TX HHS Form H1046. Inpatient Medical Services Certification

The TX HHS Form H1046, Inpatient Medical Services Certification, is a crucial document that helps solve the problem of verifying inpatient medical treatment for patients who are inmates of an institution. This form is typically used by healthcare practitioners to certify that a patient received inpatient treatment as defined by the Texas Health and Human Services Commission (HHSC). The attending practitioner or other practitioner familiar with the patient's case fills out this form.

The form requires the practitioner to provide specific information, including the patient's contact details, date of birth, and Social Security number. Additionally, the practitioner must certify that the patient received inpatient treatment for at least 24 hours and that the hospitalization lasted for a specified period. The certification does not guarantee coverage by Medicaid, but it is a necessary step before HHSC can process the patient's application.

Key features of this form include the requirement for practitioner certification, specific conditions for inpatient treatment, and the need to provide detailed information about the patient's stay. Healthcare practitioners should be aware that they are responsible for reviewing the patient's medical records and certifying their professional opinion under penalty of perjury. By completing this form, practitioners help facilitate the processing of Medicaid applications for patients who have received inpatient medical services.

• The form is used to certify inpatient medical treatment for patients who are inmates of an institution.
• The attending practitioner or other practitioner familiar with the patient's case fills out this form.
• The certification does not guarantee coverage by Medicaid, but it is a necessary step before HHSC can process the patient's application.