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1554
![Form H1003 "Appointment of an Authorized Representative to Allow Another Person to Act for You" - Texas](https://data.templateroller.com/pdf_docs_html/2071/20713/2071384/form-h1003-appointment-of-an-authorized-representative-to-allow-another-person-to-act-for-you-texas.png "Form H1003 "Appointment of an Authorized Representative to Allow Another Person to Act for You" - Texas")
Form H1003 "Appointment of an Authorized Representative to Allow Another Person to Act for You" - Texas
Size: 99 KB
1 page
This form may be used in the state of Texas when individuals would like to let another person legally act for them in certain situations.
![Form 5506-NAR "Texas Nurse Aide Registry Employment Verification" - Texas](https://data.templateroller.com/pdf_docs_html/2016/20162/2016251/form-5506-nar-texas-nurse-aide-registry-employment-verification-texas.png "Form 5506-NAR "Texas Nurse Aide Registry Employment Verification" - Texas")
Form 5506-NAR "Texas Nurse Aide Registry Employment Verification" - Texas
Size: 84 KB
2 pages
This form is used and needs to be completed by a nurse aide and their employer to verify employment. To remain on active status and to provide services in nursing facilities, nurse aides have to do such verifications at least every two years.
![Form HRG-83 "Ssn Maintenance Memorandum" - Texas](https://data.templateroller.com/pdf_docs_html/2071/20718/2071802/form-hrg-83-ssn-maintenance-memorandum-texas.png "Form HRG-83 "Ssn Maintenance Memorandum" - Texas")
![Instructions for Form 325 "Primary Health Care Annual Reporting Form" - Texas](https://data.templateroller.com/pdf_docs_html/1958/19581/1958178/instructions-for-form-325-primary-health-care-annual-reporting-form-texas.png "Instructions for Form 325 "Primary Health Care Annual Reporting Form" - Texas")
![Form 1048 "Summary Sheet for Services to Individuals With Idd in Nf" - Texas](https://data.templateroller.com/pdf_docs_html/2120/21206/2120655/form-1048-summary-sheet-for-services-to-individuals-with-idd-in-nf-texas.png "Form 1048 "Summary Sheet for Services to Individuals With Idd in Nf" - Texas")
![Form 2605 "Member Sk-Sai Mdcp Review Signature" - Texas](https://data.templateroller.com/pdf_docs_html/2120/21206/2120662/form-2605-member-sk-sai-mdcp-review-signature-texas.png "Form 2605 "Member Sk-Sai Mdcp Review Signature" - Texas")
![Form H1175 "Ebt Change Request" - Texas](https://data.templateroller.com/pdf_docs_html/2120/21206/2120678/form-h1175-ebt-change-request-texas.png "Form H1175 "Ebt Change Request" - Texas")
![Form 3209 "Chemical Dependency Treatment Facility Licensure Application Checklist for Change in Status Applicants" - Texas](https://data.templateroller.com/pdf_docs_html/2120/21206/2120667/form-3209-chemical-dependency-treatment-facility-licensure-application-checklist-for-change-in-status-applicants-texas.png "Form 3209 "Chemical Dependency Treatment Facility Licensure Application Checklist for Change in Status Applicants" - Texas")
![Form 3900 "Application for Certificate of Deafness for Tuition Waiver" - Texas](https://data.templateroller.com/pdf_docs_html/2120/21206/2120668/form-3900-application-for-certificate-of-deafness-for-tuition-waiver-texas.png "Form 3900 "Application for Certificate of Deafness for Tuition Waiver" - Texas")
![Form 3031 "Children With Special Health Care Needs (Cshcn) Program Application" - Texas](https://data.templateroller.com/pdf_docs_html/2120/21206/2120665/form-3031-children-with-special-health-care-needs-cshcn-program-application-texas.png "Form 3031 "Children With Special Health Care Needs (Cshcn) Program Application" - Texas")
Form 3031 "Children With Special Health Care Needs (Cshcn) Program Application" - Texas
Size: 160 KB
12 pages
![Form 8584 "Comprehensive Nursing Assessment" - Texas](https://data.templateroller.com/pdf_docs_html/2120/21206/2120675/form-8584-comprehensive-nursing-assessment-texas.png "Form 8584 "Comprehensive Nursing Assessment" - Texas")
![Form 2962 "Verification of Liability Insurance" - Texas](https://data.templateroller.com/pdf_docs_html/2120/21206/2120664/form-2962-verification-of-liability-insurance-texas.png "Form 2962 "Verification of Liability Insurance" - Texas")
![Form H1822 "Abawd E&t Work Requirement Verification" - Texas](https://data.templateroller.com/pdf_docs_html/2120/21206/2120679/form-h1822-abawd-e-t-work-requirement-verification-texas.png "Form H1822 "Abawd E&t Work Requirement Verification" - Texas")
![Form H1172 "Ebt Card, Pin and Data Entry Request" - Texas](https://data.templateroller.com/pdf_docs_html/2120/21206/2120677/form-h1172-ebt-card-pin-and-data-entry-request-texas.png "Form H1172 "Ebt Card, Pin and Data Entry Request" - Texas")
![Form 3610 "Informal Review Request" - Texas](https://data.templateroller.com/pdf_docs_html/2127/21278/2127837/form-3610-informal-review-request-texas.png "Form 3610 "Informal Review Request" - Texas")
![Form 1347 "Emflaza Authorization Request (Medicaid)" - Texas](https://data.templateroller.com/pdf_docs_html/2120/21206/2120658/form-1347-emflaza-authorization-request-medicaid-texas.png "Form 1347 "Emflaza Authorization Request (Medicaid)" - Texas")
![Form 5534 "Medication Aide General Statement Enrollment" - Texas](https://data.templateroller.com/pdf_docs_html/2120/21206/2120672/form-5534-medication-aide-general-statement-enrollment-texas.png "Form 5534 "Medication Aide General Statement Enrollment" - Texas")
![Form 5523 "Medication Aide Experience Documentation Report" - Texas](https://data.templateroller.com/pdf_docs_html/2120/21206/2120671/form-5523-medication-aide-experience-documentation-report-texas.png "Form 5523 "Medication Aide Experience Documentation Report" - Texas")
![Form 8648 "Identification of Preferences" - Texas](https://data.templateroller.com/pdf_docs_html/2120/21206/2120674/form-8648-identification-of-preferences-texas.png "Form 8648 "Identification of Preferences" - Texas")
![Form 4205 "Consent by Foster Parent or Medical Consenter for Health Passport" - Texas](https://data.templateroller.com/pdf_docs_html/2120/21206/2120670/form-4205-consent-by-foster-parent-or-medical-consenter-for-health-passport-texas.png "Form 4205 "Consent by Foster Parent or Medical Consenter for Health Passport" - Texas")
![Form 1325 "Synagis Prior Authorization Addendum (Cshcn)" - Texas](https://data.templateroller.com/pdf_docs_html/2120/21206/2120657/form-1325-synagis-prior-authorization-addendum-cshcn-texas.png "Form 1325 "Synagis Prior Authorization Addendum (Cshcn)" - Texas")
![Form 1321 "Synagis Standard Prior Authorization Addendum (Medicaid)" - Texas](https://data.templateroller.com/pdf_docs_html/2120/21206/2120656/form-1321-synagis-standard-prior-authorization-addendum-medicaid-texas.png "Form 1321 "Synagis Standard Prior Authorization Addendum (Medicaid)" - Texas")
![Form 8660 "Performance Evaluation of Internship/Practicum Supervisor and Overall Experience" - Texas](https://data.templateroller.com/pdf_docs_html/2105/21051/2105168/form-8660-performance-evaluation-of-internship-practicum-supervisor-and-overall-experience-texas.png "Form 8660 "Performance Evaluation of Internship/Practicum Supervisor and Overall Experience" - Texas")
![Form 3008 "Cost Share Collections/Refund Report" - Texas](https://data.templateroller.com/pdf_docs_html/2105/21051/2105147/form-3008-cost-share-collections-refund-report-texas.png "Form 3008 "Cost Share Collections/Refund Report" - Texas")
![Form 3015 "Application for a Child Care Administrator License or a Child-Placing Agency Administrator License" - Texas](https://data.templateroller.com/pdf_docs_html/2105/21051/2105144/form-3015-application-for-a-child-care-administrator-license-or-a-child-placing-agency-administrator-license-texas.png "Form 3015 "Application for a Child Care Administrator License or a Child-Placing Agency Administrator License" - Texas")
![Form 1319 "Pharmacy Claims Billing Request" - Texas](https://data.templateroller.com/pdf_docs_html/2105/21051/2105138/form-1319-pharmacy-claims-billing-request-texas.png "Form 1319 "Pharmacy Claims Billing Request" - Texas")
![Form 1054 "Community Living Options" - Texas](https://data.templateroller.com/pdf_docs_html/2105/21051/2105137/form-1054-community-living-options-texas.png "Form 1054 "Community Living Options" - Texas")
![Form 3955 "Application for Driver Identification Visor Card" - Texas](https://data.templateroller.com/pdf_docs_html/2105/21051/2105157/form-3955-application-for-driver-identification-visor-card-texas.png "Form 3955 "Application for Driver Identification Visor Card" - Texas")
![Form 4211 "Respite Funding Agreement" - Texas](https://data.templateroller.com/pdf_docs_html/2105/21051/2105159/form-4211-respite-funding-agreement-texas.png "Form 4211 "Respite Funding Agreement" - Texas")
![Form 3016 "Administrator Licensing - Reference for an Applicant" - Texas](https://data.templateroller.com/pdf_docs_html/2105/21051/2105143/form-3016-administrator-licensing-reference-for-an-applicant-texas.png "Form 3016 "Administrator Licensing - Reference for an Applicant" - Texas")
![Form 0011 "Consent to Transfer to a Texas State Operated Facility" - Texas](https://data.templateroller.com/pdf_docs_html/2105/21051/2105131/form-0011-consent-to-transfer-to-a-texas-state-operated-facility-texas.png "Form 0011 "Consent to Transfer to a Texas State Operated Facility" - Texas")
![Form 0012 "Request for Interstate Transfer" - Texas](https://data.templateroller.com/pdf_docs_html/2105/21051/2105133/form-0012-request-for-interstate-transfer-texas.png "Form 0012 "Request for Interstate Transfer" - Texas")
![Form 3222 "Confidentiality of Patient Records" - Texas](https://data.templateroller.com/pdf_docs_html/2111/21116/2111630/form-3222-confidentiality-of-patient-records-texas.png "Form 3222 "Confidentiality of Patient Records" - Texas")
![Form 2071 "Monthly Report of Nutrition Services Incentive Program (Nsip) Eligible Meals and Title Xx Meals" - Texas](https://data.templateroller.com/pdf_docs_html/2111/21116/2111628/form-2071-monthly-report-of-nutrition-services-incentive-program-nsip-eligible-meals-and-title-xx-meals-texas.png "Form 2071 "Monthly Report of Nutrition Services Incentive Program (Nsip) Eligible Meals and Title Xx Meals" - Texas")
![Form 6004 "Texas Provider Marketing" - Texas](https://data.templateroller.com/pdf_docs_html/2105/21051/2105163/form-6004-texas-provider-marketing-texas.png "Form 6004 "Texas Provider Marketing" - Texas")
![Form 8636 "Volunteer/Intern Assignment Description" - Texas](https://data.templateroller.com/pdf_docs_html/2105/21051/2105167/form-8636-volunteer-intern-assignment-description-texas.png "Form 8636 "Volunteer/Intern Assignment Description" - Texas")
![Form 6517 "Individual Program Plan (Ipp) Service Review" - Texas](https://data.templateroller.com/pdf_docs_html/2105/21051/2105164/form-6517-individual-program-plan-ipp-service-review-texas.png "Form 6517 "Individual Program Plan (Ipp) Service Review" - Texas")
![Form 3091 "Comprehensive Nursing Assessment" - Texas](https://data.templateroller.com/pdf_docs_html/2105/21051/2105150/form-3091-comprehensive-nursing-assessment-texas.png "Form 3091 "Comprehensive Nursing Assessment" - Texas")
![Form 3001 "Quarterly Financial Report" - Texas](https://data.templateroller.com/pdf_docs_html/2105/21051/2105142/form-3001-quarterly-financial-report-texas.png "Form 3001 "Quarterly Financial Report" - Texas")
