Texas Health and Human Services Forms

This document is a Spanish consent form used for minors between the ages of 13 and 18 who are seeking treatment for opioid use disorder in Texas.

This form is used for identifying the need for a surrogate parent and assigning them in the state of Texas.

This form is used for requesting non-emergency medical transportation services in Texas. It allows individuals to arrange transportation for medical appointments and treatments.

This form is used for requesting records from the Texas Health and Human Services Department in Texas.

This Form is used for certifying nongovernmental contractors in Texas. It ensures that contractors meet certain requirements to provide services to the government.

This form is used for nongovernmental contractors in Texas to certify their eligibility for certain tax exemptions or benefits.

This Form is used for requesting a summary of a fair hearing in the state of Texas.

This form is used for reporting the action taken on a hearing decision in Texas.

This form is used for submitting additional information or making modifications to the Form 4800-DA in the state of Texas.

This form is used for requesting access to a system or service in Texas and includes an agreement between the user and the provider.

This form is used for reporting any deficiencies found during an inspection of a facility in Texas and creating a plan to address and correct those deficiencies.

This Form is used for contractor referrals in the state of Texas.

This Form is used for reporting a death or service termination in the state of Texas. It is an official document that must be filled out and submitted according to the guidelines provided.

This document is used for reporting the summary of contract monitoring visits in Texas.

This form is used for obtaining consent for Health Insurance Premium Payment (HIPP) in Texas. It allows individuals to authorize and request the state to pay their health insurance premiums.

This form is used for enrolling in the Texas Enrollment Systems Attestation program. It is required for participating in the program.

This form is used for enrolling in the Texas Health Insurance Premium Payment (HIPP) Program and setting up direct deposit for insurance premium payments.

This form is used to apply for the Health Insurance Premium Payment (HIPP) Program in Texas.

This Form is used for granting consent to participate in the Health Insurance Premium Payment (HIPP) program in Texas.

This document is in Spanish and it is titled "Formulario 5022-S Forma De Deposito Directo Del Programa Hipp - Texas." It is a form used for direct deposit in the HIP program in Texas.

This form is used for changing your address in the state of Texas.

This Form is used for authorizing the use and release of health insurance information in the state of Texas.