TX HHS Form 3691-A. Service Area Designation HCS. TxHmL. CDS and TAS

The TX HHS Form 3691-A, Service Area Designation for HCS, TxHmL, CDS, and TAS, is a crucial document that helps solve the problem of designating service areas for various programs. This form is typically used in situations where healthcare services need to be designated or re-designated across different regions. The form is usually completed by legal entities, such as healthcare providers, organizations, or government agencies.

The form consists of two main sections: Section 1, which requires legal entity information, and Section 2, which designates service areas by region. The conditions for completing the form are clearly stated in the text, with specific instructions on when to skip certain sections based on contract type. For instance, if the contract type is CDS-CLASS, users should skip Section 2 and complete Section 3 instead.

Key features of this form include the requirement for legal entity information and the designation of service areas by region. The form also outlines specific responsibilities and follow-up actions that need to be taken. For instance, if a contract type is CDS-HCS or CDS-TxHmL, users should skip Section 2 and complete Section 4 instead. By using this form, healthcare providers and organizations can ensure compliance with regulations and provide essential services to their communities.

• This form is used for designating service areas for various programs, including HCS, TxHmL, CDS, and TAS.
• The form consists of two main sections: Section 1 (Legal Entity Information) and Section 2 (Service Areas by Region).
• Users should skip certain sections based on contract type, as specified in the form.