TX HHS Form 1052. Public Provider Choice Request

The Public Provider Choice Request Form (TX HHS Form 1052) is a crucial document issued by the Texas Health and Human Services (HHS) for individuals with intellectual and developmental disabilities. This form enables individuals to express their preference for a public provider of home and community-based services, such as the Local Intellectual and Developmental Disability Authority (LIDDA). The form is designed to facilitate informed decision-making and ensure that individuals receive the most suitable care.

The TX HHS Form 1052 is intended for use by individuals with intellectual and developmental disabilities who require public provider services. It provides a structured framework for individuals to articulate their needs, preferences, and reasons for choosing a specific public provider. The form also requires individuals to provide information about private providers they have contacted, if applicable, and explain why these providers are not suitable or desirable.

The Public Provider Choice Request Form (TX HHS Form 1052) is an essential tool for ensuring that individuals with intellectual and developmental disabilities receive the care and support they need. By completing this form, individuals can exercise their right to choose a public provider that best meets their needs and preferences. The form is designed to be user-friendly and easy to understand, making it accessible to individuals who require assistance in navigating the complex healthcare system.