Texas Health and Human Services Forms

This Form is used for the Individual Plan of Care (IPC) cover sheet in the state of Texas. It is a document that provides information about the individual's care plan.

This document is used as a cover sheet for Class Ipc/Idrc cases in Texas.

This Form is used for orientation and supervisory visits for habilitation service providers in the state of Texas.

This form is used for creating a Personal Assistance Services (PAS)/Habilitation Plan in the state of Texas. It outlines the needs and goals for individuals who require assistance with daily activities and encourages personalized care.

This form is used for applying to participate in the Title XIX Medicaid program in Texas specifically for ICF/IID, nursing facility or rural hospital swingbed programs.

This form is used for transferring ownership of an ICF/IID (Intermediate Care Facility for Individuals with Intellectual Disabilities) in Texas.

This form is used for transferring ownership of a property in Texas. It serves as an affidavit confirming the transfer and may be required by the state or local government.

This document is used for creating an Individual Transportation Plan for residents of Texas.

This form is used for providing contact information for individuals under 22 years of age in Texas.

This form is used for renewing the license of an end stage renal disease facility in Texas.

This form is used for the involuntary termination of Consumer Directed Services (CDS) Individual Plan of Care (IPC) in Texas.

This form is used for requesting to continue the suspension of waiver program services in Texas.

This Form is used for requesting the termination of services provided by HCS/TXHML waiver provider in Texas.

This form is used for providing a notice of a transaction involving a resident in the state of Texas.

This form is used for denying an application for a class in Texas.

This form is used for providing a notice to Medicare beneficiaries in Texas who are receiving skilled nursing facility services.

This form is used for conducting a consultant review in the state of Texas. It is a document that helps evaluate the performance and effectiveness of consultants.

This type of document, Form 3624, is used for terminating, reducing, or denying class status in the state of Texas.

This Form is used for obtaining approval for a class application in Texas. It is available in both English and Spanish languages.

This form is used for obtaining specialized nursing certification in the state of Texas.

This form is used for creating a backup plan for service providers in Texas in case of unforeseen events or disruptions.

This Form is used for confirming departure from the Texas program.

This form is used for confirming the withdrawal of a document in the state of Texas.

This form is used for requesting informal dispute resolution in the state of Texas. It allows individuals to address and resolve issues without going to court.

This form is used for applying for the reallocation of Medicaid beds in Texas for Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID).

This form is used for requesting a formal hearing in the state of Texas.