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

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 receiving Community Living Assistance and Support Services (CLASS) or Community First Choice (CFC) benefits. This form helps solve the problem of accurately tracking and verifying the services provided, ensuring that recipients receive the necessary support and care.

The form is divided into several sections, including Person Information, Case Management Agency/Provider Agency Information, Pre-Enrollment Assessment Fees, Case Management Services, Direct Services, Record of Time, and Certification. Key features include required information such as service month and year, Medicaid number, social security number (for applicants only), agency type, name, and contract number. The form also includes sections for case management services, direct services, and record of time, which can be used to track the delivery of specific services.

This form should be used by service providers who deliver CLASS or CFC services, including case managers and direct services agencies. It is essential to complete this form accurately and thoroughly to ensure that recipients receive the necessary support and care. The form's certification section requires both the service provider and timekeeper to verify the accuracy of the information recorded.