Form Title
1581 Informacion en espanol Consumer Directed Services Option Overview
1582 Informacion en espanol Consumer Directed Services Responsibilities
1583 Informacion en espanol Employee Qualification Requirements
1584 Informacion en espanol Consumer Participation Choice
1586 Informacion en espanol Acknowledgement of Information Regarding Support Consultation Services in the Consumer Directed Services (CDS) Option
1740 Informacion en espanol Service Backup Plan
2067 Case Information
2124 Community Support Transportation Log
3594 Individual Plan of Care (IPC) Cover Sheet
3596 PAS/Habilitation Plan - CLASS/DBMD/CFC
3598 Individual Transportation Plan
3627 Specialized Nursing Certification
3628 Provider Agency Model Service Backup Plan
4800-D Fair Hearing Request Summary
4800-DA 4800-D Addendum
6500 Individual Plan of Care (IPC) - DBMD/CFC
6500-T IPC Service Delivery Transfer Worksheet
6501 Individual Program Plan
6502 Denial of Application for DBMD
6503 DBMD Summary of Services Delivered
6504 Prior Authorization for Dental Services
6505 Daily Census Documentation
6507 Rationale for Adaptive Aids, Medical Supplies, and Minor Home Modifications
6508 Specifications for Minor Home Modifications
6510 Decline of Offer for Deaf Blind with Multiple Disabilities (DBMD) Program Enrollment
6515 CLASS/DBMD Nursing Assessment
8001 Informacion en espanol Medicaid Estate Recovery Program Receipt Acknowledgement
8493 Notification Regarding a Death in HCS, TxHmL and DBMD Programs
8507 Understanding Program Eligibility - CLASS/DBMD
8578 Intellectual Disability/Related Condition Assessment
8598 Non-Waiver Services
8601 Informacion en espanol Verification of Freedom of Choice
8604 Transition Assistance Services (TAS) Assessment and Authorization
8605 Documentation of Completion of Purchase
8662 Related Conditions Eligibility Screening Instrument
H1010 Informacion en espanol Texas Works Application for Assistance - Your Texas Benefits (English and Spanish)
H1200 Application for Assistance - Your Texas Benefits
H1200-EZ Application for Assistance - Aged and Disabled (Large Print)
H1746-A MEPD Referral Cover Sheet
H1746-B Batch Cover Sheet
H3034 Informacion en espanol Disability Determination Socio-Economic Report
H3035 Informacion en espanol Medical Information Release/Disability Determination

Informacion in espanol = form also available in Spanish.