Form Title
0090-I Notice of Admission, Departure, Readmission or Death of an Applicant/Recipient of Supplemental Security Income and/or Medical Assistance Only in a State Institution
1038 Medical Facility Referral
1205 Trust Fund Monitoring Findings
1207 Notification of Eligibility Special Medicaid Programs
1207-S Notification of Eligibility Special Medicaid Programs (Spanish)
1214 Request for Pension Information
1214-TSI Request for Pension Information - TSI
1220 Patient Trust Fund Monitoring Report
1230 Notification of Eligibility - Regular Medicaid Benefits
1230-TP-30-Att Notification of Eligibility - Emergency Medicaid Program
1232 Notification of Ineligibility
1235 Notice of Appointment or Delay
1247 Notice of Delay in Certification
1259 Correction of Applied Income
1290 Long Term Care Claim
2076 Authorization to Release Medical Information
3600 Application for Participation in Title XIX Medicaid: ICF/IID, Nursing Facility or Rural Hospital Swingbed Program
3604 Ownership Transfer Affidavit
3641 Alzheimer's Assisted Living Disclosure Statement
3643 Nursing Restorative Care Report
3645 Monthly Medicaid Occupancy Report
3646 Request for Formal Hearing
3707 Fire Report for Long Term Care Facilities
3716 Application to Increase Licensed Capacity of a Long-Term Care Facility
3720-N Application for Nursing Facility License and Participation in Title XIX Medicaid
3725 Licensure Change of Ownership Affidavit
4719 Fire Drill Report
4732 Nongovernmental Contractor Certification
4732-A Nongovernmental Contractor Certification (Part II)
8730 Nursing Facility Augmentative Communication Device (ACD) System Authorization
H1200 Application for Assistance - Your Texas Benefits

Informacion in espanol = form also available in Spanish.