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 to request modifications to their living spaces. This form is typically used in situations where an individual requires adaptive aids, medical supplies, or minor home modifications to ensure their safety and well-being.

The form requires the individual's name, Medicaid number, and physical address of the location to be modified. The individual must also provide specifications for the item/service to be purchased, which may include attaching additional documentation to the form. Additionally, the form needs to be signed by the individual or their legally authorized representative (LAR), as well as a case management agency representative.

The TX HHS Form 3849-A is an essential tool for ensuring that individuals with disabilities or medical needs receive the necessary support and accommodations to live independently. Key features of this form include required information, such as the individual's name and address, as well as specifications for the requested modifications. By filling out this form, individuals can request the adaptive aids, medical supplies, or minor home modifications they need to thrive in their daily lives.

• The form is used by individuals with disabilities or medical needs who require adaptive aids, medical supplies, or minor home modifications to ensure their safety and well-being.
• The form requires the individual's name, Medicaid number, and physical address of the location to be modified.
• The form must be signed by the individual or their legally authorized representative (LAR), as well as a case management agency representative.