TX HHS Form 1012. Mental Illness and Dementia Resident Review

The Texas Health and Human Services (HHS) issues the TX HHS Form 1012, Mental Illness and Dementia Resident Review, to determine whether further evaluation is needed for nursing facility residents with a current Negative PASRR Level 1 (PL1) Screening for Mental Illness. This form is designed to identify individuals who may require additional assessment due to mental illness or dementia.

The form consists of two main sections: Section A, which collects identifying information about the resident and the nursing facility, and Section B, which focuses on dementia review. In this section, healthcare professionals are asked to determine whether the individual has a primary diagnosis of dementia as defined by PASRR. If the answer is yes, the physician must sign and date the form attesting to the dementia diagnosis.

The TX HHS Form 1012 is an essential tool for healthcare providers and nursing facilities in Texas, ensuring that residents receive appropriate care and services. By completing this form, healthcare professionals can identify individuals who may require additional evaluation or treatment, ultimately improving the quality of life for these residents.