TX HHS Form 3074. Physician Certification of Terminal Illness

The TX HHS Form 3074, Physician Certification of Terminal Illness, is a crucial document that helps solve the problem of verifying a patient's terminal condition for Medicaid or Medicare hospice coverage. This form is typically used in situations where a patient has elected to receive hospice care and requires certification from their physician(s) to confirm their terminal illness.

The form requires specific information, including the patient's name, address, and medical identification numbers, as well as the physician's signature and date of certification. The form also includes conditions for oral verification, which must be obtained within two days of the election date and entered into the patient's hospice record by the hospice physician or RN.

The TX HHS Form 3074 is an essential tool for healthcare professionals to certify a patient's terminal illness and ensure that they receive the necessary Medicaid or Medicare hospice coverage. Key features include:

• Required information: patient name, address, medical identification numbers, and physician signature
• Conditions for oral verification: obtained within two days of election date and entered into patient's hospice record
• Situations where the form is used: verifying a patient's terminal condition for Medicaid or Medicare hospice coverage