TX HHS Form H1280. Statement of Residence Maintenance Needs

The Texas Health and Human Services (HHS) Form H1280, Statement of Residence Maintenance Needs, is a crucial document that helps resolve the issue of maintaining a patient's residence while they are receiving care in a nursing facility. This form is typically completed by applicants who intend to return to their residence within six months of admission.

The form requires the applicant to provide information about their current living situation and their plans for returning home. Specifically, it asks the applicant to list the monthly mortgage or rent payments they need to make to maintain the property, as well as average monthly utilities expenses (excluding telephone). The applicant must also sign and date the statement, indicating their intention to return to the residence within six months.

The attending practitioner is also required to complete a section of the form, certifying that the patient is likely to return to their residence within the specified timeframe. This ensures that the necessary arrangements are made to maintain the property until the patient's return. Key features of this form include:

• Required information from the applicant and attending practitioner
• A six-month timeline for returning to the residence
• A certification process to ensure the patient's intention to return home