TX HHS Form 5013. Contractor Referral

The TX HHS Form 5013, Contractor Referral, is a crucial tool for professionals working in adult protective services. This form helps facilitate the referral process between Health and Human Services (HHS) and contractors who can provide guardianship services to individuals in need.

This form requires essential information about the proposed ward, including their name, social security number, date of birth, and county of residence. The contractor must also provide details about themselves, such as their name, phone number, and area code. Key sections include the referral date, guardianship type, and a brief description of why guardianship is necessary for the proposed ward.

The TX HHS Form 5013 should be used when an adult protective services worker identifies an individual who requires guardianship services. This form helps ensure that the contractor has all the necessary information to provide appropriate care and support. The contractor must sign and date the form, indicating their acceptance or decline of the referral.