TX HHS Form 4118. Respite Service Delivery Log

The TX HHS Form 4118, Respite Service Delivery Log, is a practical tool used to track and record the provision of respite services to individuals. This form helps solve the problem of ensuring that essential care and support are delivered in a timely manner, allowing caregivers to take breaks and recharge. It should be used whenever respite services are provided to an individual, such as in-home care or community-based services.

The form requires information on the activities of daily living (ADLs) assisted, including time spent providing assistance for tasks like personal hygiene, mobility, and meal preparation. Important sections include the "Mark (initial or check) all areas in which you provided assistance to the person" area, where caregivers can indicate the specific services rendered. This form is particularly useful in scenarios where individuals require ongoing support with daily living activities.

The Respite Service Delivery Log also includes a section for recording comments and special events or occurrences related to the provision of respite services. This feature allows caregivers to document any notable events, such as changes in an individual's condition or unexpected challenges faced during service delivery. By using this form, caregivers can maintain accurate records and ensure that essential care is delivered consistently.