TX HHS Form 3617. Request for Transfer of Waiver Program Services

The TX HHS Form 3617, Request for Transfer of Waiver Program Services, is a crucial document that facilitates the transfer of waiver program services from one provider to another. This form helps solve the problem of individuals with intellectual or developmental disabilities who need to change their service providers while maintaining continuity of care.

This form should be used when an individual or their legally authorized representative wants to transfer their waiver program services to a new provider. Key features include required information such as person details, transferring and receiving program provider information, and LIDDA and SC data. The form also includes sections for emergency transfers, which require supporting documentation.

The TX HHS Form 3617 is an essential tool for individuals with intellectual or developmental disabilities who need to transfer their waiver program services. By completing this form, individuals can ensure a smooth transition of care while maintaining the continuity and quality of services provided by their new program provider.