TX HHS Form 3621-T. CLASS and CFC IPC Service Delivery Transfer Worksheet

The TX HHS Form 3621-T, CLASS and CFC IPC Service Delivery Transfer Worksheet, is a practical tool designed to facilitate the transfer of services between Community Living Assistance and Support Services (CLASS) or First Choices (CFC) providers. This form helps solve the problem of ensuring seamless continuity of care for individuals receiving services by streamlining the process of transferring service delivery.

The form requires specific information, including the effective period of the transfer, type of transfer, and transfer date. It also outlines responsibilities for both the current and new service providers, as well as follow-up actions to be taken. The worksheet is typically filled out by case management agencies or direct services agencies, ensuring that all necessary details are captured and communicated effectively.

Key features of this form include the provision of specific spaces for required information, such as the type of services being transferred (e.g., PT, OT, Speech Therapy). Additionally, the form includes sections for dental, vision, and hearing services, as well as nursing services. This comprehensive approach helps ensure that all aspects of an individual's care are considered during the transfer process.

• The TX HHS Form 3621-T is used to facilitate the transfer of services between CLASS or CFC providers.
• The form requires specific information, including effective period, type of transfer, and transfer date.
• The worksheet is typically filled out by case management agencies or direct services agencies.