TX HHS Form 1049. Initial Documentation of Provider Choice

The TX HHS Form 1049, Initial Documentation of Provider Choice, is a crucial document that helps individuals with intellectual and developmental disabilities (IDD) or their legally authorized representatives (LARs) make informed decisions about their care. This form is used in situations where an individual requires Home and Community-based Services (HCS) or Texas Home Living (TxHmL) services.

The form collects essential information from the LIDDA (Local Intellectual and Developmental Disability Authority) contact, including the provider's legal name, doing business as name, contract number, and component code. Additionally, it requires the person's information, such as printed name and title of the LAR or representative. The form also includes an acknowledgement section where the individual or their representative confirms receipt of a list of available providers in their service area and understands that they can transfer to another provider at any time.

This form is essential for ensuring that individuals with IDD receive the care and support they need while empowering them to make choices about their services. Key features of this form include the requirement for LIDDA contact information, provider details, and acknowledgement of available providers in the service area. By completing this form, individuals can initiate or modify their HCS or TxHmL services, making it a critical step in the process.

• This form is used by individuals with intellectual and developmental disabilities (IDD) or their legally authorized representatives (LARs).
• The form collects essential information from LIDDA contacts, including provider details and person's information.
• It requires acknowledgement of available providers in the service area and understanding of transfer options.