TX HHS Form H3035. Medical Information Release and Disability Determination

The TX HHS Form H3035, Medical Information Release and Disability Determination, is a crucial document used to determine eligibility for state assistance programs listed in the Texas Health and Safety Code. This form allows applicants or their authorized representatives to release medical information to healthcare providers and government agencies, facilitating the disability determination process.

This form requires essential information from the applicant, including name, date of birth, social security number, application/case number, and a list of medical/mental conditions that affect their daily life. The applicant must also authorize the release of medical records to healthcare providers, government agencies, or other relevant parties. Key sections include PART I, which outlines the applicant's eligibility for state assistance programs, and SECTION II, where the applicant provides detailed information about their medical needs.

The form is typically used when an individual applies for disability benefits from Texas Health and Human Services (HHS) and requires verification of their medical needs to determine eligibility. The applicant or authorized representative must sign this authorization form to give HHS permission to contact healthcare providers, government agencies, or other relevant parties to request copies of their health information. This form is essential in facilitating the disability determination process and ensuring that applicants receive the necessary support and services.