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
Form 1126, Physician's Assessment
Form 1125, Resident's Request to Remain in Facility
Form 1085, State of Texas Emergency Assistance Registry
Form 1084, Certification for Warrants Lost, Destroyed, Stolen or Not Received ES
Form 1049, Initial Documentation of Provider Choice ES
Form 1040, CFC Non-Waiver Packet Information and Checklist
Form 1031, Case Record Transfer
Form 1026, Verification of Railroad Retirement Benefits
Form 1025, Request for Information Medicare Advantage Coordination
Form 1023, Request for Services Funded by General Revenue
Form 1020-V, Acknowledgement of Responsibility for Reporting Abuse, Neglect and Exploitation and Reasonable Suspicion of Crime
Form 1020, Acknowledgement of Responsibility for Reporting Abuse, Neglect and Exploitation and Reasonable Suspicion of Crime
Form 0702, Fax Cover Sheet for TxHmL and HCS
Form 0067, Consent by Roommate for Authorized Electronic Monitoring ES
Form 0066, Request for Authorized Electronic Monitoring