0702 | Fax Cover Sheet for TxHmL and HCS | |
1572 | Nursing Tasks Screening Tool | ES |
1581 | Consumer Directed Services Option Overview | ES |
1582 | Consumer Directed Services Responsibilities | ES |
1583 | Employee Qualification Requirements | ES |
1584 | Consumer Participation Choice | ES |
1586 | Acknowledgement of Information Regarding Support Consultation Services in the Consumer Directed Services (CDS) Option | ES |
1592 | RN Delegation Checklist | |
1740 | Service Backup Plan | ES |
1741 | Corrective Action Plan | ES |
1742 | Service Backup Plan for HCS, TxHmL and CFC Services | |
1744 | TxHmL/CFC Entrance Conference | |
2124 | Supported Home Living/Community Support Transportation Log | ES |
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) | |
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 | ES |
5842 | TxHmL Financial Eligibility Information | |
8401 | Employment First Discovery Tool | |
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 | |
8582 | Individual Plan of Care - TxHmL/CFC | |
8583 | HCS and TxHmL Program Contact Information | ES |
8584 | Nursing Comprehensive Assessment | |
8586 | TxHmL Service Coordination Notification | ES |
8599 | Individual Plan of Care (IPC) Cover Sheet | |
8601 | Verification of Freedom of Choice | ES |
8608 | Sample Appeal Letter | |
8627 | Request for Review of Individual Plan of Care (IPC) Cost Over Maximum Cost Ceiling Cover Sheet | |
8662 | Related Conditions Eligibility Screening Instrument | |