Texas Health and Human Services

The Prescribed Pediatric Extended Care Center Informal Dispute Resolution Request (TX HHS Form 3639) is a crucial document for prescribed pediatric extended care centers (PPECCs) to resolve disputes in a timely and efficient manner. This form enables PPECCs to request an informal dispute resolution (IDR) process when faced with a statement of violations from the Texas Health and Human Services Commission.

The TX HHS Form 3641, Alzheimer's Assisted Living Disclosure Statement, is a crucial document that helps individuals and families make informed decisions about care for loved ones with Alzheimer's disease or related disorders. This form is typically used by assisted living facilities in Texas to disclose the services they provide and how these services cater to the unique needs of residents with dementia.

The TX HHS Form 3641-A, Alzheimer's Disclosure Statement for Nursing Facilities, helps solve the problem of providing transparent information about dementia care services to residents. This form is used by nursing facilities that advertise or promote specialized services for individuals with Alzheimer's disease or related disorders. The administrator of the facility typically completes this form.

The TX HHS Form 3642, ICF/IID Medicaid Bed Reallocation Application, is a crucial tool for healthcare providers in Texas. This form helps solve the problem of insufficient Medicaid bed capacity by allowing applicants to request reallocated beds for their facilities. The application is typically filled out by healthcare providers, such as corporations, LLCs, partnerships, or individuals/sole proprietors, who need to increase their Medicaid bed capacity.

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.