TX HHS Form 3057. Kidney Health Care Program Physician Assessment

The TX HHS Form 3057, Kidney Health Care Program Physician Assessment, is a crucial document used when a signed and dated copy of the applicant's CMS 2728 form is not available. This form helps solve the problem of verifying an applicant's medical information for the Kidney Health Care Program.

This form requires the applicant's physician to provide essential information about the applicant's current treatment, including the type of treatment, start date at the current facility, and training details. The physician must also acknowledge that the facts on the form are true and correct by signing below.

The TX HHS Form 3057 is an important tool for healthcare professionals to provide accurate information about their patients applying for the Kidney Health Care Program. It should be used when a CMS 2728 form is not available, ensuring that the application process can proceed smoothly.