TX HHS Form 2110. Community Care Intake

The TX HHS Form 2110, Community Care Intake, is a crucial document that helps solve the problem of assessing an individual's needs for community care services. This form is typically used in situations where an individual requires assistance with daily living activities or has complex healthcare needs. The form is usually filled out by the individual themselves, or on their behalf by a caregiver or social worker.

The form requires specific information to be provided, including personal details such as name, date of birth, and address. It also asks about the individual's marital status, language preference, and whether they have a referral from another agency. The form further inquires about the individual's living arrangement, Medicare status, and current hospital or nursing facility stay.

The key features of this form include the need for the individual to declare their resources and income, as well as describe their caregiving arrangement. The form also asks about specific needs such as nursing tasks, administration of medications, meal preparation, bathing, toileting, mobility, and other daily living activities. By completing this form, individuals can receive the necessary community care services to support their daily lives.

• This form is used for assessing individual's needs for community care services
• Typically filled out by the individual themselves or on their behalf by a caregiver or social worker
• Requires specific information such as personal details, marital status, and language preference
• Aids in determining the individual's caregiving arrangement and daily living needs