate Sex Offender Treatment Provider Licensure Application October 11, 2022
Form 3249, Hospital Waiver Request October 11, 2022
Form 3250, Hospital Statute and Rule Waiver Request Application for Facility Physical Plant and Construction Requirements October 11, 2022
Form H1200, Application for Assistance – Your Texas Benefits ES October 6, 2022
Form 3033, Hemophilia Assistance Program (HAP) Application October 5, 2022
Medical Power of Attorney (MPOA) ES October 5, 2022
Declaration for Mental Health Treatment (DMHT) ES October 5, 2022
Directive to Physicians and Family or Surrogates ES October 5, 2022
Statutory Durable Power of Attorney (SDPOA) ES October 5, 2022