TX HHS Form 8495. Exclusion of Host Home/Companion Care (HH/CC) Provider from the Board of Nursing (BON) Definition of Unlicensed Person

The TX HHS Form 8495, Exclusion of Host Home/Companion Care (HH/CC) Provider from the Board of Nursing (BON) Definition of Unlicensed Person, helps solve the problem of clarifying the role of HH/CC providers in Texas. This form is typically used by Registered Nurses (RNs) who work with individuals receiving care through HH/CC programs.

The form requires the RN to assess and determine that four specific criteria have been met: the HH/CC provider meets the definition of Client Responsible Adult, maintains a stable and beneficial relationship, is willing and able to assume responsibility for the individual's healthcare, and has adequate supports available. The RN must also develop a nursing service plan that includes reporting any changes in conditions or medical treatment.

Key features of this form include the comprehensive assessment and development of a nursing service plan. By completing this form annually, the RN ensures that HH/CC providers are excluded from the BON definition of unlicensed person and that necessary care is provided to individuals receiving services.

• This form is used by Registered Nurses working with individuals in Host Home/Companion Care programs.
• The form requires a comprehensive assessment of the HH/CC provider's role and responsibilities.