TX HHS Form H2065-A. Notification of Community Care Services

The TX HHS Form H2065-A, Notification of Community Care Services, is a crucial document that helps individuals notify the relevant authorities about changes in their community care services. This form is typically filled out by health and human caseworkers or individuals who are receiving community care services.

This notification form requires important information such as changes in income, assets, address, or condition within 10 days of the change. It also outlines specific procedures for service changes, including pending final medical approval. The form emphasizes the responsibility to report any updates and provides details on copayment changes and effective dates.

Key features of this form include:

• The requirement to report changes in income, assets, address, or condition within 10 days
• Pending final medical approval for service changes
• Copayment changes and effective dates
• A statement of rights on page 2