TX HHS Form 3612. Transfer Process Checklist

The TX HHS Form 3612, Transfer Process Checklist, is a crucial tool for service coordinators to facilitate the transfer of individuals from one program provider or Financial Management Services Agency (FMSA) to another. This form helps solve the problem of ensuring a smooth transition process that meets the individual's needs and preferences.

The key features of this form include the required information such as the individual's name, CARE ID, and legal guardianship details. The form also highlights important sections for reviewing the current individual plan of care (IPC) and developing a transfer IPC. Common scenarios of use include situations where an individual desires to transfer to a new provider or FMSA, and the service coordinator must facilitate this process within three days after notification.

This form should be used when an individual expresses their desire to transfer from one program provider or FMSA to another. The transfer process must begin within three days of notification and be completed within 10 days after the transfer effective date. Conditions explicitly mentioned in the text include the requirement for the service coordinator to review legal guardianship information, obtain signatures on Form 3612, and complete data entry in the HHSC data system.