TX HHS Form 1066. Transfer Request for PASRR DME and CMWC

The Texas Health and Human Services (HHS) Form 1066, Transfer Request for PASRR DME and CMWC, serves as a crucial tool for nursing facility residents who require the transfer of previously approved durable medical equipment (DME) or custom manual wheelchairs (CMWC). This form is specifically designed for individuals who have been identified as Preadmission Screening and Resident Review (PASRR) positive.

The purpose of this form is to facilitate the transfer of DME or CMWC from a discharging nursing facility to an admitting nursing facility. The form requires identifying information about the resident and their legally authorized representative, as well as details about the discharging and admitting facilities. Additionally, the form necessitates the submission of a "Receipt Certification" on the LTC Portal by the admitting facility once the DME or CMWC is delivered.

This form is essential for ensuring a seamless transition of necessary medical equipment or wheelchairs between nursing facilities. By completing Form 1066, healthcare providers and administrators can streamline the process of transferring approved DME or CMWC, ultimately improving the quality of care for residents. The Texas HHS issues this form to ensure compliance with PASRR regulations and promote efficient communication among healthcare professionals.