TX HHS Form 4116-Dental. Dental Summary Sheet

The TX HHS Form 4116-Dental, also known as the Dental Summary Sheet, is a crucial document for tracking dental services provided to clients. This form helps solve the problem of accurately recording and reporting dental care services, ensuring that all necessary information is captured and easily accessible.

This summary sheet requires key information such as service date, dollars spent, and requisition fee, as well as the client's care ID number and contact details. The form also includes a certification section where the provider must attest that it meets all requirements set forth in the Home and Community-Based Services/Texas Home Living Billing Guidelines.

The Dental Summary Sheet is typically used by healthcare providers to document dental services provided to clients, and is an essential tool for billing and reimbursement purposes. By using this form, providers can ensure compliance with guidelines and regulations, and maintain accurate records of client care. Key points to note include:

• Required information includes service date, dollars spent, requisition fee, and client care ID number.
• The form must be certified by the provider upon submission.
• The Dental Summary Sheet is used for dental services provided to clients under Home and Community-Based Services/Texas Home Living programs.