TX HHS Form 4122. Host Home/Companion Care Service Delivery Log

The TX HHS Form 4122, Host Home/Companion Care Service Delivery Log, is a practical tool designed to track and record the delivery of host home and companion care services. This form helps solve the problem of ensuring that essential services are being provided to individuals in need, particularly those who require assistance with daily living activities or have complex medical conditions.

The form requires information on the date and frequency of service delivery, as well as details about the services provided, such as personal hygiene, meal preparation, and household help. It also includes spaces for recording any issues or concerns that may arise during service delivery, allowing caregivers to address these matters promptly. The log is typically used by caregivers who provide host home and companion care services to individuals in their own homes or temporary settings.

This form is essential for ensuring the quality and continuity of care provided to vulnerable populations. By recording service delivery details and any issues that may arise, caregivers can identify areas for improvement and make necessary adjustments to ensure the best possible outcomes for their clients. Key features of this form include:

• Required information on date, frequency, and services delivered
• Spaces for recording issues or concerns
• Useful for tracking service delivery in various settings
• Promotes quality and continuity of care