Texas

TX HHS Form 5403. Media Release Authorization to Photograph and Record a Volunteer or Service Recipient

TX HHS Form 5403. Media Release  Authorization to Photograph and Record a Volunteer or Service Recipient

The TX HHS Form 5403, Media Release Authorization to Photograph and Record a Volunteer or Service Recipient, is a crucial document for individuals who wish to participate in public events or activities while allowing Texas Health and Human Services (HHS) to capture their image or likeness.

TX HHS Form 5401. Media Release Authorization to Photograph or Record a Resident of a State Supported Living Center (SSLC) or Patient of a State Hospital (SH)

TX HHS Form 5401. Media Release  Authorization to Photograph or Record a Resident of a State Supported Living Center (SSLC) or Patient of a State Hospital (SH)

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.

TX HHS Form 5205. Breast and Cervical Diagnostic Procedure Complication Reimbursement Request

TX HHS Form 5205. Breast and Cervical Diagnostic Procedure Complication Reimbursement Request

The TX HHS Form 5205, Breast and Cervical Diagnostic Procedure Complication Reimbursement Request, is a crucial document for healthcare providers to seek reimbursement for complications arising from breast and cervical diagnostic procedures. This form helps solve the problem of seeking financial compensation for medical services provided to patients who experience complications following these procedures.

TX HHS Form 5204. Office-based Procedures Performed in an Ambulatory Surgical Center Pre-Authorization Request

TX HHS Form 5204. Office-based Procedures Performed in an Ambulatory Surgical Center Pre-Authorization Request

The TX HHS Form 5204, Office-based Procedures Performed in an Ambulatory Surgical Center Pre-Authorization Request, is a crucial document for healthcare professionals to complete before performing office-based procedures in an ambulatory surgical center. This form helps solve the problem of ensuring that the necessary pre-authorization is obtained from Texas Health and Human Services (HHS) Breast and Cervical Cancer Services (BCCS) prior to commencing treatment.

TX HHS Form 5202. Patient Navigation Consent

TX HHS Form 5202. Patient Navigation Consent

The TX HHS Form 5202, Patient Navigation Consent, is a crucial document that helps solve the problem of ensuring patients receiving navigation services understand their ongoing care coordination needs. This form is typically used in situations where patients have abnormal test results or require additional evaluation. The patient navigator or healthcare provider fills out this form to obtain the patient's consent for ongoing assessment and care planning.