Texas

Form 6700, “Use and Release of Health Information Authorization,” is a document used in Texas to give the Health and Human Services Commission (HHS) permission to release a person’s Medicaid claims history. Because Medicaid claim data includes sensitive health information, Texas law requires a formal written authorization before any portion of this information can be shared. This form ensures that the individual understands what will be released, to whom it will be provided, and for what purpose.

The TX HHS Form 6520, Deaf Blind with Multiple Disabilities (DBMD) Record of Completion for the DBMD Program Service Provider Training, is a crucial document that helps ensure service providers in Texas have received necessary training to support individuals with deaf-blindness and multiple disabilities. This form is typically used by program directors, case managers, and other service providers who work with clients with deaf-blindness and multiple disabilities.

The TX HHS Form 6519, Deaf Blind with Multiple Disabilities (DBMD) Record of Completion for General Orientation Training, is a crucial document that helps ensure service providers in Texas have completed the necessary training to work with individuals who are deaf-blind with multiple disabilities. This form is typically used by service providers, such as case managers, employment assistance specialists, and individualized skills trainers, to demonstrate their completion of general orientation training.

The TX HHS Form 6518, Deaf Blind with Multiple Disabilities (DBMD) Record of Completion for Person-Specific Training, is a crucial document that helps ensure service providers are equipped to meet the unique needs of individuals with deaf-blindness and multiple disabilities. This form is typically used in situations where service providers need to demonstrate their understanding of an individual's specific needs, including methods of communication, adaptive aids, and managing challenging behavior.

The TX HHS Form 6517, Individual Program Plan (IPP) Service Review, is a crucial document that helps healthcare providers evaluate the effectiveness of services delivered to individuals with disabilities. This form is typically used in situations where an individual's needs are being assessed and services are being reviewed for authorization or continuation.

The TX HHS Form 6515, CLASS or DBMD Nursing Assessment, is a crucial tool for healthcare professionals to assess the needs of individuals with disabilities. This form helps solve the problem of identifying the individual's nursing requirements, which enables caregivers to provide personalized care and support.

The TX HHS Form 6510, Decline of Offer for DBMD Program Enrollment, is a crucial document that helps individuals who have received information about the Deaf Blind with Multiple Disabilities (DBMD) Program to formally decline participation in the program. This form is typically used by applicants or their legally authorized representatives (LARs) who have decided not to enroll in the DBMD services.

The TX HHS Form 6509, CLASS/DBMD Coordination of Care, is an addendum designed to facilitate the coordination of care between a Registered Nurse (RN) and the Service Planning Team (SPT). This form helps ensure that individualized services are planned and delivered according to the unique needs of individuals with Community Living Assistance and Support Services (CLASS) or Deaf Blind with Multiple Disabilities (DBMD).

The TX HHS Form 6508, Specifications for Minor Home Modifications, helps individuals with disabilities make necessary changes to their living spaces. This form is typically used in situations where minor modifications are required to ensure accessibility and safety. The form is usually filled out by DBMD Provider Agencies, Landlords, or Participants/Responsible Parties who need to document the proposed modifications.

The TX HHS Form 6507, "Rationale for Adaptive Aids, Medical Supplies, and Minor Home Modifications," is a crucial document that helps individuals with deaf-blind multiple disabilities obtain necessary adaptive aids, medical supplies, and minor home modifications. This form is typically filled out by healthcare professionals or service providers to support the individual's treatment, rehabilitation, or ability to compensate for functional limitations.