TX HHS Form 3054. Primary Home Care Service Delivery Record

The TX HHS Form 3054, Primary Home Care Service Delivery Record, is a crucial tool for healthcare professionals to document the services provided to individuals receiving primary home care. This form helps solve the task of accurately recording the time and tasks performed by caregivers, ensuring that clients receive the necessary support and attention.

The form requires essential information such as the employee's name and number, individual's name and number, and the tasks assigned, including bathing, meal preparation, and exercising. The "Scheduled or Authorized Hours" section allows for precise time tracking, while the "Record of Time" section provides a space to note any additional hours worked. This form should be used by caregivers and healthcare professionals to document their services and ensure that clients receive the necessary support.

This form is an important tool for Texas Health and Human Services (HHS) and other healthcare organizations to maintain accurate records and provide quality care to individuals receiving primary home care services. By completing this form, caregivers can certify that they have worked the recorded hours and completed the assigned tasks, ensuring transparency and accountability in their work.