Texas

Form 5502-MA is the official application used in Texas by nursing graduates and nursing students who want to obtain a Medication Aide permit through the Health and Human Services Commission (HHSC). This form allows eligible applicants to seek authorization to administer medications in licensed nursing facilities or intellectual disability facilities while they are not yet licensed as professional or vocational nurses.

The TX HHS Form 5498-NATCEP, Nurse Aide Daily Sign-in Sheet, is a crucial tool for tracking student attendance and completion of training hours in the Texas Health and Human Services (HHS) Nurse Aide Training and Competency Evaluation Program (NATCEP). This form helps ensure that students meet the program's requirements and instructors can accurately monitor progress.

Form 5007, titled “CMBHS Access Request and User Agreement”, is a mandatory document for behavioral health providers in Texas who need access to the Clinical Management for Behavioral Health Services (CMBHS) system. This form is not a casual administrative sheet — it is a legal agreement between a provider organization and the Texas Health and Human Services System Agency. It determines who is allowed to access sensitive behavioral health data, under what conditions, and with what responsibilities.

The Texas Nurse Aide Performance Record (Form 5497-NATCEP) is a key document used within the Nurse Aide Training and Competency Evaluation Program (NATCEP). This form records the performance of nurse aide trainees across a range of essential skills, ensuring compliance with state standards for healthcare personnel.

The Ten Day Facility Observation Form 5406 is a crucial tool for ensuring the quality of long-term care facilities in Texas. This form helps surveyors complete their basic training program by observing the operations of an unrelated facility for at least 10 working days within a 14-day period, as required by Senate Bill 1839.

The TX HHS Form 5405, Life Safety Code Facility Observation Program, is a comprehensive checklist designed to help newly hired Regulatory Services surveyors conduct thorough observations of long-term care facilities. This form provides a framework for identifying potential areas of concern and ensuring compliance with life safety codes.

The TX HHS Form 5404, Facility Observation Program, is a checklist designed to help newly hired Regulatory Services surveyors conduct comprehensive observations of long-term care facilities. This form provides a framework for identifying key areas of focus, ensuring that all aspects of facility operations are evaluated.

Form 5403 is an authorization form used by Texas Health and Human Services (HHS) to obtain written consent from a volunteer or service recipient to be photographed, audio recorded, or video recorded. The form documents an individual’s permission for HHS to use these materials for specific program-related purposes such as education, training, and public information.

This form is designed to protect individual rights while allowing HHS programs to responsibly document and share their activities.

The TX HHS Form 5402, Office of Communications Media Release, is a crucial document for individuals who need to grant permission for photography, audio, or video recording by Texas Health and Human Services (HHS) for program development, education, and promotion purposes.

Form 5401 is an official authorization used by Texas Health and Human Services (HHS) to obtain consent for photographing, audio recording, or video recording a resident of a State Supported Living Center (SSLC) or a patient of a State Hospital (SH). This form protects individual rights while allowing HHS to use media materials for specific, limited purposes related to public programs.