Texas Health and Human Services

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.

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 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 5302, WIC General Information Feedback, serves as a valuable tool for resolving questions or problems related to the Women, Infants, and Children (WIC) program. This form is typically used by individuals seeking assistance or clarification on various aspects of the program.

The TX HHS Form 5301, WIC Director Orientation Training Registration, is a crucial document for ensuring effective communication and planning in the Women, Infants, and Children (WIC) program. This form serves as a pre-registration tool for WIC directors to attend orientation training sessions.

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.