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 used to report the termination of services or the death of an individual under the guardianship program. This form helps ensure that important information about the circumstances surrounding the death or service termination is documented and communicated effectively.

The form requires key details such as 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 are any unusual circumstances surrounding the death. Additionally, the form inquires about potential neglect or abuse and whether an ongoing investigation is underway.

This report should be used whenever a service termination or death occurs under the guardianship program. The information provided on this form helps Contract Managers and other relevant authorities stay informed about important events and take necessary actions to ensure the well-being of individuals in their care. By completing Form 5014, contractors can provide critical context and support the effective oversight of the HHS Guardianship Program.