TX HHS Form 1745. Service Delivery Log with Written Narrative/Written Summary

The TX HHS Form 1745, Service Delivery Log with Written Narrative/Written Summary, is a crucial document for tracking service delivery in Consumer Directed Services. This form helps employers and service providers maintain accurate records of services provided to individuals, ensuring compliance with Medicaid regulations.

This log requires the following information: employer name, service provider name, service type, hours worked, and a written narrative or summary of services delivered. The form also includes certifications from both the service provider and employer, confirming the accuracy of the submitted information. It is essential to note that submitting false or fraudulent time sheets can result in a Medicaid fraud referral.

Key features of this form include:

• The requirement for a written narrative or summary of services delivered
• The need for certifications from both the service provider and employer
• The importance of accurate and complete information submission
• The potential consequences of submitting false or fraudulent time sheets