TX HHS Form 3849-A. Specifications for Adaptive Aids/Medical Supplies/Minor Home Modifications

The TX HHS Form 3849-A, "Specifications for Adaptive Aids/Medical Supplies/Minor Home Modifications," is a crucial document that helps individuals with disabilities or medical needs request modifications to their living spaces. This form should be used when an individual requires adaptive aids, medical supplies, or minor home modifications to ensure safe and comfortable living conditions.

This form is divided into four sections: Section I - Direct Service Agency (DSA) Individual's Information; Section II - Individual/Legally Authorized Representative (LAR); Section III - Case Management Agency; and Section IV - Landlord/Property Owner. The required information includes the individual's name, Medicaid number, physical address of the location to be modified, and specifications for the requested item or service. The form also requires signatures from the person writing the specifications, DSA representative, case manager, and landlord/property owner (if applicable).

This form is an essential tool for individuals with disabilities or medical needs who require adaptive aids, medical supplies, or minor home modifications to maintain their independence and quality of life. By providing clear and detailed specifications, this form helps ensure that the requested modifications are implemented correctly and safely.