Texas Health and Human Services Forms

This form is used for notifying and explaining rights and responsibilities, procedures to file a complaint, and how to report abuse, neglect, or exploitation in Texas.

This type of document is used for registering essential home care services provided in Texas.

This Form is used for reporting financial errors in emergency response services in the state of Texas.

This form is used for reporting and reviewing the utilization of day activity and health services in Texas. It helps track and analyze the utilization of services to inform decision-making and improve the quality of care provided.

This Form is used for applying for health care assistance in the state of Texas.

This document is used for the County Indigent Health Care Program (CIHCP) in Texas. It is a worksheet used to assess and determine eligibility for the program.

This form is used for requesting an exemption from the eligibility requirements for the Children With Special Health Care Needs (CSHCN) Services Program in Texas.

This form is used for requesting information related to the County Indigent Health Care Program (CIHCP) in Texas.

This Form is used for reporting changes to the County Indigent Health Care Program (CIHCP) in Texas. It is used to update information and ensure accurate and up-to-date records for the program.

This type of document, Form 3067 Appointment Notice - Texas, is used to notify individuals in Texas about upcoming appointments.

This form is used for recording health care services provided by the County Indigent Health Care Program in Texas.

This Form is used for notifying critical omissions related to Day Activity and Health Services (DAHS) in Texas.

This form is used for notifying critical omissions in personal attendant services in Texas.

This form is used for reporting the monthly financial information for the County Indigent Health Care Program (CIHCP) in Texas.

This form is used for verifying regional eligibility for the Children With Special Health Care Needs Services Program in Texas.

This Form is used for requesting a dispute resolution regarding eligibility for the County Indigent Health Care Program (CIHCP) in Texas.

This form is used for releasing case record information in Texas.

This form is used for notifying individuals in Texas about their eligibility for certain benefits or programs.

This form is used for claim processing notifications in the state of Texas. It provides information and updates regarding the status of a claim.

This form is used for transitioning individuals into the community after residing in a Texas institution. It is available in both English and Spanish.

This Form is used for requesting payment rates for facilities in Texas.

This form is used for notifying applicants of the Supplemental Security Income (SSI) program in Texas about the status of their appeal.

This Form is used for a provider to assign themselves as an appellant in Texas.

This form is used for notifying individuals in Texas about their ineligibility for a specific purpose or benefit.

This form is used for reporting self-employment income in the state of Texas.

This Form is used for employment verification in the state of Texas.

This form is used for submitting an end of year report in the state of Texas. It is necessary to provide financial and other relevant information for record-keeping purposes.

This Form is used for lodging complaints related to the Home and Community Based Services for Adult Mental Health in Texas.

This form is used for requesting state assistance funds in Texas, with a 90 percent funding rate.

This form is used for reporting a general physical examination in Texas. It allows healthcare professionals to document and communicate the results of a patient's overall physical health.