Texas Health and Human Services Forms

This Form is used for verifying freedom of choice in Texas.

This form is used for assessing and authorizing Transition Assistance Services (TAS) in Texas.

This document is used for filing a complaint with the State Long-Term Care Ombudsman Program in Texas regarding regulatory services investigations for long-term care facilities.

This Form is used for filing a grievance regarding a certification decision made by the ombudsman in the state of Texas.

This document is for identifying, addressing, and resolving conflicts of interest in the state of Texas.

This Form is used for documenting and recording information related to the State Long-Term Care Ombudsman Program in Texas. It helps in maintaining a case record of individuals receiving long-term care services and their complaints, grievances, and resolutions.

This form is used for requesting an exception for tax payment in the state of Texas.

This form is used for notifying the deadline for Form 8592 in the state of Texas.

This form is used for requesting an exception for the payment of taxes in Texas.

This Form is used for requesting authorization for pre-enrollment in the Managed Health Mart (MHM) program in Texas.

This form is used for reporting long-term care ombudsman activities in Texas. It helps gather information about the ombudsman's work in addressing issues and resolving complaints in long-term care facilities.

This form is used for obtaining consent from individuals to release their records to the certified ombudsman in Texas.

This form is used for consenting to release records to the Certified Ombudsman in Texas. It allows for the sharing of information for the purpose of addressing grievances and advocating for elderly individuals in long-term care facilities.

This form is used for requesting a review of the individual plan of care (IPC) cost over the maximum cost ceiling in Texas.

This form is used for designating a Long-Term Care Ombudsman as a representative and requesting to appeal a nursing facility discharge in Texas.

This form is used for reporting criminal offenses in the state of Texas. It is a requirement to report criminal offenses and this form helps to streamline the process.

This form is used for maintaining continuity of care for patients in Texas. It helps healthcare providers ensure that the necessary medical information is shared between different healthcare settings and professionals, promoting seamless and coordinated care.

This form is used for evaluating the performance of interns in Texas. It assesses their overall performance during the internship period.

This Form is used for applying for admission to a State Supported Living Center (SSLC) in Texas.

This document is a Form 8665-S for a Person-Directed Plan in Texas. It is used for a specific type of plan in Texas.

This form is used for creating a person-directed plan in the state of Texas. It allows individuals to outline their specific goals, preferences, and support needs for their own care and services.

This form is used for submitting individual data for tax purposes in the state of Texas.

This form is used for volunteers in Texas to sign an agreement acknowledging their participation in an orientation session.

This form is used for individuals volunteering in Texas to provide a statement about their volunteer activities.

This document is for applying as a volunteer or intern in Texas.

This form is used for individuals in Texas to provide information regarding their criminal history.

This Form is used for disclosing criminal history in the state of Texas.

This form is used for the delivery and completion of purchase confirmation for ICF/IID ACD in Texas.

This form is used for obtaining consent from a person who is sponsoring an immigrant in the state of Texas. It is necessary for the sponsorship process.

This type of document is used for obtaining consent from the person sponsoring an immigrant in Texas.