TX HHS Form 2464. Rehabilitative Services Request

The TX HHS Form 2464, Rehabilitative Services Request, is a crucial document for individuals seeking rehabilitative services from the Therapy Department. This form helps solve the problem of requesting necessary therapies such as physical, speech, or occupational therapy to improve functional status.

This form requires specific information including the recipient's diagnosis, date of evaluation, and primary medical diagnosis. It also asks about the individual's functional status at present and 30-day goals. The form must be complete before it can be reviewed. Key features include the need for a diagnosis of intellectual disability, cerebral palsy, development delay, or closed head injury before the age of 22 years, as well as the requirement to establish a plan of care for staff to follow and discharge the patient.

The form is typically filled out by individuals seeking rehabilitative services from the Therapy Department. It is essential to note that ROM, splinting, positioning, wound care, pain management, sensory stimulation, and/or staff/family training are not covered in this program. The form also emphasizes the importance of making significant measurable progress to qualify for recertification.

• The form is used by individuals seeking rehabilitative services from the Therapy Department.
• The form requires specific information including diagnosis, date of evaluation, and primary medical diagnosis.
• The form must be complete before it can be reviewed.