TX HHS Form 1027. Caregiver Status Questionnaire

The Caregiver Status Questionnaire (TX HHS Form 1027) is a tool used by Texas Health and Human Services (HHS) to gather information about individuals who require care and the unpaid caregivers assisting them. The questionnaire aims to identify caregivers providing support with daily activities, such as shopping, household tasks, meal preparation, doctor's visits, or personal care.

The purpose of this form is to determine whether an individual has an unpaid caregiver who helps them with these essential activities. If a caregiver is identified, the interviewer will ask additional questions to gather contact information and discuss resources available to support the caregiver. This information enables HHS staff to provide targeted assistance and services to both the care recipient and their caregiver.

This questionnaire is designed for use by HHSC staff, who will insert specific references as needed. The form is an essential tool in the intake process, allowing staff to efficiently gather necessary information and provide appropriate support to individuals requiring care and their unpaid caregivers. By completing this questionnaire, HHS can better serve its clients and ensure they receive the resources and services they need.