TX HHS Form H3033. Report of Physical or Mental Examination

The Report of Physical or Mental Examination (Form H3033) is a crucial document for determining eligibility for TANF, medical assistance, or employment services in Texas. This form helps solve the problem of assessing an individual's physical or mental condition to determine their suitability for these programs.

This report requires the examining physician to perform a basic physical examination and provide information on various aspects of the patient's health, including medical history, vision, neck, chest, cardiac status, and more. The form also includes space for noting any limitations in the field of vision and the patient's overall prognosis. Additionally, it asks about the patient's vascular system, gastrointestinal, and genitourinary systems.

The Report of Physical or Mental Examination (Form H3033) is typically completed by examining physicians and submitted to Texas Health and Human Services (HHS) as part of the application process for TANF, medical assistance, or employment services. Key features of this form include:

• Required information on physical examination findings
• Assessment of patient's overall prognosis
• Documentation of limitations in field of vision
• Information on various bodily systems (vascular, gastrointestinal, genitourinary)