Texas Health and Human Services

The TX HHS Form 8005, ICF/IID Nursing Supervision For Unlicensed Assistive Personnel (UAP), is an example form designed to facilitate the supervision of unlicensed assistive personnel in providing nursing care to individuals with intellectual or developmental disabilities. This form helps solve the problem of ensuring that UAP are adequately trained and supervised to provide high-quality care, thereby promoting the health and well-being of these individuals.

The TX HHS Form 8003, Documentation of Transportation as Part of HCBS-AMH Service, is a practical tool for service providers to document transportation services delivered to individuals receiving Home and Community Based Services Adult Mental Health (HCBS-AMH) Program. This form helps solve the problem of tracking and recording transportation services, ensuring that necessary information is captured and maintained for program evaluation and reporting purposes.

The TX HHS Form 8001, Medicaid Estate Recovery Program Receipt Acknowledgement, is a crucial document that helps individuals applying for long-term care services paid by Medicaid understand the state's obligation to inform them about Medicaid estate recovery. This form serves as a receipt acknowledgement, confirming that the applicant has been informed of their rights and responsibilities regarding Medicaid estate recovery.

The TX HHS Form 7484, Hospital Report for Newborn Child or Children, is a crucial document that helps hospitals report the birth of a child to the Texas Health and Human Services Commission (HHSC). This form is used by hospitals to provide essential information about newborn children whose mothers are currently eligible under the Texas Medicaid Program. The hospital must complete this form within five days after the birth of the child to avoid delays in receiving notice of the Medicaid Recipient number.

The Texas Health and Human Services (HHS) Child Care Regulation Plan of Action form is a practical tool designed to help child care providers develop a plan to address deficiencies identified during inspections. This form is used in situations where the provider needs to bring their operation into compliance with minimum standards, administrative rules, and statute.

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.

Form 6104 is the official incident reporting document used by freestanding emergency medical care facilities in Texas to report serious, reportable events to state regulators. The form captures detailed information about incidents involving patient harm, safety risks, professional misconduct, emergency transfers, fires, deaths, or other events that require regulatory review and follow-up.

Form 5506-NAR is an official employment verification form used by Certified Nurse Aides (CNAs) in Texas to renew their listing on the Texas Nurse Aide Registry. The form documents recent employment, required training, and compliance with eligibility rules so that the Health and Human Services Commission (HHSC) can confirm that the nurse aide remains qualified to work in long-term care and related settings.

Form 5873 is an official checklist used in Texas during the application process for provisional contracts under Waiver and Community-based Programs and Services for Medicaid and CHIP. This document helps both applicants and Texas Health and Human Services Commission (HHSC) staff confirm that all required forms and supporting documents are included before a contract application is reviewed.

The Form 5503-MA, Medication Aide Program Verification of Curriculum, is used by the Texas Health and Human Services Commission (HHSC) to verify that the courses completed by a medication aide applicant meet the curriculum requirements specified in TAC 557.107(c)(2). This form ensures that applicants have received proper training from an accredited school of nursing before they can practice as a medication aide in Texas.