TX HHS Form 3106. Comprehensive Rehabilitation Services Referral

The Comprehensive Rehabilitation Services Referral Form 3106 helps solve the problem of referring individuals in need of rehabilitation services to the appropriate providers. This form is typically used in situations where an individual requires comprehensive rehabilitation services due to a traumatic injury or condition. The form is designed for healthcare professionals, such as treating physicians and trauma nurse coordinators, to refer patients to Texas Health and Human Services (HHS) Comprehensive Rehabilitation Services.

The form requires key information, including the individual's name, contact details, medical records, and diagnosis. It also asks about the individual's language preference and whether they have a medical power of attorney or guardian. The form must be completed in its entirety and accompanied by all necessary supporting documentation before submission. Mandatory questions are denoted by asterisks.

The Comprehensive Rehabilitation Services Referral Form 3106 is an essential tool for healthcare professionals to facilitate the referral process. Key points include:

• Required information includes individual's name, contact details, medical records, and diagnosis
• Mandatory questions are denoted by asterisks
• The form must be completed in its entirety and accompanied by supporting documentation before submission
• The form is designed for healthcare professionals to refer patients to Texas HHS Comprehensive Rehabilitation Services