TX HHS Form 6503. DBMD and CFC Summary of Services Delivered

The TX HHS Form 6503, DBMD and CFC Summary of Services Delivered, is a crucial document that helps service providers summarize the services they have delivered to individuals with Health and Human Deaf Blind with Multiple Disabilities (DBMD) and Community First Choice (CFC). This form is typically used in situations where service providers need to record and report the services they have provided to these individuals.

The form requires service providers to provide information about the services they have delivered, including occupational therapy, physical therapy, speech, hearing, and language therapy, respite care, case management, and specialized nursing. The form also includes spaces for recording hours worked by employees who provided the services. Additionally, the form requires the service provider's name, signature, and date, as well as the timekeeper's name, signature, and date.

This summary of services delivered is an essential tool for tracking and reporting the services provided to individuals with DBMD and CFC. By using this form, service providers can ensure that they are meeting the needs of these individuals and providing high-quality care. Key features of this form include:

• Required information about the services delivered
• Spaces for recording hours worked by employees who provided the services
• Service provider's name, signature, and date
• Timekeeper's name, signature, and date