TX HHS Form 1349. Drug Utilization Review Board Annual Disclosure

The TX HHS Form 1349, Drug Utilization Review Board Annual Disclosure, is a crucial document that helps solve the problem of ensuring accurate and timely disclosures from individuals appointed to the Texas Vendor Drug Program's Drug Utilization Review Board. This form is typically used in situations where an individual is initially applying to the board or has been appointed and needs to submit their annual attestation.

This form requires the submission of personal information, including name, home address, office/work mailing address, phone numbers, email addresses, and a travel point of contact. Additionally, individuals must provide the name, title, and contact information of their representative who will work with Vendor Drug Program staff to coordinate travel reimbursement for DUR board meetings in Austin.

Key features of this form include the requirement for annual submissions as part of the attestation process. The form also outlines specific procedures for submitting personal information and designating a representative for travel coordination. By completing and submitting this form, individuals can ensure compliance with program requirements and facilitate efficient processing of their travel reimbursement claims.

• This form is used by individuals appointed to the Texas Vendor Drug Program's Drug Utilization Review Board.
• The annual submission is required as part of the attestation process.
• Personal information, including name and contact details, must be provided.