TX HHS Form 4116-MHM-AA. Minor Home Modification and Adaptive Aids Summary Sheet

The TX HHS Form 4116-MHM-AA, Minor Home Modification and Adaptive Aids Summary Sheet, is a crucial document for individuals seeking home modifications or adaptive aids to enhance their daily living experience. This form helps solve the problem of identifying necessary modifications or aids required to support independent living, particularly for those with disabilities or chronic illnesses.

This summary sheet serves as a vital tool for healthcare professionals, caregivers, and individuals themselves to record and certify minor home modifications and adaptive aids. The form requires information on the type of modification or aid, its purpose, and any relevant details about the individual's needs and circumstances. By submitting this form, the certifying party ensures that all requirements outlined in the Home and Community-Based Services/Texas Home Living Billing Guidelines are met.

The Minor Home Modification and Adaptive Aids Summary Sheet is typically used in situations where individuals require minor home modifications or adaptive aids to maintain their independence and quality of life. Key features of this form include the required information on the type of modification or aid, its purpose, and any relevant details about the individual's needs and circumstances. By using this form, healthcare professionals and caregivers can ensure that necessary modifications or aids are implemented to support individuals' daily living needs.

• This form is used for minor home modifications or adaptive aids required to support independent living.
• The form requires information on the type of modification or aid, its purpose, and any relevant details about the individual's needs and circumstances.
• The certifying party must ensure that all