TX HHS Form 3069. Health Care Services Record

The TX HHS Form 3069, Health Care Services Record, is a crucial document that helps track and manage healthcare services provided to indigent patients in Texas. This form is typically used by healthcare providers to record the date of service, billed amount, paid amount, and date paid for various health care services.

The form requires essential information such as the date of service, date received, billed amount, paid amount, and date paid. It also includes space for recording additional details about the patient's health care services. This document is an important tool for healthcare providers to maintain accurate records of their patients' health care services and to ensure that all necessary information is captured.

This form is essential for healthcare providers who participate in the Texas Indigent Health Care Program, as it helps them keep track of the health care services they provide to eligible patients. By using this form, healthcare providers can ensure that they are meeting their responsibilities under the program and providing high-quality care to those who need it most.

• This form is used by healthcare providers to record health care services provided to indigent patients in Texas.
• The form requires essential information such as date of service, billed amount, paid amount, and date paid.
• This document is an important tool for healthcare providers to maintain accurate records of their patients' health care services.