TX HHS Form 8662. Related Conditions Eligibility Screening Instrument

The TX HHS Form 8662, "Related Conditions Eligibility Screening Instrument", is a tool used to determine an individual's eligibility for certain services based on their related conditions. This form helps solve the problem of identifying individuals who may require additional support or accommodations due to various health-related factors.

This instrument consists of three main sections: Applicant Data, Functional Criteria, and Major Life Activities. The Applicant Data section requires information such as name, sex, date of birth, social security number, and presenting diagnosis(es). The Functional Criteria section assesses an individual's ability to perform tasks such as verbally or non-verbally communicating, acquiring knowledge, and transferring skills to new situations. The Major Life Activities section considers factors like reasoning, eye-hand coordination, and self-direction.

The Form 8662 is typically used in scenarios where an individual's related conditions may impact their daily life, such as difficulties with communication, mobility, or cognitive function. This form is intended for use by professionals who need to assess an individual's eligibility for services that cater to their specific needs.