Form Title
0702 Fax Cover Sheet for TxHmL and HCS
1572 Informacion en espanol Nursing Tasks Screening Tool
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
1592 RN Delegation Checklist
1740 Informacion en espanol Service Backup Plan
1741 Informacion en espanol Corrective Action Plan
1742 Service Backup Plan for HCS, TxHmL and CFC Services
1744 TxHmL/CFC Entrance Conference
1746 HCS/TxHmL/CFC Exit Conference
2124 Community Support Transportation Log
3598 Individual Transportation Plan
3610 Informal Review Request
3611 Involuntary Termination of Consumer Directed Services (CDS) Individual Plan of Care (IPC) Cover Sheet (HCS and TxHmL)
3612 Transfer Process Checklist
3615 Request to Continue Suspension of Waiver Program Services
3616 Request for Termination of Services Provided by HCS/TxHmL Waiver Provider
3617 Request for Transfer of Waiver Program Services
4116-Dental Dental Summary Sheet
4116-MHM-AA Minor Home Modification/Adaptive Aids Summary Sheet
4117 Supported Employment/Employment Assistance Service Delivery Log
4118 Respite Service Delivery Log
4120 Day Habilitation Service Delivery Log
5607 Review of DFPS Reports and ANE Trends
5608 Waiver Survey and Certification TxHmL DFPS Checklist
5611 Personnel Checklist
5842 TxHmL Financial Eligibility Information
8492 Random Sample Review of Nursing On-Call Required Submission of Documentation
8493 Notification Regarding a Death in HCS, TxHmL and DBMD Programs
8494 Notification Regarding An Investigation of Abuse, Neglect or Exploitation
8509 Unlicensed Personnel Tracking of Delegated Tasks
8510 HCS/TxHmL CFC PAS/HAB Assessment
8511 Understanding Program Eligibility
8572 TxHmL Individual Profile Information
8574 Administration of Medications by Unlicensed Personnel
8575 Notification of Local Authority (LA) Reassignment
8578 Intellectual Disability/Related Condition Assessment
8580 Request for Variance of Supported Employment - Employer Requirements
8581 Corrective Action Plan Form
8582 Individual Plan of Care - TxHmL/CFC
8583 Informacion en espanol HCS and TxHmL Program Contact Information
8584 Nursing Comprehensive Assessment
8586 Informacion en espanol TxHmL Service Coordination Notification
8599 Individual Plan of Care (IPC) Cover Sheet
8601 Informacion en espanol Verification of Freedom of Choice
8608 Sample Appeal Letter
8627 Request for Review of Individual Plan of Care (IPC) Cost Over Maximum Cost Ceiling Cover Sheet
8628 Request to Increase in Service Category Limits Worksheet
8662 Related Conditions Eligibility Screening Instrument

Informacion in espanol = form also available in Spanish.