TX HHS Form 5014. Report of Death or Service Termination

The TX HHS Form 5014, Report of Death or Service Termination, is a crucial document that helps resolve the issue of reporting the termination of services or the death of an individual under the guardianship program. This form is typically used by contractors working with the Texas Health and Human Services (HHS) Guardianship Program to report significant events such as service terminations or deaths.

The form requires key information, including the date of the service termination or date of the ward's death, location of the deceased at the time of death, source of information regarding the ward's death, cause of death if known, and whether there is reason to suspect that the death occurred under unusual circumstances. Additionally, the form inquires about reports of neglect or abuse and whether an ongoing investigation into the ward's death is underway.

This report serves as a critical tool for HHS Guardianship Program staff to track and monitor the status of wards under their care. By completing this form, contractors can provide essential information that helps ensure the well-being and safety of individuals in the program. Key points to note include:

• The report is used to document significant events such as service terminations or deaths.
• The form requires specific information about the date, location, and circumstances surrounding the event.
• The report helps HHS Guardianship Program staff track and monitor the status of wards under their care.