TX HHS Form H1836-A. Medical Release and Physician's Statement

Form H1836-A, titled Medical Release/Physician's Statement, is used by the Health and Human Services Commission (HHSC) in Texas to verify medical conditions that may prevent individuals from participating in employment services programs. This form is essential for determining eligibility for exemptions under programs like TANF, SNAP, or Medicaid.

Purpose and Importance of the Form

The main purpose of Form H1836-A is to provide HHSC with accurate medical information from a licensed physician. This helps the agency determine whether the applicant can work, participate in activities to prepare for work, or qualify for medical exemptions.

Submitting this form correctly ensures timely processing of benefits and compliance with federal and state regulations. Errors or omissions can lead to delays or denial of exemptions.

Section-by-Section Explanation

Section I – To Be Completed by Staff

This section collects administrative details about the patient, case number, caregiver, and HHSC office. Staff should ensure all fields are accurately filled to avoid delays in processing.

• Common errors: Missing case numbers or incorrect office codes.

Section II – To Be Completed by Physician

The physician evaluates the patient’s ability to work or participate in preparatory activities. This section has three parts:

Part A – Personal Disability

Physicians select the appropriate category based on the patient’s capacity for work:

• Fully able to work (full-time or part-time)
• Able to work with restrictions (requires Parts B and C)
• Unable to work (temporary or permanent disability, requires Part C)

Tip: Provide accurate durations for temporary disabilities to avoid misclassification.

Part B – Activity Restrictions

This section details physical limitations, including sitting, standing, walking, lifting, or other activities. Physicians should specify maximum hours and restrictions clearly.

• Common mistakes: Omitting maximum lifting weights or work hours.
• Best practice: Include all restrictions and any recommendations for modified work tasks.

Part C – Diagnosis

Physicians list primary and secondary disabling diagnoses, adding any relevant comments. Accurate documentation here ensures proper program evaluation.

Section III – To Be Completed by Patient or Representative

This section authorizes the release of medical information. Patients or their legal representatives sign to allow HHSC to verify the medical condition. Signing is mandatory only if seeking exemption from employment services.

• Key point: Two witnesses are required if the patient cannot sign.
• Legal implication: Signing gives HHSC permission to contact healthcare providers for verification.

Practical Tips for Completing Form H1836-A

• Ensure all staff and patient fields are accurately filled.
• Physicians should check all boxes relevant to restrictions.
• Attach supporting medical records if necessary.
• Double-check signatures and witness sections.
• Submit the form promptly to avoid delays in benefit processing.

Real-Life Examples

• Maria, a single mother on SNAP, submits Form H1836-A to receive exemption from work activities due to a recent surgery.
• John, temporarily disabled after an accident, needs Part B to outline activity restrictions while participating in limited community work tasks.
• Susan, with a permanent medical condition, uses the form to document her inability to work, ensuring compliance with federal program rules.

Documents That May Be Required

• Recent medical records or test results
• Physician’s notes supporting disability
• Proof of authorization if signed by a representative

Frequently Asked Questions (FAQ)

Who must complete this form?

The patient, their representative, and a licensed physician must complete respective sections.

Is this form required for all benefit applications?

No, it is only required if the applicant seeks an exemption from employment participation due to medical conditions.

Can a physician complete the form electronically?

Yes, if the agency accepts electronic signatures, otherwise a printed signature is required.

What happens if the form is incomplete?

Incomplete forms can delay benefit approvals or exemptions.

How long is the authorization valid?

The expiration date must be specified; typically, it is valid for the duration of the exemption process.

Micro-FAQ (Quick Answers)

• Purpose: Verify medical conditions for employment program exemptions.
• Who files: Patient or representative with physician input.
• Deadline: Submit when requesting exemption.
• Attachments: Medical records, physician notes.
• Submitted to: HHSC and Texas Workforce Commission.

Related Forms

• Form H1840 – Disability Verification for SNAP
• Form H1850 – Employment Services Exemption Request
• Form H1820 – TANF Medical Certification

Form Details

• Form Name: Medical Release/Physician's Statement
• Form Number: H1836-A
• Region: Texas
• Revision Date: March 2015-E