TX HHS Form 3094. Application for Program Benefits

The TX HHS Form 3094, Application for Program Benefits, is a crucial document that helps individuals apply for healthcare assistance through the Epilepsy Program. This form can be completed by anyone seeking benefits, including those who are applying on behalf of a child.

This application requires applicants to provide personal information, including their name, date of birth, and contact details. Additionally, applicants must indicate their preferred method of communication and language spoken. The form also asks about immediate medical needs and whether the applicant is a veteran or former military service member. It's essential to note that this form can be used in situations where individuals need healthcare assistance, such as those with epilepsy or other health conditions.

The TX HHS Form 3094 is designed to be completed by the primary responsible adult or adult applicant. Key features of this form include the requirement for comprehensive health care coverage information and the option to authorize healthcare providers to contact applicants via voice mail or text messaging. By completing this form, individuals can gain access to essential healthcare benefits and services. Here are some key points to keep in mind:

• This form is used to apply for healthcare assistance through the Epilepsy Program.
• The application requires personal information, including name, date of birth, and contact details.
• The form asks about immediate medical needs and whether the applicant is a veteran or former military service member.
• This form can be used in situations where individuals need healthcare assistance, such as those with epilepsy or other health conditions.