TX HHS Form 1349. Drug Utilization Review Board Annual Disclosure

The Texas Health and Human Services (HHS) Form 1349, Drug Utilization Review Board Annual Disclosure, serves as an annual attestation for individuals appointed to the Drug Utilization Review Board. This form requires personal information, including name, home address, office/work mailing address, phone numbers, email addresses, and fax numbers.

The purpose of this form is to provide essential details about the individual's contact information, allowing the Vendor Drug Program staff to coordinate travel reimbursement for DUR board meetings in Austin. Additionally, the form requests the name and contact information of a representative who will work with program staff on processing travel reimbursements.

This annual disclosure form is used by HHS to maintain accurate records and ensure effective communication with appointed members of the Drug Utilization Review Board. By submitting this form, individuals demonstrate their commitment to transparency and cooperation with the Vendor Drug Program. The form can be completed and submitted electronically to [email protected] or [email protected].