TX HHS Form 1058. Request for Home and Community-based Services Crisis Diversion Slot

The TX HHS Form 1058, Request for Home and Community-based Services Crisis Diversion Slot, is a crucial tool for individuals with intellectual or developmental disabilities who require urgent support. This form helps address crisis situations where immediate assistance is needed to prevent hospitalization, institutionalization, or other adverse outcomes.

This form is typically used in emergency situations when an individual's primary caregiver is unavailable, they are experiencing behavioral issues, or they have been discharged from a facility and need alternative care arrangements. The form requires information about the local Intellectual and Developmental Disability Authority (LIDDA), the person being served, including their diagnosis and suspected intellectual disability or related condition. Additionally, it asks for details on the reason for requesting crisis diversion services and any organizations or advocates currently assisting the individual.

To facilitate a timely response, this form must be completed with accurate and relevant information. Key features include the LIDDA's contact person, phone number, and email address, as well as the person's diagnosis, suspected intellectual disability, and reason for requesting crisis diversion services. By filling out this form, individuals can ensure that they receive the necessary support to prevent a crisis situation from escalating further.

• This form is used in emergency situations where immediate assistance is needed to prevent adverse outcomes.
• The form requires information about the local Intellectual and Developmental Disability Authority (LIDDA) and the person being served, including their diagnosis and suspected intellectual disability or related condition.