TX HHS Form H1038. Medical Facility Referral

The Texas HHS Form H1038, Medical Facility Referral, is a crucial document for individuals seeking assistance from the Texas Health and Human Services Commission. This form helps solve the problem of applying for Temporary Assistance for Needy Families (TANF) and/or Medical Assistance, providing essential support to those in need.

This form is typically used by medical facility staff to refer patients who are not currently receiving public assistance but require assistance. The form requires applicants to provide personal information, including name, date of birth, address, and Medicare claim number. Additionally, the form allows for representation by a person acting on behalf of the applicant, providing an opportunity for caregivers or advocates to assist with the application process.

Key features of this form include the required sections for applicant information, medical facility details, and representative information (if applicable). The form also includes spaces for worker completion after referral receipt, including dates, categories, and eligibility determinations. By completing this form, applicants can initiate the process for receiving necessary assistance from the Texas Health and Human Services Commission.

• This form is used by medical facility staff to refer patients who are not currently receiving public assistance but require assistance.
• The form requires applicants to provide personal information, including name, date of birth, address, and Medicare claim number.
• The form allows for representation by a person acting on behalf of the applicant, providing an opportunity for caregivers or advocates to assist with the application process.