TX HHS Form H1263-B. Certification of No Medical Contraindication - Dental

The Certification of No Medical Contraindication - Dental (Form H1263-B) helps resolve the issue of determining the amount that a patient must pay for their care in a nursing facility. This form is used when routine dental services are required, and it ensures that these services do not pose any medical risks to the patient.

This form requires the attending practitioner's certification that the dental service(s) are necessary and not medically contraindicated for the patient. The practitioner must sign and date the form to indicate their approval or disapproval of the treatment plan. The completed form is then returned in a postage-paid envelope, allowing the Texas Health and Human Services Commission (HHSC) to process the deduction from the patient's income.

To complete this form, the attending practitioner should review the dental treatment plan and certify that the services are not medically contraindicated for the patient. Key points to consider include:

• The form is used when routine dental services are required in a nursing facility setting.
• The attending practitioner must certify that the services are necessary and not medically contraindicated for the patient.
• The completed form is returned to HHSC to process the deduction from the patient's income.