TX HHS Form 2604. STAR Kids Individual Service Plan Service Tracking Tool

The STAR Kids Individual Service Plan - Service Tracking Tool (Form 2604) is a practical tool designed to help facilitate the delivery of services to medically dependent children in Texas. This form is used to track individual service plans and monitor progress towards achieving specific goals and objectives.

This form requires essential information, including date of birth, Medicaid number, social security number, ISP effective dates, type of authorization, county, plan code start and end dates, CDS option, service category, estimated annual service units, and total estimated waiver costs. The form also includes spaces for recording minor home modifications, transition assistance services, and patient-driven payment model long-term care (PDPM LTC) level managed care organization name.

The STAR Kids Individual Service Plan - Service Tracking Tool is an essential tool for service coordinators, caregivers, and healthcare professionals working with medically dependent children. By using this form, they can ensure that individualized services are delivered effectively and efficiently, and that progress towards achieving specific goals and objectives is tracked and monitored.

• This form is used to track individual service plans and monitor progress towards achieving specific goals and objectives.
• It requires essential information, including date of birth, Medicaid number, social security number, ISP effective dates, type of authorization, county, plan code start and end dates, CDS option, service category, estimated annual service units, and total estimated waiver costs.