TX HHS Form 3050. DAHS Health Assessment or Individual Service Plan

The TX HHS Form 3050, DAHS Health Assessment or Individual Service Plan, is a crucial tool for healthcare professionals to assess the functional and physical status of individuals receiving Day Activity and Health Services (DAHS). This form helps identify potential problems, conditions, and symptoms experienced within the last 30 days, enabling caregivers to develop personalized plans for improving health outcomes.

The form consists of five sections: Identification and Background Information, Assessment of Functional/Physical Status, Alteration in Nutrition/Metabolism, Elimination, Cardiac/Respiratory Status, Skin, Body Control, Neurological Status. Key features include the required Medicaid ID Number, Start of Care Date, and Sex information. The form also allows for comments and additional space for recording observations.

This form is typically used when an individual requires DAHS to address specific health concerns or needs. Common scenarios of use include assessing individuals with chronic conditions, such as diabetes or heart disease, or those experiencing cognitive decline or mobility issues. By completing this form, healthcare professionals can develop targeted care plans that cater to the unique needs and circumstances of each individual.