TX HHS Form 0011. Consent to Transfer to a Texas State Operated Facility

The Texas Health and Human Services (HHS) Form 0011, Consent to Transfer to a Texas State Operated Facility, is a crucial document for individuals seeking treatment, rehabilitation, or habilitation at a state-operated facility. This form serves as a consent mechanism, allowing the individual to request a referral to another state-operated facility.

This form is designed for use by individuals who are currently receiving services at a Texas state-operated facility and wish to transfer their care to another such facility. The document explains the purpose of the form, the individual's right to withdraw consent at any time, and the importance of understanding the contents of the form.

The completed Form 0011 must be submitted electronically or by mail to the Texas Interstate Compact Coordinator, who is responsible for ensuring compliance with state and federal privacy regulations. The submission process involves including an Authorization for Release of Information, which is essential for maintaining confidentiality and adhering to relevant laws and guidelines.