The TX HHS Form 3646, Request for Formal Hearing, is a crucial document that helps resolve disputes between facilities or agencies and the Texas Health and Human Services (HHS) department. This form is typically completed by an authorized representative of a facility or agency when they disagree with a proposed action taken by HHS, such as certification noncompliance, termination, or decertification.
The TX HHS Form 3647, Assisted Living Disclosure Statement, is a crucial tool for empowering individuals making informed decisions about their care. This form helps solve the problem of inconsistent information about assisted living facilities by providing a uniform format for describing policies and services.
The TX HHS Form 3648, DAHS Informal Dispute Resolution (IDR) Request, is a crucial document for Day Activity and Health Services (DAHS) facilities to request an IDR. This form helps facilities dispute survey findings and violations, ensuring that any issues are addressed promptly.
The TX HHS Form 3649, Assisted Living Facility Background Disclosure Statement for Applicants for Employment, is a crucial document that helps ensure the safety and well-being of residents in assisted living facilities. The form is used to gather information about job applicants' criminal history and residency status, allowing facilities to make informed hiring decisions.
The TX HHS Form 3650, Assisted Living Facility Memory Care Disclosure Statement, is a crucial document that helps solve the problem of ensuring transparency in memory care services provided by assisted living facilities. This form is typically used when an assisted living facility advertises or promotes its provision of memory care services to residents with Alzheimer's disease or related disorders.
The Memory Care Disclosure Statement for Nursing Facilities (Form 3651) helps families make informed decisions about care by providing standardized information about the services offered by nursing facilities that advertise or promote memory care. This form is typically completed by nursing facility administrators to describe the specialized dementia care provided, including any designated units or secured areas.
The TX HHS Form 3657, Pre-Enrollment Assessment, helps individuals with disabilities or chronic illnesses prepare for community-based services. This form is typically used in situations where an individual requires assistance with daily living activities, such as personal care, transportation, or household tasks.
The Texas Health and Human Services (HHS) Form 3660, Request for Adaptive Aids, Medical Supplies, Minor Home Modifications or Dental Services/Sedation, is a crucial document that helps individuals with disabilities access necessary support services. This form is typically completed by the individual themselves, along with their case manager, to request adaptive aids, medical supplies, minor home modifications, or dental services/sedation.
The TX HHS Form 3681-A. Community Services Contract Application - Addendum A is a crucial document for entities operating assisted living facilities in Texas. This form helps solve the problem of ensuring compliance with state regulations and facilitates the contracting process between facility operators and the Texas Health and Human Services (HHS) agency.
Form 3596 is a detailed service planning document used in Texas Medicaid waiver programs to define, authorize, and schedule Personal Assistance Services (PAS) and habilitation supports for individuals enrolled in CLASS, DBMD, and Community First Choice (CFC). The form translates an individual’s daily support needs into approved service hours, tasks, and weekly schedules that providers and caregivers must follow.
