Texas Health and Human Services Forms

This form is used for authorizing the release of medical information in the state of Texas.

This form is used for communicating with managed care programs in Texas. It is used to provide information or request assistance related to healthcare services.

This form is used for collecting data on the different tiers in Texas.

This form is used for the Star+plus Home and Community Based (HCBS) Program in Texas. It is for individuals who need long-term care services and want to receive these services in their home or community instead of a nursing facility. The form gathers information about the individual's eligibility and helps determine their level of care needs.

This form is used for confirming continued interest in the Star+Plus Home and Community Based Services Program (HCBS) in Texas. It is a program that provides home and community-based services for eligible individuals.

This Form is used for confirming interest in the Home and Community Based Services (HCBS) Program - Star+PLUS in Texas.

This form is used for applying for Medicaid in Texas specifically for breast and cervical cancer patients.

This form is used for reporting instances of noncooperation in the state of Texas.

This form is used for transmitting choices information in the state of Texas.

This form is used for applying for Medicaid coverage for breast and cervical cancer in Texas.

This form is used for referring individuals to workforce orientation in the state of Texas.

This form is used for granting authorization to disclose medical information in Texas.

This form is used for TANF recipients in Texas who are applying for an employment hardship exemption. It is a job search worksheet that helps individuals document their efforts to find a job while experiencing certain hardships.

This form is used for conducting a needs assessment in Texas. It includes a questionnaire and task/hour guide to determine an individual's eligibility for certain services.

This form is used for gathering information about the socio-economic situation of individuals applying for disability benefits in the state of Texas.

This form is used for releasing medical information and determining disability in the state of Texas.

This form is used for reporting a pregnancy in the state of Texas.

This form is used for reporting a pregnancy in the state of Texas. It is available in both English and Spanish.

This document is used in Texas for obtaining authorization to disclose medical information or determine disability.

This Form is used for reporting the results of a physical or mental examination in the state of Texas. It is used to provide crucial information to the relevant authorities for evaluation and decision-making processes.

This form is used for reporting Qi transactions in the state of Texas. It provides information on the transactions made by a Qualified Intermediary (Qi) in real estate exchanges.

This form is used for providing a notice to residents regarding transactions made with designated vendor numbers in Texas.

This form is used for certifying emergency medical services for the Chip Perinatal program in Texas. It is available in both English and Spanish.

This Form is used for creating a money receipt in the state of Texas. It is used to document the receipt of funds in various transactions.

This form is used for acknowledging the receipt of an application in the Texas Health and Human Services Commission (HHSC).

This Form is used for obtaining an Out Card from the Texas Health and Human Services Commission (HHSC). An Out Card allows individuals to temporarily leave a HHSC facility and return within a specified period.

This Formulario H3675-S is used to acknowledge receipt of a solicitud (application) in Texas.

This form is used for recording money receipts in Texas, and it is available in both English and Spanish.

This form is used for obtaining authorization to conduct a pre-enrollment assessment for managed care in the state of Texas.

This form is used for notifying qualifying individuals in Texas about their eligibility for the Qualifying Individuals Program. It is available in both English and Spanish.