TX HHS Form 4119. Residential Support Services (RSS) and Supervised Living (SL) Service Delivery Log

The TX HHS Form 4119, Residential Support Services (RSS) and Supervised Living (SL) Service Delivery Log, is a tool used to document the delivery of services for individuals receiving RSS or SL support. This form helps solve the problem of tracking and recording the provision of essential daily living skills, personal hygiene, and community integration activities.

The log requires information such as the date, time, and details of service delivery, including personal care tasks like dressing, grooming, and toileting. It also captures data on housekeeping, medication administration, and specialized therapies. For individuals receiving SL services, no night initials are necessary. The form is designed for use by NNGLE Health and Human Home and Community-based Services/Texas Home Living Services providers.

This log should be used to document the delivery of RSS and SL services on a regular basis, ideally at the end of each day or shift. It serves as a valuable tool for monitoring progress, identifying areas for improvement, and ensuring that individuals receive the necessary support to maintain their independence and overall well-being. The TX HHS Form 4119 is an essential resource for providers seeking to deliver high-quality services and meet the unique needs of their clients.