Texas Health and Human Services

The TX HHS Form 3087, TMHP Confidentiality Agreement, is a crucial document that ensures the confidentiality, integrity, and continuity of information resources for the County Indigent Health Care Program (CIHCP). This form is used to confirm the understanding and agreement among staff members regarding the handling of client-sensitive information accessed through the Automated Inquiry System (AIS) or Texas Medicaid & Healthcare Partnership (TMHP).

The TX HHS Form 3088, Request for State Assistance Funds (90 Percent), is a crucial document that helps healthcare providers request reimbursement from the Texas Health and Human Services (HHS) for health care services provided under the County Indigent Health Care Program. This form is typically used by county officials to seek funding for indigent health care services, ensuring that essential medical services are available to those in need.

The TX HHS Form 3089, HCBS-AMH Complaint, is a crucial tool for addressing concerns and resolving issues related to Adult Mental Health (AMH) services in Texas. This form helps individuals or entities report complaints about the quality of care, treatment, or services provided by contractors, subcontractors, local mental health authorities, or state hospitals.

The TX HHS Form 3090, "Nursing Health Screening Within 72 Hours of Community Placement," is a crucial document for healthcare professionals to assess the health status of individuals placed in community settings. This form helps solve the problem of ensuring that essential medical information is gathered and documented within a short timeframe, typically within 72 hours of placement.

The TX HHS Form 3091, HCBS-AMH Comprehensive Nursing Assessment, is a crucial tool for healthcare professionals to comprehensively evaluate the physical and mental health of individuals receiving Adult Mental Health (AMH) services. This form helps identify the individual's presenting problem, psychiatric diagnoses, medical diagnoses, and major medical/surgical history, ensuring that their unique needs are addressed.

The TX HHS Form 3092, Medication Administration Record, is a practical tool designed to help healthcare professionals accurately track and record medication administration for patients. This form is typically used in situations where patients require multiple medications or have complex treatment regimens.

The TX HHS Form 3093, KHC Travel Claim for Home Dialysis and Kidney Transplant Patients, is a crucial document that helps individuals with end-stage renal disease or kidney transplants track and claim mileage reimbursement for medical-related travel. This form is typically used by patients who undergo home dialysis or have undergone a kidney transplant, as well as their healthcare providers.

The TX HHS Form 3094, Application for Program Benefits, is a crucial document that helps individuals apply for healthcare assistance through the Epilepsy Program. This form can be completed by anyone seeking benefits, including those who are applying on behalf of a child.

The TX HHS Form 3095, Voluntary Referral Hold Request, is a crucial document for Home and Community-based Services Adult Mental Health (HCBS-AMH) providers. This form allows them to request voluntary referral holds as outlined in the HCBS-AMH Provider Manual, enabling them to temporarily suspend referrals due to various reasons such as service availability or financial constraints.

The TX HHS Form 3100, "Information Regarding Authorized Electronic Monitoring for Assisted Living Facilities," is a crucial document that enables residents or their authorized representatives to conduct electronic monitoring in assisted living facilities. This form helps solve the problem of ensuring resident autonomy while also maintaining facility safety and security.