TX HHS Form 3625. CLASS and CFC Documentation of Services Delivered

The TX HHS Form 3625, CLASS and CFC Documentation of Services Delivered, is a crucial tool for service providers to document the services they deliver to individuals with disabilities or chronic conditions. This form helps solve the problem of tracking and recording the services provided, ensuring that accurate records are kept for billing, reimbursement, and compliance purposes.

The form requires specific information from the service provider, including details about the person receiving services, the agency providing services, and the services delivered. Key features include the pre-enrollment assessment fees, case management services, direct services, and record of time in or out. The form also includes a certification section where the service provider and timekeeper verify the accuracy of the information recorded.

This form is typically used by Community Living Assistance and Support Services (CLASS) and Community First Choice (CFC) agencies to document services delivered to individuals with disabilities or chronic conditions. Key points to note include:

• The form requires specific information about the person receiving services, including Medicaid number and Social Security number.
• The form must be completed by the service provider and timekeeper for each service delivery.
• The certification section ensures that the accuracy of the recorded information is verified.