TX HHS Form 2464. Rehabilitative Services Request

The TX HHS Form 2464, Rehabilitative Services Request, is a crucial document for individuals seeking rehabilitation services. This form helps solve the problem of requesting necessary therapy services to improve functional status and overall well-being.

This form requires important information such as the recipient's diagnosis, date of evaluation, primary medical diagnosis, and Medicare provider number. The form also asks about the individual's current functional status and 30-day goals, which are essential for establishing a plan of care. Additionally, the form notes that certain services like ROM, splinting, positioning, wound care, pain management, sensory stimulation, and staff/family training are not covered in this program.

The TX HHS Form 2464 should be used when an individual requires rehabilitative services such as physical therapy (PT), speech therapy (ST), occupational therapy (OT), or social security benefits. The form is specifically designed for individuals with a diagnosis of intellectual disability, cerebral palsy, development delay, or closed head injury before the age of 22 years. Note that if the recipient has one of these diagnoses, they should complete Form 2465, Specialized Services Request, instead.