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 crucial tool for ensuring seamless transitions in healthcare services. This form helps facilitate the transfer of services from one provider to another, streamlining the process for individuals with Deaf Blindness with Multiple Disabilities (BMD) or Community First Choice (CFC) IPC needs.

This worksheet requires essential information such as the person's name, social security number, Medicaid number, and service category. It also outlines the transfer type, effective date, and responsible providers. The form is typically used in situations where a change in provider is necessary due to relocation, changes in care requirements, or other circumstances.

The key features of this form include the required information for both transferring and receiving providers, as well as the service category and IPC effective period. By using this worksheet, healthcare professionals can ensure a smooth transfer of services, minimizing disruptions and ensuring continuity of care. Key points to note:

• This form is used for individuals with Deaf Blindness with Multiple Disabilities (BMD) or Community First Choice (CFC) IPC needs.
• The form facilitates the transfer of healthcare services from one provider to another.
• It requires essential information such as the person's name, social security number, Medicaid number, and service category.