TX HHS Form H1051-IME. Receipt of Durable Medical Equipment

The TX HHS Form H1051-IME, Receipt of Durable Medical Equipment, is a crucial document that helps individuals or authorized representatives confirm the receipt of medical equipment. This form is typically used in situations where an individual requires durable medical equipment (DME) for their care and needs to demonstrate proof of receipt to facilitate cost deductions.

This form requires specific information from the recipient or authorized representative, including the name and address of the place where the equipment was delivered, as well as the date of delivery. The form also asks whether the individual has received the DME item listed above, with options for "Yes" or "No". If the answer is "Yes", the recipient must provide their signature and date.

Key features of this form include the requirement to provide proof of receipt, which enables the deduction of incurred medical expenses. The form also provides contact information for HHSC, including phone numbers and fax numbers, as well as a mailing address. Additionally, the form includes instructions for individuals who are deaf, hard of hearing or speech impaired.

• This form is used to confirm receipt of durable medical equipment (DME) for nursing facility care purposes.
• The recipient or authorized representative must provide proof of receipt to facilitate cost deductions.
• The form requires specific information, including the name and address of the place where the equipment was delivered, as well as the date of delivery.