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 tool used to facilitate the transfer of services between different providers or agencies for individuals receiving Community Living Assistance and Support Services (CLASS) or First Choices (CFC) Intensive Personal Care (IPC) services. This form helps solve the problem of ensuring a seamless transition of care when an individual's service needs change.

This worksheet requires information such as the effective period, transfer type, and transfer date for the IPC service delivery. It also includes sections for case management agencies, direct services agencies, and other relevant providers. The form is typically used in scenarios where an individual's service needs are changing, such as when they move to a new location or require additional support.

The form highlights important information, including the required fields for HHS use only, and mentions specific types of services that may be involved, such as dental, occupational, and speech therapy. The TX HHS Form 3621-T is an essential tool for ensuring continuity of care and supporting individuals with complex service needs.