TX HHS Form 6500-T. DBMD and CFC IPC Service Delivery Transfer Worksheet

The TX HHS Form 6500-T, DBMD and CFC IPC Service Delivery Transfer Worksheet, is a tool used to facilitate the transfer of services between providers for individuals with Deaf Blindness with Multiple Disabilities (BMD) or Community First Choice (CFC) services. This form helps solve the problem of ensuring continuity of care when an individual's service provider changes.

This worksheet requires key information such as the person's name, social security number, Medicaid number, and IPC effective period. The transfer type, effective date from and to, and vendor numbers for both transferring and receiving providers must also be provided. The form is typically used in scenarios where a change of service provider is necessary, such as when an individual moves or changes their care plan.

The DBMD and CFC IPC Service Delivery Transfer Worksheet (TX HHS Form 6500-T) is an essential tool for ensuring the smooth transfer of services and minimizing disruptions to an individual's care. By completing this form, providers can ensure that all necessary information is shared, and continuity of care is maintained.