Texas Health and Human Services Forms

This Form is used for terminating Medicaid Buy-In for Children in Texas (Spanish version).

This form is used for applying for a license to operate a chemical dependency treatment facility in the state of Texas. It must be completed and submitted to the appropriate regulatory agency for review and approval.

This form is used for renewing a license for a birthing center in Texas. It is an addendum to Form 3213.

This type of document is used for determining Medicaid eligibility for children in Texas in the previous months.

This document is used for designating a trusted person to make medical decisions on your behalf in Texas.

This Form is used for adding a second cardholder to the Lone Star Card in Texas. The form is available in both English and Spanish.

This form is used for applying for the Medicaid Buy-In for Children program in Texas.

This document is used for maintaining Social Security Numbers (SSN) in the state of Texas.

This form is used for meal providers to the homeless in Texas to submit an affidavit.

This document provides a checklist for parents in Texas to ensure their child's hearing is being properly assessed and monitored. It covers important aspects regarding hearing health and helps parents track their child's progress.

This Form is used for filing a first level appeal of a provider investigation finding in the state of Texas. It allows providers to dispute the findings and present their case for reconsideration.

This Form is used for filing a second level appeal regarding a provider investigation finding in Texas.

This document is used for developing a plan of operation for licensed center and home operations in Texas. It outlines the policies and procedures that must be followed to ensure the safety and well-being of children in these facilities.

This form is used for notifying the state of Texas about a satellite site of a chemical dependency treatment facility.

This form is used for attesting the optional co-payment for Covid-19 chip providers in Texas.

This document is used for reviewing DFPS reports and ANE trends in the state of Texas. It provides a structured form for analyzing and evaluating the reports and trends related to child welfare and protection in Texas.

This form is used for referring elderly and disabled individuals to the Medicaid for the Elderly and People with Disabilities program in Texas. The form acts as a cover sheet for the referral process.

This form is used for referring projects to residential treatment centers in Texas.

This Form is used for the Local Mental Health Authority (LMHA) or Local Behavioral Health Authority (LBHA) to submit their monthly report in Texas.