TX HHS Form 3619. Medicare/Skilled Nursing Facility Patient Transaction Notice

The TX HHS Form 3619, Medicare/Skilled Nursing Facility Patient Transaction Notice, is a crucial document that helps resolve issues related to patient transactions in skilled nursing facilities. This form is typically used in situations where patients are transitioning from hospitals or other institutions to skilled nursing facilities, and it provides a record of the transaction details.

The form requires essential information such as the patient's Medicaid recipient number, social security number, Medicare claim number, name, address, vendor number, provider number, service group, and dates of qualifying stay. It also includes spaces for comments and state board license numbers. The administrator must certify that they have reviewed the transaction details and confirm that the date of above transaction is accurate.

The TX HHS Form 3619 plays a vital role in ensuring transparency and accountability in patient transactions. Key features include:

• Required information for patient identification and transaction tracking
• Spaces for comments to provide additional context or explanations
• Certification by the administrator to ensure accuracy and authenticity